Colorectal Cancer Screening Compliance Research Articles

Colorectal Cancer Screening Compliance and Contemplation in Gynecology Patients

Colorectal cancer screening (CRCS) should be a necessary part of gynecology (GYN) providers' preventive practices. The purpose of our study is to examine CRCS recommendations and adherence in this population. A questionnaire was administered to a prospective cohort of patients awaiting health maintenance exams at six academic and private gynecology offices. Patients reported demographics, CRC/breast/cervical screening adherence, CRCS recommendations, and future likelihood of CRCS. A total of 461 women aged 51 years and older completed the questionnaire. Sixty-six percent of respondents were compliant with CRCS compared to 93% and 86% for breast and cervical cancer screening, respectively (p < 0.001). GYN providers recommended CRCS in 43% of patients. Sixty-three percent were planning to undergo future CRCS. On multivariable analysis, characteristics associated with CRCS adherence included (odds ratio, 95% confidence interval): older age (1.1 per year, 1.1-1.2), previous mammography (3.7, 1.4-9.7), family history (FH) of CRC/polyps (1.9, 1.0-3.4), friend with CRC (2.6, 1.5-4.7), and any doctor recommending CRCS (8.2, 4.6-14.7). CRCS rates were higher among patients who received a recommendation from a PCP (primary care provider) than from a GYN provider. Factors associated with intention to undergo CRCS include previous mammography (1.4, 4.2-12.0), any doctor recommendation (6.4, 3.7-11.0), and FH of CRC/polyps (3.5, 1.9-6.3). CRCS recommendations by both GYNs and PCPs had a greater impact on CRCS contemplation than those from a PCP or GYN alone. In gynecology patients, having multiple providers recommend CRCS increases the likelihood of patients' intentions to undergo CRCS. However, CRCS compliance is primarily driven solely by PCP recommendations. Regardless, strategies must be in place to prompt gynecologists and nurse practitioners to discuss CRCS in eligible patients.

CO2 insufflation during colonoscopy decreases post-interventional pain in deeply sedated patients: a randomized controlled trial

Air insufflation during colonoscopy is considered the standard method in most endoscopic centers. Notably, several studies have reported reduced abdominal pain after colonoscopy with CO2 insufflation in unsedated and in lightly sedated patients. The present study was designed to assess the efficacy of CO2 insufflation after colonoscopy in moderately and deeply sedated patients. We also evaluated whether CO2 insufflation increases patients' compliance for colorectal cancer screening. A total of 300 consecutive patients allocated to colonoscopy were randomly assigned to either CO2 or air insufflation. Propofol was titrated to a level of deep sedation and propofol combined with midazolam was used for moderate sedation. Post-interventional pain levels and satisfaction with the procedure were registered on a 10-point visual analog scale. Compliance for colorectal cancer screening was ascertained separately. CO2 insufflation was used during colonoscopy in 157 patients; conventional air was used in 143 patients. The two groups were comparable with regard to age, sex and body mass index. Neither major nor minor complications were observed. Pain sensation was significantly lower in the CO2 group at 15 min, 30 min and 6 h after colonoscopy (P<0.01); at 12 h no difference was observed. In contrast, levels of patient satisfaction did not show any significant difference. Voluntary colorectal cancer screening appeared not to be influenced by the type of insufflation gas used. CO2 insufflation in deeply and moderately sedated patients during colonoscopy has no impact on patients' satisfaction with the procedure or on their attitude to voluntary colorectal cancer screening. However, the use of CO2 insufflation significantly diminishes abdominal pain after colonoscopy.

