Student elective for Suzanne Gaskell (360G-Wellcome-080977_Z_06_Z)

Colorectal cancer (CRC) accounts for 9% of all cancers making it the third most common cancer worldwide. CRC is accountable for around 7% of all cancer deaths, with approximately 60% of these being in developed countries. Although mortality rates have been slowly declining in many countries, the disease remains unacceptably common. It has thus become a high health priority for many developed countries. In America and Canada, where CRC screening for CRC is encouraged, there is a wide variation in the patterns of utilization of screening services among populations. An study found that almost twice the number of people aged 50 and older reported recent colorectal cancer screening with an endoscope procedure than screening with an FOBT; 40.4% versus 21.8% respectively. IN the same year, 50% of Americans aged 50 years and older reported that they had not had any colorectal cancer screening. Between 1997 and 2001 there was a 21% increase in annual FOBT and a 29% increase in 5- yearly lower endoscopies, amongst persons at average risk. Compared with the use of other cancer screening tests, colorectal cancer screening rates are low. The problem of too many average risk adults not being screened persists. Reasons for this include a lack of an efficacious screening method, low engagement by health care providers in recommending screening to their patients, and low awareness of the public about the need for and importance of screening. The objective of this retrospective cohort study is to analyze whether certain patterns of health services utilization lead to early (TNM stage I) versus late (TNM stage II-IV) diagnoses, and if these patterns impact survival.