Colorectal Cancer Knowledge, Risk Perception, and Screening Inclination Among Previously Unscreened Adults

Abstract

Introduction: Colorectal cancer (CRC) remains the 3rd most common cancer in the US. Most CRCs are preventable, but screening participation remains suboptimal. Several factors have been associated with screening compliance, such as perception of CRC risk. Enrollment is complete in our randomized controlled study examining the impact of the National Cancer Institute Colorectal Cancer Risk Assessment Tool (CCRAT) on screening attitudes and behavior. Here we present our study cohort’s baseline CRC knowledge, risk perception, and screening intent based on the transtheoretical model (TTM) of behavioral change. Methods: 229 primary care patients 50-75 years old eligible for first time CRC screening were randomized to risk-assessment with the CCRAT or education control from Oct 2015 to Jan 2018. Baseline data were analyzed in aggregate to preserve blinding before final follow-up on screening behavior through Jan 2019. Based on screening intent, patients were assigned to the pre-contemplation, contemplation or preparation TTM stage. Univariable multinomial models were used to explore predictors of TTM stage. Results: Most patients were Caucasian (54.6%) or Asian (30.1%) with college or higher education (94.3%) and annual incomes $75,000 or more (65.1%) (Table 1). Most heard of colonoscopy (99.1%) and fecal immunochemical tests (74.7%) but rarely other tests. 57.2% expressed fear of finding CRC on screening, 57.2% considered their absolute CRC risk neither likely nor unlikely, and 40.2% considered it unlikely/very unlikely (Table 2). Perception of risk relative to the average person was similar to perception of absolute risk. 9.2% already scheduled screening, 55.9% contemplated screening and 44.1% were pre-contemplative. Those of older age were less likely contemplative (OR 0.95 [95%CI;0.91-0.99]), while those with a family CRC history (OR 11.9 [3.1-45.8]) or perceived high relative CRC risk (OR 14.0 [2.2-91.1]) were more likely preparative(Table 3). Conclusion: Among a cohort of higher socioeconomic status who had not yet received CRC screening, familiarity with leading CRC screening tests was high, fear of finding CRC at screening was common, and perceived absolute CRC risk overestimated true risk. Only a minority had active plans to undergo screening. Those with a family history of CRC and perception of high relative CRC risk had high intent to screen, while older patients were slightly less inclined. The impact of the CCRAT on risk perception, TTM stage, and screening behavior remains to be determined.293_A Figure 1 No Caption available.293_B Figure 2 No Caption available.293_C Figure 3 No Caption available.