For Fecal Occult Blood Test Research Articles

A Scoring Method to Prioritize Fecal Occult Blood Testing as a First Step in Colorectal Cancer Screening in Resource-Limited Settings.

This study aims to develop a scoring method that can be used by primary care physicians from remote areas or resource-limited settings to estimate the need for fecal occult blood testing (FOBT) as a first step in colorectal cancer screening. This method relies on several modifiable risk factors that can influence a positive FOBT, an indication of the presence of colorectal polyps, or even colorectal cancer. The scoring method considers, besides the age and gender of the patient, the body mass index (BMI), smoking status, and the diagnoses of diabetes mellitus (type 2 diabetes), dyslipidemia, and hypertension. It does not need any paraclinical exams, which is an advantage when access or material resources are limited. The retrospective study was spread over forty-three months, respectively, from October 2019 to April 2023, and included 112 patients. The score that we designed is a numerical value between 0 and 7. The values between 0 and 3 represent a smaller risk of a positive FOBT (9.68%), values 4 and 5 represent a medium risk (14.75%), while values 6 and 7 represent a greater risk (40%). Using this score, a physician can determine if a patient has a greater risk and recommend it to prioritize taking a FOB test.

Association between atherogenic index of plasma and colorectal neoplasms in patients with hypertension.

Association between atherogenic index of plasma and colorectal neoplasms in patients with hypertension.

Characteristics and outcomes for fecal occult blood test (FOBT) screen detected (SD) versus non-screen detected (NSD) colorectal cancer (CRC).

42 Background: FOBT based screening for CRC has been shown in multiple studies to reduce CRC mortality. Beyond the well described earlier stage at diagnosis, other characteristics of SD cancers have not been well studied. Since 2006 Australians aged 50-74 have regularly been mailed an immunochemical FOBT via the National Bowel Cancer Screening Program (NBCSP), with participation rate stable around 40%. Methods: To explore patient (pt), tumour, treatment and outcome data for SD compared to NSD, we examined a multi-site CRC database where prospectively collected data includes method of detection. Categories include SD via the NBCSP, cases that were symptomatic or incidentally found on imaging (NSD), and cases detected by screening outside the NBCSP (OSD). High risk features for Australian Clinicopathological Staging System (ACPS) Stage B included emergency presentation, T4, lymphovascular invasion and <12 lymph nodes examined. Results: Of 6969 registry pts diagnosed 06/2006–06/2020, 4107 (59%) were aged 50-74, including 473 (12%) SD, 3228 (79%) NSD and 406 (10%) OSD. SD versus NSD pts were younger (mean 62.4 v 64.2 years), had better ASA score (ASA 1-2: 79% v 66%, Odds Ratio [OR] 1.9, p<0.001), earlier stage at diagnosis (ACPS A/B/C/D = 38%/21%/28%/5% v 17%/29%/26%/21%, p<0.001), were more often left-sided (41% v 33%, OR 1.44, p<0.001) but less frequently located in the rectum (28% v 36% OR 0.70, p=0.001). There was no difference by gender. SD tumors were more often well/moderately differentiated (76% v 66%, OR 1.65, p<0.001) and less often mucinous (16% v 20%, OR 0.66, p=0.002). SD stage A tumours were more often T1 (66% v 43%, OR 0.36, p<0.001). SD stage B tumours were more often T3 (92% v 85%, OR 0.43, p=0.033), and had fewer high risk features (60% v 49%, OR 0.64, p=0.036). SD stage C pts had a similar rate of N2 disease (25% v 31%, p=0.20), but more often received adjuvant chemotherapy (96% v 86%, OR 3.6, p=0.002). De novo stage D and relapsed SD pts more often underwent metastatic resection (46% v 25%, OR 2.6, p<0.001). Relapse free survival (RFS) in stage A-C, progression free survival in stage D (PFS), and overall survival (OS) was superior for SD and is in Table. Conclusions: We show for the first time to our knowledge that SD CRCs have many distinct and favourable prognostic features that appear to be driving favourable stage based outcomes when compared to NSD patients. This prognostic data could inform adjuvant therapy decision making and surveillance strategies for SD CRC. [Table: see text]

Factors Associated with Cancer Screening Among Hopi Men.

Cancer screening rates remain low among American Indian men, and cancer screening behaviors and barriers to cancer screening among American Indian men are not well understood. This study evaluated cancer screening behaviors in 102 Hopi men who were 50years of age or older from the Hopi Survey of Cancer and Chronic Disease. Reported cancer screening frequencies were 15.7%, 45.1%, and 35.3% for fecal occult blood test (FOBT), colonoscopy, and prostate-specific antigen (PSA) test, respectively. Among men who reported having had a FOBT, 81.2% had the test more than 1year ago. Among men who reported a colonoscopy, 60.8% had colonoscopy within the past 3years. Similarly, among men who reported having had PSA, 72.3% had PSA within the past 3years. "No one told me" was the most common answer for not undergoing FOBT (33.7%), colonoscopy (48.2%), and PSA (39.4%). Men who reported having had a PSA or digital rectal exam were three times as likely to also report having a FOBT or colonoscopy (odds ratio [OR] 3.19, 95% confidence interval [CI]: 1.21-8.46). Younger age (< 65) was associated with reduced odds of ever having prostate cancer screening (OR 0.28, 95% CI: 0.10-0.77). Ever having colorectal cancer screening and previous diagnosis of cancer increased odds of ever having prostate cancer screening (OR 3.15, 95% CI: 1.13-8.81 and OR 5.28, 95% CI: 1.15-24.18 respectively). This study illustrates the importance of community cancer education for men to improve cancer screening participation.

