PORTSMOUTH, VA — Even universal healthcare doesn’t assure that patients will take advantage of colorectal cancer screening.

That’s according to a study published in Military Medicine, which looked at screening rates of MHS beneficiaries around 50 years old.1

Background information pointed out that colorectal cancer is the second-leading cause of cancer deaths in the United States and that screening tests are underutilized. Researchers from the Naval Medicine Center in Portsmouth, VA, and colleagues sought to determine the proportion of individuals at average risk who utilized a recommended initial screening test in a universal healthcare coverage system.

The retrospective cohort study focused on 275,665 active duty and retired military members, as well as civilian beneficiaries of the MHS. Included were people of average risk born from 1960 to 1962 and eligible for full benefits on their 50th birthday were evaluated. Socioeconomic status was determined using military rank or rank of benefits sponsor. Medical record codes were used to gauge adherence to the U.S. Preventive Services Task Force guidelines for initial colorectal cancer screening colonoscopy, sigmoidoscopy, fecal occult blood test or fecal immunohistochemistry test. The study also identified average risk individuals who obtained early screening ages 47 to 49.

Results indicated that 38.4% adhered to screening guidelines, with another 7.2% having been screened early. Colonoscopy (82.7%) was the most common screening procedure. Researchers determined that the highest odds of being screened were associated with being active duty military (odds ratio [OR] 3.63, 95% confidence interval [CI] 3.43 to 3.85), having highest socioeconomic status (OR 2.37, 95% CI 2.31 to 2.44), and having managed care insurance (OR 4.36, 95% CI 4.28 to 4.44).

“Universal healthcare coverage does not ensure initial colorectal cancer screening utilization consistent with guidelines no does it eliminate disparities,” the authors concluded.


  1. McEvoy CS, Shah NG, Roberts SE, Carroll AM, et. Al. Universal Healthcare Coverage Does Not Ensure Adherence to Initial Colorectal Cancer Screening Guidelines. Mil Med. 2020 Nov 19:usaa319. doi: 10.1093/milmed/usaa319. Epub ahead of print. PMID: 33211098.