Colorectal Cancer Screening Uptake Research Articles

Preferences for potential innovations in non-invasive colorectal cancer screening: A labeled discrete choice experiment for a Dutch screening campaign

Background. The introduction of innovative non-invasive screening tests (e.g. tests based on stool and blood samples or both) may be a solution to increase colorectal cancer (CRC) screening uptake. However, preferences for these non-invasive screening tests have not been investigated in great detail yet. The purpose of this article therefore is to elicit individuals’ preferences for different non-invasive screening tests in a Dutch screening campaign context.Material and methods. We investigate preferences by means of a labeled discrete choice experiment. Data of 815 individuals, aged 55–75 years, are used in the analysis.Results. Multinomial logit model analysis showed that the combi-test is generally preferred over the blood-test and the (currently available) stool-test. Furthermore, besides the large effect of screening test type, there are significant differences in preference depending on participants’ socio-demographic background. Finally, the analysis showed a significant positive effect on screening test choice for the attributes sensitivity, risk reduction, and level of evidence and a non-significant effect for the attribute unnecessary follow-up test.Conclusion. Introducing new non-invasive screening tests that are based on a combination of stool and blood samples (or blood sample only) has the potential to increase CRC screening participation compared to the current standard stool-based test.

Impact of the United Kingdom National Bowel Cancer Awareness Campaign on Colorectal Services

Poor public awareness may account for the advanced stage at diagnosis, hence, poorer survival. With the aim of reducing colorectal cancer deaths, the United Kingdom National Bowel Cancer Awareness Campaign was rolled out from January 2012. Currently, the United Kingdom government target is to have all patients suspected to have cancer seen within 2 weeks of referral from general practitioners. This has significant impact on the workload for endoscopists. The study aimed to measure the impact on colorectal services following the National Bowel Cancer Awareness Campaign. The data between February and July 2012 (onset of campaign) were prospectively collected and compared with data retrospectively collected between February and July 2011 inclusive (before campaign). This study was conducted at a single center, university hospital. The number of 2-week wait referrals, investigations, and colorectal cancers detected were assessed. Demographics, staging, and treatment of cancers were compared between groups along with the uptake of colorectal cancer screening. The total number of 2-week wait referrals increased by 47% with a resultant 38% increase in colonic investigations (p = 0.034) and a 23% increase in cancers detected (p = 0.0157). There was a 6.5% increase in the uptake of screening (p = 0.001) and a 62.5% decrease in the number of patients with colorectal cancer presenting as an emergency. This short period of study is a major limitation. Although the data were from prospectively maintained databases, some data were analyzed retrospectively. Because only a single unit was assessed, results across a wider population may be more pronounced. There was also a referral bias in the compliance of primary care in the adherence to the 2-week wait referral criteria, because these criteria can be abused to get anxious patients into secondary care quickly. The National Bowel Cancer Awareness Campaign significantly increased the demand for colorectal services. With a potentially more favorable oncological outcome, further evaluation of supporting this greater workload demand is warranted.

Practical Application of Health Belief Model to Enhance the Uptake of Colorectal Cancer Screening

Background Health care providers have a pivotal role in promoting people’s screening behaviors resulting in early detection of cancer. This study was conducted to examine the effect of an intervention program based on Health Belief Model (HBM) on knowledge and participation of administrative personnel of one of the major medical schools of Iran in colorectal cancer screening program Methods 156 official administrative personnel’s with average risk for colorectal cancer working in Shiraz Mesical Sciences University including its affiliated hospitals were enrolled in the study. Their demographic data, level of knowledge, willingness and perception barriers to participate in screening programs were examined via two separated questionnaires. All the subjects were asked to provide stool sample for fecal occult blood test (FOBT). Then they were randomly assigned to experimental or control group (n=78).The experimental group was exposed to the interventional program. Two groups of the study were followed for three months. Then knowledge and the rate of subjects' participation in screening program were examined. Results The results of the study revealed that most of the subjects are not interested in colorectal screening tests. Their most perceived barrier for (FOBT) and colonoscopy were lack of time and low perceived susceptibility (feeling to be healthy), respectively. Pre (1.2 ± 4.7) to post-test (11.2 ± 1.9) changes in knowledge score of the experimental group was higher than that of the control group (1.7±3.9 in the pretest and 2.6 ± 3.8 in the post test). Furthermore, participation of the experimental group in screening program was significantly higher than that of the control group (p<0.001). Conclusion Application of HBM in the interventional program on colorectal cancer may result in an increase in the knowledge & participation of subjects in the screening program.

