A Comparative Study of Rural Communities for Colorectal Cancer Screening by Means of Colonoscopy Provided by Family Physicians

Purpose: Colorectal cancer has a high incidence and prevalence in the United States and in particular, rural Texas. Some rural family physicians in Texas do colonoscopy procedures whereas other rural family physicians refer their patients to urban centers. This study will look at whether or not patients with access to family medicine physicians who perform colonoscopy exams within their own rural community are more likely to comply with colorectal cancer screening guidelines as opposed to rural patients in another community who are referred to urban centers. Methods: A 24 question survey pertaining to colon cancer and adapted from the Behavior Risk Factor Surveillance System (BRFSS) was given to patients at primary care clinics in Clifton and Haskell. Both clinics are located in small, rural towns in Texas. The family medicine physicians at the Clifton clinic provide colonoscopies within the community whereas the residents in Haskell drive to urban centers for colonoscopies. In order to take the survey, participants had to be patients of either the Clifton or Haskell clinic and be at least 50 years of age. Logistic regression was used to look at an association between the two clinics and patient colon cancer screening awareness, knowledge of what age a person should be screened for colon cancer and whether or not patients had ever had either a sigmoidoscopy or a colonoscopy. All statistics were done using SAS 9.3. Results: 92 surveys were collected at Clifton and 76 were collected at Haskell for a total of 168 surveys. Of the collected patient surveys, 80.12% patients were white and 62.05% were female with a mean age of 63.90. A higher odds (OR=3.61; CI = (1.11, 11.69)) was seen in Clifton compared to Haskell for patient colon cancer screening awareness after being adjusted for gender, race, age, employment status and family history of colon cancer. There was a higher odds (OR=2.50; CI = (1.13, 5.54) of knowing what age a person should be screened for colon cancer in Clifton compared to Haskell after being adjusted for gender, age, employment status, education level and family history of colon cancer. A higher odds (OR=3.61; CI = (1.42, 9.20)) was seen in Clifton compared to Haskell for patients ever having a colonoscopy or sigmoidoscopy after being adjusted for patient race, age, gender, education, employment status and for the patient not having insurance. Conclusion: This study supports the idea that having family medicine physicians perform colonoscopies within a rural community leads to a higher odds of patients following cancer screening guidelines. Therefore, it is beneficial to have colonoscopies performed locally in a rural community in order to better prevent colorectal cancer.