Physician and Gender Differences Among the Patient-Physician Discussion Prior to Open Access Colonoscopy

Objective: In an effort to improve colorectal cancer screening (CRCS) compliance, open-access colonoscopy (OAC) is utilized to decrease the cost and waiting time for colonoscopy. The purpose of our study was to examine the patient-physician discussion prior to OAC to assess areas to improve CRCS compliance. Methods: A questionnaire was administered to consecutive patients undergoing OAC at a private gastroenterology practice. Patients reported demographics, provider information, discussion length, and content areas of the discussion. Results: 426 subjects completed the questionnaire of which 52% were women. 70.4% of participants were Caucasian and 22.1% were African American. The average age was 52.8 (+5.3) yrs. Subjects had seen their primary care physicians (PCP) for 7.9(+7.6) yrs and averaged two visits/yr. 63% of PCPs were male. 47.2% of referring physicians were family practice(FP), 39.2% were internists(IM), and 8.9% were gynecologists(GYN). Male subjects reported a mean 9.7 +4.3 minutes of discussion about CRCS, colonoscopy procedure and preparation compared to women subjects at 7.6 +4.3 min. The female physicians' discussions were slightly longer than their male cohorts, 11.2 +1.9 vs. 10.8 +1.9 min, respectively. FPs(12.6 +4.1 min) had the most extensive discussion regarding CRCS/OAC relative to IM(7.8 +4.0 min) and GYN(6.7 +4.8 min). 25% of subjects discussed other CRCS methods besides colonoscopy. Women were less likely than men to have discussed other forms of CRCS(OR 0.36, p<0.000). 57% of subjects discussed the benefits of CRCS. GYNs (OR 9.5, p<0.005) and IMs (OR 4.3, p<0.042) were most likely to discuss benefits of CRCS with subjects. 20% of subjects reported discussing the risks of OAC and 23% reported discussing the medications to avoid. Only 52% felt that they were adequately informed prior to OAC. Women were half as likely to be adequately informed by their practitioner (OR 0.40, p<0.000), the risks of colonoscopy (OR 0.45, p<0.005) and medications to avoid(OR 0.51, p<0.012). Of all PCPs, women felt that GYNs best informed them about their procedure (OR 12.5, p<0.005). Subjects with a relationship for 10 years or greater with their doctor were 43% more likely to be adequately informed(OR 1.43, p<0.00). Female physicians were the most influential in a patient's decision to undergo a colonoscopy (OR 1.63, p<0.04). Conclusion: Despite the time devoted by PCPs, patients do not feel well informed about CRCS. Specifically, women are least likely to be informed about the CRCS process. In continuing to improve CRCS compliance, strategies must be in place to prompt PCPs to discuss the CRCS process with their patients.

Orchestrating Key Personnel to Increase Colorectal Cancer Awareness at the Worksite

Colorectal cancer is the second leading cause of deaths due to cancer for both men and women in the United States. Screening promotes the early detection of colorectal cancer and reduces the morbidity and mortality rates. Worksite wellness programs are an effective way to promote colorectal cancer prevention and screening awareness and compliance with the American Cancer Society's screening guidelines, and they provide several advantages from the perspectives of the employees, employers, and nurses. This article explains how to orchestrate key personnel to increase colorectal cancer awareness in the worksite. A review of evidence-based literature is utilized to maximize the effectiveness of these worksite education sessions. The goals for the worksite employees are to resolve their individual barriers through education, to commit to colorectal cancer screening and prevention, and to feel a sense of obligation to follow through on their plans.

S1052 The Impact of Physician Recommendations On Colorectal Cancer Screening Compliance and Contemplation in Gynecology Patients

BACKGROUND African-Americans have the highest incidence rates of colorectal cancer among all races in the United States. A study looking at colonoscopies exclusively in this population may help to minimize discomfort and maximize efficiency. The aim of this study is to determine how various factors impact cecal intubation time in African-Americans. METHODS This is a prospective study of 1122 consecutive outpatient colonoscopies. Exclusion criteria included colonic resection and strictures or exophytic masses precluding colonic evaluation; all other patients were included. Various demographic, anatomical, and historical data were recorded. BMI and mean cecal intubation time and rate were calculated. RESULTS Of the 1122 patients, 63% were female, 12% were 0.05]. CONCLUSIONS In African-Americans, factors predicting less difficult colonoscopies at our institution include male gender, younger age, increasing BMI, and procedure done by attendings alone. Factors predicting more difficult colonoscopies include female gender, older age, decreasing BMI, and trainee participation in the procedure.