Preformulated implementation intentions to promote colorectal cancer screening: A cluster-randomized trial.

To evaluate an intervention based on implementation intention principles designed to increase uptake of colorectal cancer screening, and to examine differential efficacy by socioeconomic deprivation. In England, adults aged between 60 and 69 years are invited for biennial fecal occult blood testing. A test kit and an information leaflet are mailed to each individual by the "Hubs" that deliver the national screening program. In the intervention group, three preformulated implementation intentions, based on known barriers to carrying out the test, were added to the information leaflet. Over a 12-week period, each week was randomly allocated to either the intervention (n = 12,414 invitations) or the control condition (n = 10,768), with uptake recorded at the Hub. Socioeconomic deprivation of each individual's area of residence was categorized into tertiles. There was no overall difference in uptake between control (40.4%) and intervention (39.7%) conditions, odds ratio (OR) = 0.97, 95% confidence interval (CI) [0.91, 1.04]. There was an interaction with deprivation, OR = 1.11, 95% CI [1.04, 1.18], but the positive effect observed in the lowest socioeconomic status (SES) tertile was small (35.2% vs. 33.0%), OR = 1.103, 95% CI [1.01, 1.21], and offset by a negative effect in the least deprived tertile (45.6% vs. 48.2%), OR = 0.90, 95% CI [0.82, 0.99]. The intervention had no significant effect in the middle tertile (38.9% vs. 40.8%), OR = 0.92, 95% CI [0.81, 1.04]. Preformulated implementation intentions did not increase overall colorectal cancer screening uptake and failed to make a sufficiently large impact on uptake among lower SES groups to merit their future use in this context.

Predictors of Low Colorectal Cancer Screening in an Urban Academic Family Practice

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.

Colorectal Cancer Screening among Government Servants in Brunei Darussalam

This study concerns uptake and results of colorectal cancer (CRC) screening of government servant as part of the Health Screening Program that was conducted in Brunei Darussalam in 2009. Government servants above the age of 40 or with family history of CRC were screened with a single fecal occult blood test (FIT, immunohistochemistry). Among 11,576 eligible subjects, 7,360 (66.9%) returned their specimen. Subjects with positive family history of CRC (n=329) or polyps (n=135) were advised to attend clinics to arrange screening. All the subjects with positive FIT (n=142, 1.9%) were referred to the endoscopy unit for counselling for screening colonoscopy. Overall only 17.7% of eligible subjects attended for screening; 54.9% (n=79/142) of positive FIT, 8.8% (n=29/329) of positive family history of CRC and none with history of polyps (n=0/135). Of these, only 54 patients (50.5%) agreed for colonoscopy, 52 (48.6%) declined as they were asymptomatic, and one was not offered (0.9%) due to his very young age. On screening colonoscopy, 12.9% (n=7) had advanced lesions including a sigmoid carcinoma in situ and six advanced polyps. The other findings included non advanced polyps (n=21), diverticular (n=11) and hemorrhoids (n=26). One patient who missed his screening colonoscopy appointment re-presented two years later and was diagnosed with advanced right sided CRC. All the advanced lesions were detected in patients with positive FIT, giving a yield of 20.5% for advanced lesions including cancers in the 5.1% FIT positive subjects. Our study showed screening for CRC even with a single FIT was effective. However, the uptake rate was poor with just over half of the patients agreeing to screening colonoscopy. Measures to increase public awareness are important. Since one limitation of our study was the relatively small sample size, larger studies should be conduced in future.

