Abstract
Purpose: The primary objective was to describe the specific socio-demographic variables that are associated with colorectal cancer (CRC) under-screening in an urban, inner city population. The secondary objective was to determine the overall proportion of eligible patients who are not appropriately screened. Methods: A retrospective chart review of patients eligible for average-risk CRC screening as per Ontario’s ColonCancerCheck program guidelines was conducted at an academic, inner city family health practice associated with St. Michael’s Hospital in Toronto, Ontario. Simple measures of association, including t-tests and chi-square tests, were used to determine the relationships between screening and demographic characteristics. Based on a type I error rate of 0.05 and an appropriate sample size, the calculated power for this study was 0.82. Results: A total of 200 patients were randomly selected; 54% were male; the majority were non-immigrants (77.5%) and were employed or retired (76.5%). Fifty-five percent of screened patients were up to date as per guidelines; 29.5% and 31% were up to date with a fecal occult blood test or a colonoscopy respectively. Individuals with psychiatric illness (p = 0.0005), with no history of prior cancer screening for other cancers (p = 0.0001), on disability or unemployed (p = 0.0010), or who were younger (p = 0.0062) were significantly less likely to undergo CRC screening. Conclusion: Colorectal cancer screening rates at this academic, urban family practice were very similar to province wide screening rates. Future studies should focus on group specific interventions to increase CRC screening uptake in low CRC screened populations.
Highlights
Colorectal cancer (CRC) is currently the third most prevalent cancer and second most common cause of cancer mortality among Canadians, with an estimated 23,800 new cases and 9200 projected deaths expected for 2013 [1]
A total of 110 patients (55%) were up to date with CRC screening according to guidelines
The two most common screening methods were guaiac fecal occult blood testing (gFOBT) and colonoscopy: 60 patients (30%) had a gFOBT and 62 patients (31%) had a colonoscopy that fell within screening guidelines
Summary
Colorectal cancer (CRC) is currently the third most prevalent cancer and second most common cause of cancer mortality among Canadians, with an estimated 23,800 new cases and 9200 projected deaths expected for 2013 [1]. In April 2008, Cancer Care Ontario (CCO) initiated a province-wide CRC screening initiative called the ColonCancerCheck program [2]. This program targeted Ontarians aged 50 - 74 and recommended that they undergo at-home screening using guaiac fecal occult blood testing (gFOBT) biennially. Ontarians that had received a flexible sigmoidoscopy (FS) in the last 5 years or a colonoscopy in the last 10 years were considered to be upto-date with CRC screening [2] [3] This program resulted in a significant rise in CRC screening: from 37.9% among screening-eligible adults in 2005 to 53% in 2010. Increasing screening rates are important as it has been reported that even with only 70% of the eligible population screened, CRC mortality could drop by a corresponding 13% - 15% [2]
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