Open Access Open Badges Research article

Self-reported colorectal cancer screening of Medicare beneficiaries in family medicine vs. internal medicine practices in the United States: a cross-sectional study

Angela Y Higgins1, Anna R B Doubeni1, Karon L Phillips2, Adeyinka O Laiyemo3, Becky Briesacher4, Jennifer Tjia4 and Chyke A Doubeni14*

Author Affiliations

1 Department of Family Medicine and Community Health, University of Massachusetts (UMass) Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA

2 Program on Aging and Care, Scott & White Memorial Hospital, 2401 South 31st. Street, Temple, TX 76508, USA

3 Division of Gastroenterology, Department of Medicine, Howard University College of Medicine, 2041 Georgia Avenue, NW, Washington, DC 20060, USA

4 Meyers Primary Care Institute and Division of Geriatrics, UMass Medical School, 377 Plantation Street, Worcester, MA 01605, USA

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BMC Gastroenterology 2012, 12:23  doi:10.1186/1471-230X-12-23

Published: 21 March 2012



The benefit of screening for decreasing the risk of death from colorectal cancer (CRC) has been shown, yet many patients in primary care are still not undergoing screening according to guidelines. There are known variations in delivery of preventive health care services among primary care physicians. This study compared self-reported CRC screening rates and patient awareness of the need for CRC screening of patients receiving care from family medicine (FPs) vs. internal medicine (internists) physicians.


Nationally representative sample of non-institutionalized beneficiaries who received medical care from FPs or internists in 2006 (using Medicare Current Beneficiary Survey). The main outcome was the percentage of patients screened in 2007. We also examined the percentage of patients offered screening.


Patients of FPs, compared to those of internists, were less likely to have received an FOBT kit or undergone home FOBT, even after accounting for patients' characteristics. Compared to internists, FPs' patients were more likely to have heard of colonoscopy, but were less likely to receive a screening colonoscopy recommendation (18% vs. 27%), or undergo a colonoscopy (43% vs. 46%, adjusted odds ratios [AOR], 95% confidence interval [CI]-- 0.65, 0.51-0.81) or any CRC screening (52% vs. 60%, AOR, CI--0.80, 0.68-0.94). Among subgroups examined, higher income beneficiaries receiving care from internists had the highest screening rate (68%), while disabled beneficiaries receiving care from FPs had the lowest screening rate (34%).


Patients cared for by FPs had a lower rate of screening compared to those cared for by internists, despite equal or higher levels of awareness; a difference that remained statistically significant after accounting for socioeconomic status and access to healthcare. Both groups of patients remained below the national goal of 70 percent.

Colorectal cancer screening; Primary care physicians; Colonoscopy; Fecal occult blood test