Dedicated Outreach Is Effective in Increasing Uptake of Colorectal Cancer Screening in an Underserved Population

Dedicated Outreach Is Effective in Increasing Uptake of Colorectal Cancer Screening in an Underserved Population

Assessment of family history of colorectal cancer in primary care: Perceptions of first degree relatives of people with colorectal cancer

ObjectiveFirst degree relatives (FDRs) of someone with colorectal cancer (CRC) are at increased risk of the disease. In this study we examine the factors associated with discussing family history of CRC with a health professional. MethodsPeople with CRC, recruited through the population-based Victorian Cancer Registry in Australia, were asked to refer FDRs to the study. Eight hundred and nineteen FDRs completed a telephone interview. ResultsThirty-six percent of FDRs recalled ever being asked about their family history of bowel cancer by a health professional. Factors associated with having this discussion were being aged 50–60 years, having a university education, being in the potentially high risk category, being very worried about getting bowel cancer and knowing that family history increases risk through discussions with family, friends or their own education. ConclusionDespite evidence that doctor endorsement is a key factor in the uptake of CRC screening, our study shows that the majority of FDRs do not recall being asked by a health professional about their family history. Practice implicationsThere is a need to identify the most appropriate method to improve rates of health professional discussion of family history with relatives of CRC patients in order to improve screening rates.

Prevention of Colorectal Cancer: The Future Is Now

An estimated 140,000 new cases of colorectal cancer (CRC) were diagnosed in the USA in 2013. This review focuses on primary, secondary, and tertiary efforts to improve outcomes for patients at risk of CRC. Primary prevention to prevent the occurrence of CRC should focus on the reduction of modifiable CRC risk factors, including education regarding the deleterious effects of Western diets consisting of red and processed meats and the dangers of a sedentary lifestyle and obesity. Foods containing folates, vitamin D, and calcium may be protective against CRC and their consumption should likely be encouraged. Secondary preventive screening efforts can have a profound effect on reducing mortality by identifying neoplasia when precancerous lesions such as adenomas may be removed or when early-stage CRCs exist. Efforts must be made to increase the uptake of CRC screening on a worldwide level. The most resounding data for pharmacologic success in the prophylaxis of colorectal neoplasia belong to the class of aspirin and nonsteroidal anti-inflammatory drugs. Future therapies improving the efficiency of CRC screening modalities and genomic medical breakthroughs to personalize prophylactic treatments will change the way CRC prevention is viewed.

Decision Aid to Technologically Enhance Shared decision making (DATES): study protocol for a randomized controlled trial

BackgroundClinicians face challenges in promoting colorectal cancer screening due to multiple competing demands. A decision aid that clarifies patient preferences and improves decision quality can aid shared decision making and be effective at increasing colorectal cancer screening rates. However, exactly how such an intervention improves shared decision making is unclear. This study, funded by the National Cancer Institute, seeks to provide detailed understanding of how an interactive decision aid that elicits patient’s risks and preferences impacts patient-clinician communication and shared decision making, and ultimately colorectal cancer screening adherence.Methods/DesignThis is a two-armed single-blinded randomized controlled trial with the target of 300 patients per arm. The setting is eleven community and three academic primary care practices in Metro Detroit. Patients are men and women aged between 50 and 75 years who are not up to date on colorectal cancer screening. ColoDATES Web (intervention arm), a decision aid that incorporates interactive personal risk assessment and preference clarification tools, is compared to a non-interactive website that matches ColoDATES Web in content but does not contain interactive tools (control arm). Primary outcomes are patient uptake of colorectal cancer screening; patient decision quality (knowledge, preference clarification, intent); clinician’s degree of shared decision making; and patient-clinician concordance in the screening test chosen. Secondary outcome incorporates a Structural Equation Modeling approach to understand the mechanism of the causal pathway and test the validity of the proposed conceptual model based on Theory of Planned Behavior. Clinicians and those performing the analysis are blinded to arms.DiscussionThe central hypothesis is that ColoDATES Web will improve colorectal cancer screening adherence through improvement in patient behavioral factors, shared decision making between the patient and the clinician, and concordance between the patient’s and clinician’s preferred colorectal cancer screening test. The results of this study will be among the first to examine the effect of a real-time preference assessment exercise on colorectal cancer screening and mediators, and, in doing so, will shed light on the patient-clinician communication and shared decision making ‘black box’ that currently exists between the delivery of decision aids to patients and subsequent patient behavior.Trial RegistrationClinicalTrials.gov ID NCT01514786