Performance Characteristics and Comparison of Two Fecal Occult Blood Tests in Patients Undergoing Colonoscopy

We investigated the use of a new type of FOBT (EZ-Detect) that uses the blood's pseudo-peroxidase activity as an enzymatic catalyst, in a one-step chromogen-substrate system performed by the patient. Asymptomatic patients >/=50 years old received three Hemoccult II (HO) cards and three EZ-Detect (EZ) packages to be used in three consecutive bowel movements. Sensitivity, specificity, positive predictive value, and negative predictive value for detection of colorectal neoplasia was calculated. The study included 207 patients, with a mean age of 58.9 years. Diagnostic accuracy for detection of adenomas was similar for the EZ and HO tests (66.7% vs. 71.0%; P=0.48), while for advanced adenomas diagnostic accuracy for the EZ and HO tests was 86.0% vs. 94.2% (P=0.01), respectively. Most patients preferred the EZ test (92% vs. 8%). We conclude that the EZ test has a diagnostic profile similar to that of the HO test for identification of adenomas; however, for advanced adenomas the diagnostic accuracy was slightly better for the HO. The EZ test was preferred by most patients, which may increase colorectal cancer screening compliance.

Estimating Development Cost for a Tailored Interactive Computer Program to Enhance Colorectal Cancer Screening Compliance

The authors used an actual-work estimate method to estimate the cost of developing a tailored interactive computer education program to improve compliance with colorectal cancer screening guidelines in a large multi-specialty group medical practice. Resource use was prospectively collected from time logs, administrative records, and a design and computing subcontract. Sensitivity analysis was performed to examine the uncertainty of the overhead cost rate and other parameters. The cost of developing the system was $328,866. The development cost was $52.79 per patient when amortized over a 7-year period with a cohort of 1,000 persons. About 20% of the cost was incurred in defining the theoretic framework and supporting literature, constructing the variables and survey, and conducting focus groups. About 41% of the cost was for developing the messages, algorithms, and constructing program elements, and the remaining cost was to create and test the computer education program. About 69% of the cost was attributable to personnel expenses. Development cost is rarely estimated but is important for feasibility studies and ex-ante economic evaluations of alternative interventions. The findings from this study may aid decision makers in planning, assessing, budgeting, and pricing development of tailored interactive computer-based interventions.

Patterns of diagnosis for colorectal cancer (CRC): Screening detected versus symptomatic presentation

1023 Background: Colorectal cancer (CRC) is a leading cause of cancer death in North America; studies have shown that screening improves survival. Conducted in British Columbia, Canada, this study was conducted to identify the proportion of screening-eligible patients with sporadic CRC who are detected by screening tests versus symptomatic presentation,and to compare baseline patient and tumor characteristics of these two groups. Methods: This retrospective cohort study identified 571 cases via the BC Cancer Registry of patients age 50 years and older presenting with first diagnosis of invasive CRC between Nov. 2002 and Apr. 2003. Patients with non-adenocarcinoma histology, HNPCC or FAP were not included. Self completed questionnaires were mailed to all patients to capture: prior screening history, screening versus symptomatic presentation, and demographic information. All respondents charts were then reviewed to corroborate screening information, and to obtain pathological information including TNM stage, grade and site (proximal versus distal colon versus rectal). Results: Of 212 eligible respondents (37% response), only 14 of 212 (6.6%) patients with a new CRC were detected via screening versus 198 of 212 (93.4%) presenting with symptoms. Respondents were average age at diagnosis 69 years, 59% male, 91% Caucasian, 37%rectal, and 18% M1 at diagnosis. No significant differences in the age, gender, ethnicity, socioeconomic status, tumour stage and site were detected between the screened versus symptomatic groups. Only 33 of 212 patients (15.6%) reported ever having a screening test. 19 of 198 cancers (9.6%) were diagnosed by symptomatic presentation despite a compliant screening history. Conclusion: Despite universal health-care access in British Columbia, only 7% of patients with a new diagnosis of CRC were detected via a screening test. Furthermore, only 15% of screening-eligible respondents have ever been screened. There were no differences in patient demographics or stage of disease at presentation but numbers in the screening cohort were limited. Significant effort is required to increase knowledge and compliance for CRC screening. No significant financial relationships to disclose.

