Does Presenting Colorectal Cancer Risk Information Increase Colorectal Cancer Screening Rates in Primary Care Patients?

Abstract

Purpose: Although colorectal cancer (CRC) screening is recommended in the U.S. for all adults age 50 and over, actual screening rates fall short of this target. This study evaluated the effectiveness of presenting an individualized bar graph of CRC risk versus a standard screening handout of increasing screening rates in a primary care setting. Methods: Outpatient records were reviewed to identify potential subjects: no prior documented screening and age >50. Potential subjects were scheduled for a routine visit in a university-based primary care clinic and were determined to be at above-average risk for CRC based on 1 or more of the following 4 risk factors: body mass index (BMI) > 27, having inflammatory bowel disease for more than 10 years, lack of folic acid supplementation, and 1 or more first degree relative with CRC. 1147 subjects were approached to determine eligibility. 210 (38%) out of 557 eligible subjects were randomized to receive from clinic staff either individualized CRC risk information presented as a bar graph and calculated from the Harvard Cancer Risk Index or a standard CRC screening handout from the CDC. All subjects were offered fecal occult blood tests (FOBT) cards and an appointment for a flexible sigmoidoscopy (FS). Chart audits were completed 6 months after index visit. Outcome measures included the number of subjects completing any CRC screening test (FOBT, FS, and/or colonoscopy). Results: The intervention group had a mean age of 55.7±4.8 and BMI of 32.0 ± 8.1 and the control group had a mean age of 55.6±4.6 and BMI of 31.3 ± 6.9. There were 67% females in each group, and there were 57% white subjects and 46% black subjects in the intervention group and 49% white subjects and 50% black subjects in the control group (p=.400). 75% of intervention subjects and 76% of control subjects were willing to take FOBT cards home (p=0.961), but only 7% of intervention subjects and 11% of control subjects completed FOBT cards (p=0.381). No subjects completed FS. 22% of intervention subjects and 23% of control subjects completed colonoscopy (p=0.951). A total of 28% of intervention subjects and 30% of control subjects completed 1 or more CRC screening test (p=0.661). Conclusion: Presentation of individualized CRC risk information by clinic staff does not result in higher CRC screening rates in primary care patients than the simple provision of general CRC screening information. Future research is needed to determine if physician presentation of CRC risk information would result in increasing screening rates.