Colorectal cancer incidence and screening in US Medicaid patients with and without HIV infection

Non-AIDS defining malignancies, particularly colorectal cancer (CRC), may be more prevalent among persons living with HIV (PLWH). Further, PLWH may be less likely to receive CRC screening (CRCS). We studied the epidemiology of CRC and CRCS patterns in PLWH and HIV-uninfected persons in a large US Medicaid population. We performed a matched cohort study examining CRC incidence in 2006 and CRCS between 1999 and 2007. Study participants were continuously enrolled in the Medicaid programs of California, Florida, New York, Ohio, and Pennsylvania. All PLWH enrollees were matched to five randomly sampled HIV-uninfected enrollees on 5-year age group, gender, and state. Adjusted odds ratios (AORs) for incident CRC (adjusted for comorbidity index) and the presence of CRCS (adjusted for comorbidity index and years in the data-set) among PLWH compared to HIV-uninfected enrollees were calculated. PLWH were not more likely to be diagnosed with CRC after adjusting for comorbidity index (unadjusted OR: 1.73, 95% confidence interval [CI]: 1.37–2.19; AOR 1.29; 95% CI: 0.98–1.70). While CRCS rates were low overall, PLWH were more likely to have received CRCS in unadjusted analyses (35.8% vs. 33.7%; OR 1.10, 95% CI: 1.07–1.13). This relationship was reversed after adjusting for comorbidity index and years in the data-set (AOR: 0.80, 95% CI: 0.77–0.83). Limitations of the study include a focus on the Medicaid population, an inability to detect fecal occult blood tests (FOBT), and having half of patients between 50 and 55 years of age. In conclusion, PLWH were not more likely to be diagnosed with CRC, but in adjusted analyses, were less likely to have received CRCS. As we showed a low rate of CRCS overall in this Medicaid population, researchers, clinicians, and policy-makers should improve access to and uptake of CRCS among all Medicaid patients, and particularly among PLWH.

Abstract C07: Colorectal cancer screening utilization among rural and minority populations in the United States