Colorectal Cancer Screening: Do We Practice What We Preach?

Compliance rates for colorectal cancer screening have been reported as low, and ignorance is the most common factor sighted to explain this. The aim of this study was to determine screening compliance among colorectal surgeons assumed to be educated of the risks of colorectal cancer. A postal survey was distributed to the members of the American Society of Colon and Rectal Surgeons. A total of 1195 members were surveyed. All respondents indicated that they advocate screening. Colonoscopy every 10 years and annual fecal occult blood testing were the most common strategies advocated to individuals with baseline risk. Colonoscopy every 5 years and annual fecal occult blood testing were the most common strategies advocated to patients with a first-degree relative with polyps or cancer. Most of these colorectal surgeons initiated their screening before 50 years of age. Colorectal cancer screening compliance is high among members of the American Society of Colon and Rectal Surgeons. These rates may be the result of awareness of the risks of colorectal cancer.

Las Mujeres Saludables: Reaching Latinas for Breast, Cervical and Colorectal Cancer Prevention and Screening

Community health advisors have effectively promoted breast and cervical cancer prevention and screening among low-income Latina women. Specific elements of such programs, such as enhanced social support, may explain successes. Promotion of colorectal cancer screening has been less studied. Promotoras de Salud (i.e., Latina health advisors) implemented a 12-week program among women recruited from community-based organizations. The program educated 366 Latinas in breast, cervical and colorectal cancer prevention and screening and emphasized social support among class members. Pre- and post-intervention assessments demonstrated significant increases for fruit and vegetable consumption (3.05 to 3.60 servings/day), and physical activity (65.15 to 122.40 minutes/week). Of women previously non-compliant, 39 percent, 31 percent and 4 percent received Pap tests, mammography, and fecal occult blood test (FOBT), respectively. A culturally aligned education program using community health advisors and emphasizing social support among participants may improve prevention and selected screening behaviors, but more intensive interventions may be required for colorectal cancer screening compliance.

Understanding non-compliance to colorectal cancer screening: a case control study, nested in a randomised trial [ISRCTN83029072

BackgroundThe major limit to colorectal cancer screening effectiveness is often low compliance. We studied the reasons for non compliance and determinants of compliance to faecal occult blood tests in Lazio, Italy.MethodsThis is a case-control study nested within a trial that tested the effect of type of test and provider on colorectal cancer screening compliance. Non compliant trial subjects were classified as cases, and compliant subjects were classified as controls. We sampled 600 cases and 600 controls matched by their general practitioner, half were invited for screening at the hospital, and the other half directly at their general practitioner's office. Cases and controls answered questions on: distance from test provider, logistical problems, perception of colorectal cancer risk, confidence in screening efficacy, fear of results, presence of colorectal cancer in the family, and gastrointestinal symptoms.ResultsAbout 31% of cases never received the letter offering free screening, and 17% of the sampled population had already been screened. The first reported reason for non-compliance was "lack of time" (30%); the major determinant of compliance was the distance from the test provider: odds ratio >30 minutes vs <15 minutes 0.3 (95%CI = 0.2–0.7). The odds ratio for lack of time was 0.16 (95% IC 0.1–0.26). The effect was stronger if the hospital (0.03 95%CI = 0.01–0.1) rather than the general practitioner (0.3 95%CI = 0.2–0.6) was the provider. Twenty-two percent of controls were accompanied by someone to the test.ConclusionTo increase compliance, screening programmes must involve test providers who are geographically close to the target population.

