Rural residents in the Carolinas are 17 percent less likely than urban residents to get a colonoscopy, a procedure that can prevent up to two-thirds of all colorectal cancer cases, a new report says.
The study also found that rural residents who do get the screening procedure are twice as likely to bypass a local healthcare provider and get the exam done in a different county.
The study looked at statewide screening data for North and South Carolina from 2001 to 2010. It found that while 59 percent of urban residents who met the exam criteria received a colonoscopy, only 49 percent of eligible rural residents did.
The American Cancer Society recommends that most adults ages 50-75 get a colonoscopy every 10 years. Alternatives to a colonoscopy include procedures such as a colon CT scan or fecal occult blood test (although the latter test mainly detects cancer, not pre-cancerous polyps).
The Affordable Care Act made colonoscopies part of preventative care, meaning insured patients can have the procedure with no out-of-pocket costs. Those changes went into effect in 2014, after the study period.
One factor that makes rural residents less likely to get colonoscopies is access, the study theorized. In South Carolina, for example, most rural counties have colonoscopy center. But only 42 percent of those counties had a center staffed by a gastroenterologist, doctors who specialize in treating the stomach and intestine.
The report, conducted by the South Carolina Rural Health Research Center, suggested that the lack of a local specialist was a major reason rural residents were more likely to seek treatment in another county.
In some regions, the extra distance patients traveled for care was significant. In rural eastern North Carolina, for example, 14 percent of patients traveled all the way to the central part of the state for a colonoscopy.
The specialist gap appears to be getting worse. From 2001 to 2010, rural South Carolina counties lost 10 gastroenterologists, while urban counties gained 17, the study found.
“The growth of colonoscopy centers from 2001 to 2010 was largely in urban areas,” the report said. For example, the volume of colonoscopies doubled at rural South Carolina ambulatory surgery centers, while the volume at urban centers increased 10-fold.
The study also noted a downward trend in the number of colonoscopies from 2001 to 2010. That was likely due to changes in Medicare reimbursement policy, which began covering the procedure for people with average risk of cancer in 2001. Researchers theorized that the number of colonoscopies climbed after the procedure became more widely available and then demand tapered off to current levels.