Abstract The American Cancer Society estimates that approximately 142,820 new colorectal cancer cases are expected to occur in the United States in 2013, with a total of 50,830 estimated deaths expected to occur. Colorectal cancer is the third most commonly diagnosed cancer and the second leading cause of cancer death among both men and women in the United States. Colorectal cancer can be prevented by early detection and colorectal cancer screening has been shown to be effective. Screening reduces mortality both by decreasing incidence and by detecting cancers at more treatable stages of disease. Despite this, colorectal cancer screening is underutilized, with only about half of people age 50 or older reporting having had colorectal cancer testing that is consistent with current screening guidelines from the American Cancer Society. Low rates of colorectal cancer screening are especially problematic among underserved populations, including rural and racial/ethnic minority populations. In particular, National Health Interview Survey data shows that Hispanics age 50 and older reported having had either a fecal occult blood test (FOBT) within the past year or sigmoidoscopy or colonoscopy within 10 years less frequently (45%) compared to non-Hispanic Whites (59%). The purpose of this study was to quantify and compare recent national surveillance data on colorectal cancer screening uptake among rural, urban, and suburban populations in the United States. Rates of FOBT and colonoscopy were estimated for these populations. Data utilized in this study included Behavioral Risk Factor Surveillance System (BRFSS) data from 2008 and 2010. A total of n=557,553 subjects that were 50 years of age and older participated in the BRFSS surveys over this time period. Subjects were coded into rural, urban, and suburban residence by using metropolitan statistical area codes. In comparison between Hispanic, American Indian, and non-Hispanic White populations, we found that rural Hispanic populations had the lowest percentage that reported a FOBT within the past year (10%; 95% CI=8.1%-12.3%) and suburban American Indian populations had the highest percentage (16%; 95% CI=12.8%-20.6%). Rural Hispanic populations also had the lowest percentage that reported a colonoscopy within the past 10 years (35%; 95% CI=32.2%-38.3%) and urban non-Hispanic White populations had the highest percentage (60%; 95% CI=59.1%-60.2%). Overall, the population with the highest percentage that was up-to-date with colorectal cancer screening was urban-dwelling non-Hispanic Whites (65%; 95% CI=64.8-65.8). In addition, 24% (95% CI=23.1%-25.4%) of rural populations that did not have a personal doctor reported having had a colonoscopy within the past 10 years, compared to 56% (95% CI=55.3%-56.1%) of rural populations, 60% (95% CI=59.9%-60.8%) of suburban populations and 60% (95% CI=59.6%-60.5%) of urban populations that had a personal doctor reporting a colonoscopy within the past 10 years. These results provide evidence that there continues to exist a great need to increase colorectal cancer screening uptake, especially among rural and underserved minority populations. Citation Format: Tomas Nuno, Ivo Abraham. Colorectal cancer screening utilization among rural and minority populations in the United States. [abstract]. In: Proceedings of the Twelfth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2013 Oct 27-30; National Harbor, MD. Philadelphia (PA): AACR; Can Prev Res 2013;6(11 Suppl): Abstract nr C07.

Risk for Advanced Colorectal Neoplasia in Asymptomatic Adults is Effectively Stratified by Phenotypic Features: Presidential Poster

Purpose: While colorectal cancer (CRC) screening is effective and cost-effective for reducing CRC incidence and mortality, it is underutilized, inefficient, and costly. The ability to stratify risk for advanced neoplasia (AN) could improve screening efficiency and uptake. Several risk factors for AN are not used in practice because of inability to integrate them to produce a risk estimate. Study aim is to create a riskstratifying index for AN (CRC, advanced adenomas, serrated polyps ≥ 1 cm). Methods: We measured socio-demographic and physical features, medical and family history, and lifestyle factors in 50-80 year olds who underwent 1st-time screening colonoscopy between 12/2004 and 9/2011, linking these factors to endoscopic and histologic findings. Using best-subsets logistic regression, we derived a risk equation on a randomly selected 2/3s of the sample. The model selected was based on optimal statistical metrics, including Mallow's C and frequency with which each variable appeared in the top 20 models. Based on model coefficients, we assigned points to each variable to create a risk score (range, -13 to 13). Scores with comparable risk magnitudes were collapsed into risk categories. The model was then tested on the remaining sample. Results: Among 3,025 subjects in the derivation set (mean age 57.3 ± 6.5 years; 52% women), prevalence of AN was 9.4% (including 26 CRCs). Model variables include age, sex, smoking, ethanol use, diet, marital status, NSAID and aspirin use, physical activity, education level, and metabolic syndrome (P-value for fit = 0.09; c-statistic = 0.78). Respective risks of AN in the low- (scores of -13 to -5), intermediate- (scores of -4 to 2) and high- (scores of 3 to 13) were 1.50% (95%, 0.07-2.8%), 6.94%, and 27.3% (P-value for trend < 0.001), with respective cohort proportions of 23%, 59%, and 18%. Ten low-risk subjects had AN (0 CRCs, 6 distal). Based on finding a distal sentinel polyp, sigmoidoscopy would have detected 7 (70%) ANs. Among the 1,475 subjects in the test set (mean age 57.2 ± 6.5 years; 52% women), AN prevalence was 8.4%. Risk of AN in the low-risk subgroup was 2.73% (CI, 1.25-5.11%) and was 5.57% and 25.4% in the intermediate- and high-risk subgroups, respectively (P<0.001), with cohort proportions of 23%, 59%, and 18%. Nine low-risk subjects had AN (0 CRCs, 5 distal, 6 detectable by sigmoidoscopy). Conclusion: This risk index effectively stratifies the risk for AN among asymptomatic adults, identifying a low-risk subgroup of 23% that may be screened effectively and efficiently with tests other than colonoscopy and a high-risk subgroup of 18% for which colonoscopy may be preferred. If validated in other settings, this index could increase the efficiency and uptake of CRC screening.