Economic Impact of Anesthetist-Administered Sedation in Outpatient Gastrointestinal Endoscopy

Purpose: Almost all gastrointestinal endoscopic procedures performed with propofol sedation (92%) use an anesthesiologist or a certified registered nurse anesthetist (CRNA) (Cohen 2005) and the economic impact of anesthetist-administered sedation in gastrointestinal endoscopy has not been economically quantified. Methods: A model was developed to quantify the economic impact of anesthetist-administered sedation in patients undergoing outpatient gastrointestinal endoscopic procedures in a hospital outpatient clinic, physician office, and ambulatory surgical center (ASC). The model was created from the perspective of the U.S. healthcare system. Reimbursement inputs for anesthesia professional services were obtained from published literature (Aisenberg 2005). As these rates vary by payer, a weighted average was calculated based on the distribution of payer type for endoscopic procedures (CDC 2001). The number of gastrointestinal endoscopic procedures performed in the U.S. was estimated using NDCHealth, Solucient, and Verispan data. To measure the robustness of model results to changes in base case inputs, sensitivity analyses were performed. Using a Monte Carlo simulation, the inputs were varied simultaneously and randomly for 1,000 iterations to determine a range of cost estimates. Results: The total number of outpatient gastrointestinal endoscopic procedures performed in the U.S. is projected to be between 20.4 and 22.3 million in 2005. Approximately 5.1 to 5.6 million of these gastrointestinal endoscopic procedures are performed with propofol sedation. The anesthetist costs associated with gastrointestinal endoscopic procedures using propofol sedation are projected to range from $1.3 to $1.4 billion in 2005. Sensitivity analyses indicated that estimated annual costs of anesthetist-administered sedation for gastrointestinal endoscopy were most influenced by anesthetist professional fees and the percent of procedures using propofol sedation. Conclusions: Anesthetist-administered sedation for gastrointestinal endoscopy results in a significant economic burden to the U.S. healthcare system. This burden is likely to increase due to population growth, potential increases in colorectal cancer screening compliance, and the increased use of propofol for gastrointestinal endoscopy. As the dynamics of reimbursement change frequently, further research is warranted to determine the entities financially responsible for this burden.

Mass Screening With CT Colonography: Should the Radiation Exposure Be of Concern?

Computed tomography colonography (CTC), particularly using noncathartic techniques, has the clear potential to increase compliance for colorectal cancer screening. Because the geometry for CTC is highly advantageous, it can be performed with lower radiation doses than almost any other CT examination. If CTC were to become a standard screening tool for the population age 50 years and older, the potential market in the United States would soon be over 100 million people. Therefore, it is pertinent to consider the radiation exposure and any potential radiation risk to the population from such a mass CTC screening program. Organ doses from CTC examinations can be estimated with standard techniques. These doses can be applied to organ- and dose-specific radiation cancer risk estimates to estimate the excess cancer risk resulting from the radiation from a paired (supine and prone) CTC examination. The cancer risks associated with the radiation exposure from CTC are unlikely to be zero, but they are small. A best estimate for the absolute lifetime cancer risk associated with the radiation exposure using typical current scanner techniques is about 0.14% for paired CTC scans for a 50-year-old, and about half that for a 70-year-old. These values probably could be reduced by factors of 5 or 10 with optimized CTC protocols. In terms of the radiation exposure, the benefit-risk ratio potentially is large for CTC.

Correlates of Colorectal Cancer Screening Compliance Among Urban Hispanics

Colorectal cancer (CRC) is the second most common cancer among Latinos; screening can reduce mortality from CRC. The aims of this study are; to assess the current compliance with free colorectal cancer screening among Hispanic women who are participating in a national breast and cervical cancer screening program (NBCCEDP), and to examine the effects of a set of key constructs from the HBM and the TPB on compliance with the Fecal Occult Blood Test (FOBT). We consecutively recruited 950 women from among those attending an initial appointment at an NBCCEDP site in northern Manhattan, and administered a questionnaire. Patients were offered a free Hemoccult kit, alongside instructions and print materials. The rate of FOBT compliance (in kit return) was 77.3%. Fatalism remained a statistically significant influence on FOBT compliance in the multivariate models, and there was a trend for higher FOBT return among West Indies women (primarily from the Dominican Republic). The findings of this study demonstrate the feasibility and acceptability of distributing FOBT kits through an existing national program for cancer screening of women. The results justify replication in a more heterogeneous group of Hispanics, with longer-term followup.

