Gender and Race/Ethnicity Affect the Cost-Effectiveness of Colorectal Cancer Screening. DISCUSSION

Colorectal Cancer Screening RESULTSCancer screening in the United States has evolved to include the use of gender and race/ethnicity to stratify patient risk. Mammography is recommended only in women because of the low incidence of male breast cancer. Prostate cancer screening is recommended for most men at age 50 but is recommended for black men at age 45 because of high age-specific incidence rates in this group. We have shown that gender-specific racial/ethnic colorectal cancer disease patterns affect the cost-effectiveness of colorectal screening. Colorectal screening was much more cost-effective in black men than in other groups. Screening black men beginning at age 45 was similar in cost-effectiveness to screening white men and black women and more cost-effective than screening Latino and Asian men and nonblack women beginning at age 50. Differences were robust and persisted after doubling the polyp incidence rate for black men. The favorable cost-effectiveness ratio of screening black men largely reflected high age-specific colorectal cancer incidence rates in this group.

Screening for colonic neoplasia is a complex process that only begins with the screening test. Program effectiveness must consider each of the steps required for treating identified lesions and their associated costs. If, however, the cost and effectiveness of identifying and treating colorectal cancer are similar in men and women of all racial and ethnic groups, it is clear that black men serve to benefit most from colorectal cancer screening. This benefit is not subtle. Our analysis indicates that screening black men for colorectal cancer beginning at age 45 would be as good or a better use of resources than screening all other groups. Pioglitazone metformin

Use of colorectal screening strategies will impact colorectal incidence rates. Racial and ethnic groups that utilize screening protocols will initially have increased colorectal cancer incidence rates as the result of the detection of asymptomatic cancers; eventually, these groups will have decreased colorectal incidence rates as a result of the excision of polyps before they become malignant. Groups that utilize screening programs also will tend to have cancers detected at earlier stages than if the cancer had been detected when symptomatic. We have commented previously that it is unlikely that age-specific California colorectal incidence rates from 1988-1995 were corrupted by the current use of screening programs. Our data indicate that the incidence of colorectal cancer in black men is higher than any other group by age 50, the currently recommended age for initiation of colorectal cancer screening. Furthermore, we assessed whether there was a trend toward increased colorectal cancer incidence rates that might reflect increased detection from screening within racial or ethnic groups in our database. We compared average annual colorectal incidence rates from 1988-1991 with rates from 1992-1995 within each racial and ethnic group at five-year intervals starting at age 45. We did not observe any significant increase in average annual colorectal cancer rates for any racial and ethnic group at any age tested.
The screening model assumed a screening methodology that is recommended for the 70-80% of patients at average risk for colorectal cancer. Our model did not discriminate between patients of high, moderate or average risk for colorectal cancer and did not address the issue of whether different racial and ethnic groups have different proportions of high- or moderate-risk patients. It is probable that different proportions of each of the four major racial and ethnic groups in this country are at high or moderate risk for colorectal cancer. For instance, polyposis syndromes and ulcerative colitis are rarely reported among Latino and Asian patients. Removing these high-risk groups from consideration will lower overall colorectal cancer incidence rates and thereby reduce cost-effectiveness within a particular racial or ethnic group. If whites and blacks have higher proportions of high-risk individuals, then modeling only those average-risk patients may yield cost-effectiveness estimates nearer to those of Latinos and Asians. The completion of population-based studies of colorectal cancer in this country will allow the segregation of racial and ethnic groups into specific risk categories that can then be individually modeled for colorectal screening cost-effectiveness. However, it is well known that the majority of colorectal cancers in men and women of all races/ethnicities occur in average-risk patients. Don’t suffer without medication. Buy cheap levitra professional online

While our study is an attempt to define more useful colorectal cancer-screening guidelines, it will not prove to be of great benefit to patients unless more men and women of each racial and ethnic group increase the practice of colorectal cancer screening. Discussion of gender-specific racial and ethnic col-orectal-cancer disease patterns may serve as a stimulus to the development of interventions that will prove most useful within each group. Discussion of unique gender-specific racial and ethnic disease patterns may also yield implications for screening guidelines for other diseases and allow for the prioritization of screening interventions in men and women of individual races/ethnicities.


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