Place of Birth, Fatalism, and Uptake of Colorectal Cancer Screening among U.S. Adults

Place of Birth, Fatalism, and Uptake of Colorectal Cancer Screening among U.S. Adults

Barriers to Colorectal Cancer Screening in Palestine: A National Study in a Medically Underserved Population

Cultural, religious, and financial barriers can hinder uptake of colorectal cancer (CRC) screening in Arab communities. We aim to understand attitudes and barriers that contribute to the low rate of CRC screening among Palestinians in the West Bank. We performed a national, cross-sectional study of Palestinian adults older than 50 years. A self-administered questionnaire was developed and validated. Data were randomly collected in all major districts of the West Bank. The primary outcome was the willingness to undergo CRC screening. Multivariable logistic regression models were used to assess the strength of association between the primary outcome and its predictors while controlling for possible confounders. Of 1601 people approached for an interview, 1352 agreed to participate (response rate, 84%). Only 193 had undergone CRC screening (14%); 1069 (79%) agreed to take a fecal occult blood test, 906 (67%) agreed to a colonoscopy examination, and 1098 (81%) were willing to undergo CRC screening if recommended by a physician. Only 194 (14%) said they had been informed about CRC screening by a physician. Urban residents were more likely to be screened for CRC than nonurban residents (odds ratio, 0.73; 95% confidence interval, 0.56-0.93; P = .011). Multivariable analysis showed that lack of education beyond elementary school or familiarity with CRC screening, distrust of Western medicine, religious objection, and finding the test to be embarrassing were all associated with decreased odds of accepting CRC screening. Based on a national, cross-sectional study of Palestinian adults, there are many cultural and religious barriers to CRC screening. Improving our understanding of these could increase screening among Arab populations in the Middle East and in Western countries.

Anticipated regret to increase uptake of colorectal cancer screening in Scotland (ARTICS): study protocol for a randomised controlled trial

BackgroundColorectal cancer is the second leading cause of cancer deaths in the UK. Screening is key to early detection. The Scottish programme of colorectal cancer screening is running successfully, and involves all adults aged between 50 and 74 years being invited to post back a faecal sample for testing every 2 years. However, screening uptake is sub-optimal: for example rates for the period November 2009 to October 2011 ranged from just 39% for males living in the most deprived areas to 67% for least deprived females. Recent research has shown that asking people to consider the emotional consequences of not participating in screening (anticipated regret) can lead to a significant increase in screening uptake.Methods/DesignWe will test a simple anticipated regret manipulation, in a large randomised controlled trial with 60,000 members of the general public. They will be randomly allocated to one of 3 arms, no questionnaire, control questionnaire or anticipated regret questionnaire. The primary outcome will be screening test kit return. Results will also be examined by demographic variables (age, gender, deprivation) as these are currently related to screening kit return.DiscussionIf this anticipated regret intervention leads to a significant increase in colorectal cancer screening kit returns, this would represent a rare example of a theoretically-driven, simple intervention that could result in earlier detection of colorectal cancer and many more lives saved.Trial registrationCurrent Controlled trials: ISRCTN74986452