Feasible economic strategies to improve screening compliance for colorectal cancer in Korea

While colorectal cancer (CRC) is an ideal target for population screening, physician and patient attitudes contribute to low levels of screening uptake. This study was carried out to find feasible economic strategies to improve the CRC screening compliance in Korea. The natural history of a simulated cohort of 50-year-old Korean in the general population was modeled with CRC screening until the age of 80 years. Cases of positive results were worked up with colonoscopy. After polypectomy, colonoscopy was repeated every 3 years. Baseline screening compliance without insurance coverage by the national health insurance (NHI) was assumed to be 30%. If NHI covered the CRC screening or the reimbursement of screening to physicians increased, the compliance was assumed to increase. We evaluated 16 different CRC screening strategies based on Markov model. When the NHI did not cover the screening and compliance was 30%, non-dominated strategies were colonoscopy every 5 years (COL5) and colonoscopy every 3 years (COL3). In all scenarios of various compliance rates with raised coverage of the NHI and increased reimbursement of colonoscopy, COL10, COL5 and COL3 were non-dominated strategies, and COL10 had lower or minimal incremental medical cost and financial burden on the NHI than the strategy of no screening. These results were stable with sensitivity analyses. Economic strategies for promoting screening compliance can be accompanied by expanding insurance coverage by the NHI and by increasing reimbursement for CRC screening to providers. COL10 was a cost-effective and cost saving screening strategy for CRC in Korea.

Testing a culturally appropriate, theory-based intervention to improve colorectal cancer screening among native Hawaiians

Background We tested an intervention based on social learning theory (SLT) to improve colorectal cancer (CRC) screening among Native Hawaiians, a group with low CRC screening rates. Method Sixteen Hawaiian civic clubs agreed to randomization. Eight control clubs received a culturally targeted presentation, a free Fecal Occult Blood Test (FOBT), and a reminder call. Eight experimental clubs also received culturally targeted education and free testing; but, in line with SLT, education was delivered by a Native Hawaiian physician and Native Hawaiian CRC survivor, and members received an FOBT demo, were challenged to involve a family member in screening, and were telephoned multiple times to address change-related emotions and barriers. Results One hundred twenty-one members age 50 and older from 16 clubs participated. At the club level, screening rates were modestly increased in four experimental clubs and six control clubs. Surprisingly, 64% of participants reported being up to date with CRC screening at baseline. Only 13 individuals (five in experimental arm and eight in the control arm) were screened for the first time through this intervention, increasing the percent screened from 59% to 67% in the experimental group and from 69% to 85% in the control group. Although individuals in the experimental arm were more likely to rate the intervention as culturally appropriate, both arms realized similar and significant gains in CRC knowledge, attitudes, intent, and self-efficacy. Conclusions For Native Hawaiian individuals belonging to a network of civic clubs, an intervention based on SLT delivered by a Native Hawaiian physician and CRC survivor was less effective at further increasing compliance than was a culturally targeted educational session delivered by a non-Hawaiian nurse. That CRC screening compliance was high prior to our intervention suggests that we targeted a very health conscious segment of the Native Hawaiian population. Future work should focus on underserved segments of this indigenous group.

