Colorectal Cancer Screening Trends in High Risk Populations: Are We Screening the People Who Need It Most?

Abstract

Purpose: Recently identified risk factors for colorectal cancer (CRC) include black race, obesity, smoking, and diabetes. This study aimed to evaluate national CRC screening trends in recently identified high risk groups as compared to the general population. Methods: This was a nationally representative population-based study using the Behavioral Risk Factor Surveillance System from the Centers for Disease Control. Up-to-date CRC screening was the outcome variable and the independent variables were the newly identified high-risk groups. Data analysis was performed using bivariate analyses with weighted logistic regression. Multivariable logistic regression was used to adjust for independent variables and covariates. Results: There were 155,020, 197,969, and 229,202 subjects in 2006, 2008, and 2010, respectively, who met the inclusion criteria and were analyzed. In the general population, CRC screening increased from 59%, 63%, and 65% in 2006, 2008, and 2010, respectively (2006 vs. 2010 p <0.001). Screening prevalences in non-Hispanic blacks were 58%, 62%, and 65%, in 2006, 2008, and 2010, respectively. The odds of CRC screening in non-Hispanic blacks was higher when compared to non-Hispanic whites in 2006 (OR 1.15, 95% CI 1.05-1.27), 2008 (OR 1.19, 95% CI 1.08-1.30), and 2010 (OR 1.23 95% CI 1.15-1.32). Among obese persons, the prevalence of up-to-date CRC screening increased from 59% in 2006 to 63% in 2008 to 66% in 2010 (2006 vs 2010 p <0.001). Obesity was independently associated with higher odds of up-to-date CRC screening in 2010 compared with normal weight (adjusted OR 1.16, 95% CI 1.11-1.23). Screening prevalences in individuals with diabetes were 63%, 66%, and 69%, in 2006, 2008, and 2010, respectively. There was a 25%, 20%, and 21% greater odds of CRC screening in people with diabetes compared to non-diabetics in 2006, 2008, and 2010, respectively. The CRC screening prevalence in current smokers was 45% in 2006, 47% in 2008, and 50% in 2010, compared with 66%, 69%, and 71% in former smokers. CRC screening prevalences were 59%, 63%, and 66% in 2006, 2008, and 2010, respectively, in people who never smoked. Current smokers had significantly lower odds of CRC screening than people who never smoked in 2006, 2008, and 2010. Conclusion: Our study shows that overall CRC screening prevalence in high risk groups is trending upwards and in some cases associated with higher screening prevalence than the general population. Despite increasing CRC screening prevalence over time, current smokers were observed to have signifi cantly lower odds of CRC screening when compared to the general population. Further studies to evaluate the etiology of poor screening practices in current smokers are necessary.