A new survey confirms that people are more likely to get tested for colorectal cancer if they have health insurance and a regular source of health care. While that finding is in line with previous studies, the survey also offers insights into other factors that may be keeping Americans -- particularly minorities and women -- from getting these lifesaving tests.

Researchers from the University of California, Los Angeles, analyzed portions of the 2001 California Health Interview Survey (CHIS), a statewide telephone survey conducted in English, Spanish, and several Asian languages. By using different languages, the survey was able to get information from people who traditionally cannot take part in these types of studies because they don't understand English, said lead researcher Ninez Ponce, PhD, MPP, an assistant professor of health services at the UCLA School of Public Health.

"Including these racial, ethnic, and linguistic groups is particularly important in accurately evaluating the nation's progress in cancer screening," she said.

More than 22,000 adults 50 and older were asked whether they had received fecal occult blood testing in the previous year or flexible sigmoidoscopy or colonoscopy in the previous 5 years. The findings were published in the journal Cancer (Vol. 101, No. 11:2523-2532).

Overall, 54% of California adults over 50 reported being tested for colorectal cancer (the survey did not ask whether people got the tests as part of routine screening or for other reasons). That rate is higher than the national average, which was 41% for men and 38% for women according to the 2000 National Health Interview Survey (Cancer Vol.;97 No. 6: 1528-1540).

Whites and African Americans reported similar rates of colon testing: 51% and 50% respectively in the 50-64 age group and 63% and 62% in the 65 and older group. Testing among Asians and Latinos lagged, however. Just 33% of Latinos in the younger age group and 52% in the older group reported colon testing. Among Asians, the figures were 42% among those 50-64 and 55% among those 65 and older.

The reasons for not receiving colon cancer testing differed by race/ethnicity and by gender. Whites and African Americans were more likely to say they didn't get tested because their doctor had not told them they needed testing. Asians and Latinos, however, were more likely to say they didn't get tested because they weren't having any problems.

Women, too, were more likely than men to say they didn't get tested because their doctor didn't tell them it was necessary. That finding was surprising, Ponce and colleagues said, because breast and cervical cancer screening tests are widely recommended and used.

Other studies have also found discrepancies between men and women in colon cancer screening, said Richard Wender, MD, clinical professor and vice chairman of the department of family medicine at Thomas Jefferson University, in Philadelphia. Wender, who is a member of the American Cancer Society Colorectal Cancer Advisory Group, was not involved in the research.

The reasons for these differences aren't clear, though. Doctors may be too busy with other topics, Wender said, or women may not feel threatened by colon cancer in the same way they do by, say, breast cancer.

"Having a cancer that is not specific to gender [may be an issue]," he said. "Men 'own' prostate cancer, women 'own' breast cancer. No one 'owns' colon cancer. It's harder to get excited about it."

Durado Brooks, MD, MPH, director of prostate and colorectal cancer for the American Cancer Society, said many people still have misperceptions about colon cancer.

"People do still believe that if they don't have family history then they're not at risk," he said, "and they also don't appreciate the tremendous preventive benefits available from screening. They're unaware that we can find polyps and remove them before cancer occurs.

"There's also the belief that if it is relevant to them, then their doctor would talk to them about it, so if their doctor doesn't bring it up, they're not likely to bring it up to their doctor," he added.

The people who were most likely to get tested for colon cancer were those who had both health insurance and a regular source of medical care. Among people 65 and older, 66% of those who had Medicare and supplemental insurance, and a regular source of care, reported being tested. People with no insurance and no regular doctor were least likely to get tested.

That's not exactly surprising, Ponce said.

"This has been found in other studies, but it continues to underscore that if everyone had health insurance and continuity of care, then colorectal cancer test use would be much higher than the disappointingly low rate of 54%," she said.

Wender said it's important for people who have insurance to take advantage of their benefits.

"Establish a regular source of care and then, once you have that source of care, it's good to know what you're supposed to have done," he said. "Ask, 'Am I due for any preventive care?'"

Ponce said both doctors and patients can do more to improve rates of colon cancer screening.

"Consumers need to know that the colorectal cancer tests are prevention measures and save lives," she said. "Once they turn 50 they should ask their doctors about getting tested. Doctors need to be knowledgeable about clinical guidelines and be mindful of cancer screening schedules for their patients. Reminders for both the patient and doctor have been shown to be helpful."

Prevention and early detection of colorectal cancer is a top priority for the American Cancer Society, which is launching a nationwide plan to increase public awareness of the need for colon cancer screening, encourage physicians to recommend these tests to patients who need them, and advocate for insurance coverage of such screening.