Adherence to colorectal cancer screening guidelines in Canada.

Maida J Sewitch,Alina Dyachenko,Caroline Fournier,Antonio Ciampi

doi:10.1186/1471-230x-7-39

Abstract

BackgroundTo identify correlates of adherence to colorectal cancer (CRC) screening guidelines in average-risk Canadians.Methods2003 Canadian Community Health Survey Cycle 2.1 respondents who were at least 50 years old, without past or present CRC and living in Ontario, Newfoundland, Saskatchewan, and British Columbia were included. Outcomes, defined according to current CRC screening guidelines, included adherence to: i) fecal occult blood test (FOBT) (in prior 2 years), ii) endoscopy (colonoscopy/sigmoidoscopy) (prior 10 years), and iii) adherence to CRC screening guidelines, defined as either (i) or (ii). Generalized estimating equations regression was employed to identify correlates of the study outcomes.ResultsOf the 17,498 respondents, 70% were non-adherent CRC screening to guidelines. Specifically, 85% and 79% were non-adherent to FOBT and endoscopy, respectively. Correlates for all outcomes were: having a regular physician (OR = (i) 2.68; (ii) 1.91; (iii) 2.39), getting a flu shot (OR = (i) 1.59; (ii) 1.51; (iii) 1.55), and having a chronic condition (OR = (i) 1.32; (ii) 1.48; (iii) 1.43). Greater physical activity, higher consumption of fruits and vegetables and smoking cessation were each associated with at least 1 outcome. Self-perceived stress was modestly associated with increased odds of adherence to endoscopy and to CRC screening guidelines (OR = (ii) 1.07; (iii) 1.06, respectively).ConclusionHealthy lifestyle behaviors and factors that motivate people to seek health care were associated with adherence, implying that invitations for CRC screening should come from sources that are independent of physicians, such as the government, in order to reduce disparities in CRC screening.

Highlights

To identify correlates of adherence to colorectal cancer (CRC) screening guidelines in average-risk Canadians
Because people who visit their physicians less frequently may be at risk for not receiving recommended preventive health care, referrals or invitations for CRC screening should come from a source that is independent of physician visits, such as the government
Inasmuch as number of practicing physicians varied widely among provinces, our findings suggest that availability and access to screening services, to gastroenterologists that perform colonoscopy, do not influence adherence to CRC screening guidelines in Canada

Summary

Introduction

To identify correlates of adherence to colorectal cancer (CRC) screening guidelines in average-risk Canadians. The best case scenario, estimated from survey data, is that 23% of the screen-eligible population has ever been screened [8] and that 53% of Canadian physicians have undergone CRC screening [13]. The universal access, publicly funded health care systems in the Canadian provinces collect information on performance of large bowel procedures, but do not collect information on use of FOBT. This is problematic because FOBT and colonoscopy are the two procedures most often performed for CRC screening. Whereas self-report could be problematic for distinguishing between sigmoidoscopy and colonoscopy, independent studies show good sensitivity and specificity for selfreported procedural use, especially when sigmoidoscopy and colonoscopy are grouped together[16,17]

Objectives

Methods

Results

Discussion

Conclusion