A doctor performs a colonoscopy on a patient

A doctor performs a colonoscopy on a patient (Jean-Paul Pelissier, Reuters / March 26, 2008)

Thirty-five percent of people with the highest incomes had an endoscopic screen in 2000, compared with 56 percent in 2008.

In contrast, 23 percent of participants below the poverty line underwent a colonoscopy or sigmoidoscopy in 2000, compared with 29 percent in 2008.

Brandi says one likely explanation for the slower uptake of endoscopic screening methods among the poorer groups is cost.

"Lower socioeconomic groups are significantly less likely to have health insurance and more likely to have barriers in terms of paying for -- even if they are covered -- more expensive procedures like colonoscopy," she told Reuters Health.

A colonoscopy can cost upwards of two thousand dollars, compared to several dollars for a home-based fecal occult blood test.

Even if people have insurance, they might have a co-pay for the exam.

"It's not all about costs," Doubeni said, however, "it's about a system of care, it's about resources, it's about access to care and cultural differences."

Doubeni said physicians need to be sensitive to the fact that some patients might prefer one test over another.

"Because these all have similar benefit, the focus should be on maximizing the number of people screened one way or another. Patient preferences are important here," Dr. Virginia Moyer, chair of the USPSTF, agreed in an email to Reuters Health.

Indeed, a recent study found that colon cancer screening rates shot up when patients got to choose which type of test they would have. (See Reuters Health story of April 9, 2012.)

"A lot of physicians in the United States, they don't even think about stool testing. They're not doing a good enough job of laying out options for patients," said Dr. Joshua Fenton, a professor at the University of California, Davis, who was not involved in the new study.

He said that encouraging home-based stool testing might be the easiest way to increase screening rates in lower socioeconomic-status individuals who don't have ready access to colonoscopy.

SOURCE: http://bit.ly/IVwt2u Cancer, online March 20, 2012.