A2-2: Systems of Support to Increase Colorectal Cancer Screening (SOS): A 2-Year Randomized Trial of an Automated Intervention with Stepped Increases of Support to Increase Uptake of Colorectal Cancer Screening

Background/Aims Screening decreases colorectal cancer (CRC) incidence and mortality, yet almost half of age-eligible patients are not screened at recommended intervals. Our objective was to determine whether interventions using electronic health records, automated mailings, and stepped increases in support increased being current for CRC testing over 2 years.

A Comparison of Colorectal Cancer Screening Uptake Among Average-Risk Insured American Indian/Alaska Native and White Women

American Indian and Alaska Native (AI/AN) women have among the lowest rates of colorectal cancer (CRC) screening. Whether screening disparities persist with equal access to health care is unknown. Using administrative data from 1996-2007, we compared CRC screening events for 286 AI/AN and 14,042 White women aged 50 years and older from a health maintenance organization in the Pacific Northwest of the U.S. The proportion of AI/AN and White women screened for CRC at age 50 was similar (13.3% vs. 14.0%, p =.74). No differences were seen in the type of screening test. Time elapsed to first screening among AI/AN women who were not screened at age 50 did not differ from White women (hazard ratio 1.0, 95% confidence interval 0.8-1.3). Uptake for CRC screening was similar among insured AI/AN and White women, suggesting that when access to care is equal, racial disparities in screening diminish.

Gender differences in predictors of colorectal cancer screening uptake: a national cross sectional study based on the health belief model.

BackgroundColorectal Cancer (CRC) is rapidly rising in Asia, but screening uptake remains poor. Although studies have reported gender differences in screening rates, there have been few studies assessing gender specific perceptions and barriers towards CRC screening, based on behavioral frameworks. We applied the Health Belief Model to identify gender-specific predictors of CRC screening in an Asian population.MethodsA nationwide representative household survey was conducted on 2000 subjects aged 50 years and above in Singapore from 2007 to 2008. Screening behaviour, knowledge and beliefs on CRC screening were assessed by face-to-face structured interviews. The response rate was 88.2%.Results26.7 percent had undergone current CRC screening with no gender difference in rates. Almost all agreed that CRC would lead to suffering (89.8%), death (84.6%) and would pose significant treatment cost and expense (83.1%). The majority (88.5%) agreed that screening aids early detection and cure but only 35.4% felt susceptible to CRC. Nearly three-quarters (74.3%) of the respondents recalled reading or hearing information on CRC in the print or broadcast media. However, only 22.6% were advised by their physicians to undergo screening. Significantly more women than men had feared a positive diagnosis, held embarrassment, pain and risk concerns about colonoscopy and had friends and family members who encouraged screening. On multivariate analysis, screening uptake showed a positive association with worry about contracting CRC and a physician’s recommendation and a negative association with perceived pain about colonoscopy for both genders. For women only, screening was positively associated with having attended a public talk on CRC and having a family member with CRC, and was negatively associated with Malay race and perceived danger of colonoscopy.ConclusionsCRC screening remains poor despite high levels of awareness of its benefits in this Asian population. Race, worry about contracting cancer, psychological barriers, and cues from the doctor and a public talk on CRC were associated with screening with gender specific differences. Strategies to increase CRC screening uptake should consider gender specific approaches to address psychological barriers and increase disease susceptibility through public health education and active promotion by physicians.

Automated reminders and increasing intense support increased uptake of colorectal cancer screening

Source Citation Green BB, Wang CY, Anderson ML, et al. An automated intervention with stepped increases in support to increase uptake of colorectal cancer screening: a randomized trial. Ann Intern ...