A MULTICENTER RANDOMIZED CONTROLLED TRIAL DESIGNED TO EVALUATE FOLLOW‐UP SURVEILLANCE STRATEGIES FOR COLORECTAL CANCER: THE JAPAN POLYP STUDY

Colorectal cancer is the third leading cause of cancer mortality, and the incidence of colorectal cancer in Japan is increasing gradually. To reduce colorectal cancer mortality, a higher compliance for colorectal cancer screening and follow‐up programs is needed. Consequently, it is necessary to establish firm recommendations based on strong evidence from postpolypectomy colonoscopic surveillance. The Japan Polyp Study (JPS) began in 2000, and its objective is to evaluate follow‐up surveillance strategies in patients who have undergone two complete colonoscopies for the control of colorectal cancer, with the removal of all detected polyps by high‐resolution chromoendoscopy, including the removal of flat or superficial depressed (0‐IIc) lesions. The JPS is scheduled to continue until the year 2010, and future data will help to develop recommendations for surveillance guidelines for such patients.

Public awareness of risk factors and screening for colorectal cancer in Europe

Colorectal cancer (CRC) is the commonest site for malignancy in Europe. The Commissioner for Health wishes to promote screening for colorectal, breast and cervical cancer in Europe. The aim of this study was to assess public knowledge of CRC in Europe and likely take up of free screening. To this end 20710 members of the public from 21 European countries were interviewed by means of a regular survey amongst consumers (Omnibus survey) using 13 stem questions. Forty-eight per cent thought the population were at equal risk of CRC, only 57% were aware of age and 54% of family history as risk factors. Although 70% were aware of dietary factors, only 30% knew that lack of exercise might be a risk factor. Only 51% had knowledge of CRC screening but 75% were 'very', or 'quite interested, in taking up faecal occult blood (FOB) screening if offered free. Barriers to screening were lack of awareness of risk (31%), youth (22%) and an un-anaesthetic test (19%). There was a big cultural difference in willingness of the public to discuss bowel symptoms: there was a major barrier in Finland (91%), Britain (84%), Luxembourg (82%), Poland (81%) and Portugal (80%); less of a barrier in Spain (49%), Italy (44%) and Iceland (39%). In conclusion, the challenge of achieving high compliance for CRC screening must be a major objective amongst EU member states and non-aligned countries of Europe in the next decade, because it is known that the non-compliant group are those at greatest risk of death from CRC. This study has shown that awareness of CRC is low in Europe and that an educational programme will be essential to achieve high compliance for CRC screening as a means of reducing deaths from bowel cancer.

