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Dr. Folasade P. May is a gastroenterologist and researcher with the VA Greater Los Angeles Healthcare System VA and UCLA. (Photo by Jeffery D. Russell)

Colorectal cancer screenings higher in Veterans who use VA or military health care

August 2, 2017

By Tristan Horrom
VA Research Communications

"VA...should be recognized for exceeding national benchmarks in colorectal screening."

A recent study found that Veterans with health coverage related to their Veteran status were significantly more likely to have up-to-date screenings for colorectal cancer than Veterans who used private health insurance instead. The study included researchers from the VA Greater Los Angeles Healthcare System and Durham VA Medical Center.

While national colorectal cancer screening rates are around 65 percent nationwide, VA had a screening rate of nearly 80 percent over the last several years. The new study shows that, although screening rates are high among Veterans on all sources of health coverage, they are significantly higher for those who receive VA care, TRICARE, or other military care.

Dr. Folasade P. May, lead author on the article, applauds VA's efforts to raise screening levels: "Colorectal cancer is common and deadly. But we can prevent disease by screening. The VA has had major success in this area and should be recognized for exceeding national benchmarks in colorectal screening."

The results appear in the August 2017 issue of Digestive Diseases and Science.

VA health coverage leads to much greater odds of screening

Colorectal cancer is a deadly disease. More than 130,000 Americans are diagnosed with this form of cancer a year, and 50,000 die from the disease annually. However, it is largely preventable. When caught early, polyps in the colon can be removed before they develop into cancer. For this reason, doctors recommend adults age 50 to 75 receive regular screening.

The researchers set out to measure cancer screening rates of Veterans who use various types of health insurance. They examined data from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System survey. The BRFSS is the nation's largest health-related telephone survey. More than 400,000 adults are surveyed annually.

Using data from the 2014 survey, the researchers included information on more than 22,000 Veterans between the ages of 50 and 75. They found that 76.7 percent of surveyed Veterans had up-to-date colorectal screenings. The rate for non-Veterans in the survey was 67.1 percent.

Of the Veterans surveyed, 19.1 percent—about a fifth—had health coverage related to their Veteran status. This included health insurance through VA or the military (including TRICARE, which is coverage for active and retired military personnel). The others used other forms of health coverage, such as private coverage, Medicare, or Medicaid.

Veterans using VA or military health coverage as their primary health coverage had a screening rate of 82.3 percent, higher than any of the other types of coverage. After performing statistical methods to account for additional factors that impact screening, the researchers concluded that Veterans with Veteran-status-related health coverage had 83 percent greater odds of having up-to-date colorectal cancer screenings, compared with Veterans with private coverage.

VA system leads to more provider interaction

Several factors affected the screening rates. Black Veterans had a higher chance of having up-to-date colorectal screenings than white Veterans. Hispanic Veterans were the least likely group to have recent screenings. Screenings were also more common in older Veterans, those who were married, and those with higher education and income.

The researchers suggest that innate characteristics of integrated health care systems such as VA's or the military's could lead to these better screening numbers. They hypothesize that Veterans receiving their health care from VA are more likely to follow their health care providers' recommendations than those outside VA. VA also has higher health care utilization than outside health coverage, meaning that VA patients see their doctors more frequently. VA's use of electronic health records to streamline care may also improve colorectal cancer screening rates. Also, VA has implemented a patient-centered medical home model to enhance delivery of primary care, which helps coordinate information between different VA services. As May explains, "Our findings emphasize how an integrated system like the VA can achieve major successes—even above other health care systems and plans."

Future research should focus on how to improve colorectal cancer screening rates for Hispanic Veterans, as well as how to improve the screening rates for the aging U.S. population as a whole, say the researchers. They suggest that studying VA's success in this area may help improve colorectal cancer outcomes for all Americans.

This research was funded through a VA Health Services Research and Development senior research career scientist award.

For more information on VA research into colorectal cancer, visit the Cancer topic page on the VA Research website.

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