Breaking the Barriers to Colorectal Cancer Screening

Despite the great strides made to encourage colorectal cancer screening and successful public awareness campaign credited with increasing colonoscopy rates by as much as 20%, one of the major barriers to improved patient compliance is the confusion surrounding insurance coverage for preventative tests. Unfortunately, there is no Federal legislation that requires insurance providers to cover preventative screenings for colorectal cancer. But in recent years, a handful of states have passed legislation designed to encourage screenings. In response to patient and physician uncertainties of whether or not insurance will pick up the tab for colorectal cancer tests, the Entertainment Industry Foundation’s National Colorectal Cancer Research Alliance (EIF’s NCCRA) and the American Gastroenterology Association (AGA) have joined forces to create a report that clearly explains state laws governing insurance coverage for cancer screenings. “EIF’s NCCRA has teamed up with AGA to applaud those states with comprehensive healthcare protections, and reinforce our key message that preventative screening is the first step to beating colorectal cancer,” said Lisa Paulsen, president and CEO of the Entertainment Industry Foundation. “By recognizing states with exemplary legislation, our hope is that others will follow suit.” The 2004 Colorectal Cancer Legislation Report Card helps people make sense out of the varied and complex laws surrounding colorectal tests. An AGA Report Card Taskforce was assembled to determine the evaluation criteria and assign a grade (A–F) for every state in the union, including Washington D.C. Legislative research was collected from numerous public sources including: the National Cancer Institute’s (NCI) State Legislative Database, National Conference of State Legislatures, American Cancer Society (ACS), and Centers for Disease Control and Prevention. This first-of-its kind, on-line report (EIF.NCCRA.org) provides web links to actual legislation for current state laws. There is also a call-to-action for those states with failing grades. People can e-mail a prepared letter to their state’s Senate Health Committee Chair to petition for quality legislation. “We believe that colorectal cancer merits a higher priority in our nation’s public health agenda,” said J. Thomas Lamont, M.D., a member of AGA’s Report Card Taskforce. “If we can persuade more states to pass preventative screening legislation, our states have the potential to save billions of dollars spent annually to treat colorectal cancer and, most importantly, save thousands of lives.” A total of 18 states received passing grades (A–C). In 2000, Virginia was the first state to adopt comprehensive colorectal cancer screening coverage that meets AGA and ACS guidelines, setting the standard for model legislation and receiving a grade “A” in this report. Since then, 12 states have followed its outstanding example, including: Connecticut, Georgia, Illinois, Indiana, Maryland, Missouri, Nevada, New Jersey, North Carolina, Rhode Island, Tennessee, Virginia, and Washington D.C. Another 3 states-Delaware, Texas, and West Virginia-received a “B” rating falling short because the law itself did not reference AGA or ACS. California and Wyoming squeezed by with passing grade of a “C” because legislation is vague and omits specifics on types of tests covered and age requirements for screening. Two-thirds of the country (34 states) remain without legislation. Among those states that failed, Oklahoma does have legislation but received a “D” because it only recommends that coverage be offered, rather than required. Many of these same states have passed insurance provisions for other cancers. For instance, breast cancer advocates have made a tremendous impact overcoming a once taboo subject and have positively influenced patient behavior. As a result, 47 states now require insurers to cover breast cancer screenings. Today, NCI reports that compliance among women to receiving mammograms has increased to 70%, while compliance for colorectal cancer screening among women remains low (27%). Colorectal cancer has the second highest death rate in the United States. Although colorectal cancer is one of the most highly preventable cancers (90% curable with early detection), fewer states have passed preventative screening legislation for this disease when compared with other cancers with lower death rates. Similar legislative advancements have provided coverage for prostate screenings (26 states) and cervical cancer screenings (23 states) whose combined death rates are far below that of colorectal cancer. This year, 5 states: Alabama, Kansas, Kentucky, Mississippi, and Pennsylvania have introduced colorectal cancer screening bills within the 2004 legislative session. Hopefully, this report card will encourage more people living in those states to take action and vocalizing their support of this type of measure. To learn more about the 2004 Colorectal Cancer Legislation Report Card released by AGA and EIF’s NCCRA, please visit www.eif.nccra.org.

A survey of women regarding factors affecting colorectal cancer screening compliance

Background. Women participate in colorectal cancer (CRC) screening less often than men. Our study objective was to understand factors related to women's use of CRC screening. We examined the personal health, medical care, and psychosocial responses to CRC and screening use of a community-based sample of women. Methods. Women aged 50–80 years at average CRC risk completed a telephone questionnaire. We asked about demographics, past use of CRC and other cancer screening tests, preventive health measures, source of primary care, and comorbidities. We also inquired about attitudes and risk perceptions regarding CRC, knowledge about CRC screening, and other frequent health concerns. Logistic regression identified predictors of screening compliance. Results. Four hundred six women (52% of women contacted, average age 63 years) provided responses. Sixty-five percent had completed some form of CRC screening in the past 5 years. Four factors were positively related to CRC screening: increasing age [adjusted odds ratio (AOR) = 1.05, (95% CI 1.03, 1.08)], perceived CRC risk [AOR = 1.92, (95% CI 1.19, 3.16)], belief that screening reduces CRC risk (AOR = 2.49, 95% CI 1.45, 4.27), and belief in following screening guidelines [AOR = 4.95, (95% CI 2.07, 11.90)]. Belief that screening would be painful [AOR = 0.52, (95% CI 0.32, 0.84)] was inversely related. Conclusions. Fear about CRC screening-related pain was the strongest impediment to screening, whereas positive attitudes about the value of CRC screening were strongly related to compliance. Addressing fears and emphasizing positive messages by providers should be included in programs promoting CRC screening in women.