Stages of Adoption for Fecal Occult Blood Test and Colonoscopy Tests for Colorectal Cancer Screening in Korea.

PurposeWhile colorectal cancer (CRC) is common in Asian countries, screening for CRC is not. Moreover, CRC screening behaviors in Asian populations remain largely unknown. The present study aimed to investigate the stages of adopting CRC screening in Korea according to screening modality.Materials and MethodsData were obtained from the 2014 Korean National Cancer Screening Survey, a cross-sectional survey that utilized nationally representative random sampling to investigate cancer screening rates. A total of 2,066 participants aged 50-74 years were included in this study. Chi-square test and multinomial logistic regressionwere applied to determine stages of adoption for fecal occult blood test (FOBT) and colonoscopy and factors associated with each stage.ResultsOf 1,593 participants included in an analysis of stage of adoption for FOBT, 36% were in action/maintenance stages, while 18%, 40%, and 6% were in precontemplation, contemplation, and relapse/relapse risk stages, respectively. Of 1,371 subjects included in an analysis of stage of adoption for colonoscopy, 48% were in action/maintenance stages, with 21% in precontemplation, 21% in contemplation, and 11% in relapse/relapse risk stages. Multinomial logistic regression highlighted sex, household income, place of residency, family history of cancer, having private cancer insurance, smoking status, alcohol use, and regular exercise as being associated with stages of adoption for FOBT and colonoscopy.ConclusionThis study outlines the distributions of stages of adoption for CRC screening by screening modality. Interventions to improve screening rates should be tailored to individuals in particular stages of adoption for CRC screening by modality.

Two sides of the coin: A qualitative study of patient and provider perspectives on colorectal, breast and cervical cancer screening in a low-income Asian community

Objectives: Patient and provider barriers to cancer screening in disadvantaged Asian populations are understudied. We conducted a qualitative study of attitudes to screening for colorectal, cervical and breast cancer within low-income communities in Singapore. Methods: Interviewers elicited perceptions of barriers/enablers to cancer screening amongst patients eligible for fecal occult blood test (FOBT)/Pap smear/mammograms, and providers serving these low-income communities. Interview transcripts were analyzed thematically using established qualitative methodology. Results: Twenty patients and nine providers were interviewed. Patient and provider comments were grouped into seven content areas: primary care characteristics (PCC), procedural issues, knowledge, costs, priorities, attitudes, and information sources. For FOBT, the most frequently mentioned content areas were knowledge (61.2%) and attitudes (16.9%) for patients, and knowledge (19.5%) and PCC (18.6%) for providers. For Pap smears, it was knowledge (23.6%) and costs (20.5%) for patients, and PCC (33.8%) and knowledge (19.1%) for providers. For mammograms, it was knowledge (41.4%) and sources of information (15.9%) for patients, and knowledge (28.8%) and procedural issues (19.2%) for providers. Conclusion: While PCC, knowledge and costs were the main contributors as perceived by physicians, knowledge and attitudes were the biggest barriers from patients’ perspectives. Differences in perceptions of cancer screening exist between low-income patients and providers serving them.

Abstract B65: Colorectal cancer screening in nonadherent black Americans

Abstract Background: Compared with other racial groups, Black Americans have higher incidence and mortality from colorectal cancer (CRC) and lower screening rates. Theory-based tailored interventions to increase screening are more likely to be successful, especially those tailoring on stage of adoption. The purpose of our study was to examine predictors of stage of adoption for fecal occult blood testing (FOBT) and colonoscopy screening among non-adherent Black Americans. Methods: We analyzed baseline data from 817 Black primary care patients enrolled in a randomized clinical trial. Participants were categorized into precontemplation, contemplation, or preparation groups. Predictor variables examined included: demographics (age, gender, education, employment, income, health insurance, and clinical site), clinical variables (body mass index, family history of CRC, and personal history of cancer), CRC health beliefs and knowledge (perceived risk, perceived benefits, perceived barriers, self-efficacy, cancer fatalism, and knowledge), and social support (marital status, family/friend encouragement, and doctor recommendation). Hierarchical modeling was used to identify significant predictors with p value equal to or less than 0.01. Results: Participants who: were older (OR = 1.04, p = .003); male (OR = 1.70, p = .007); seen at a VA site (OR = 2.80, p &amp;lt; .001); had greater perceived FOBT self-efficacy (OR = 1.59, p = .007), had family or friend encouragement of CRC testing (OR = 1.64, p = .004), and had a provider recommendation for FOBT (OR = 2.05, p &amp;lt; .001) had higher odds of being at a more advanced stage for FOBT (closer to action). Participants with a personal history of cancer (OR = 0.37, p = .002) and with greater perceived FOBT barriers (OR = 0.79, p = .042) had higher odds of being at an earlier stage of adoption for FOBT (away from action). Higher perceived colonoscopy benefits (OR = 1.56, p &amp;lt; .001); higher perceived colonoscopy self-efficacy (OR = 1.66, p &amp;lt; .001); family or friend encouragement of CRC tests (OR = 1.71, p = .001), and a doctor recommendation for colonoscopy (OR = 2.47, p &amp;lt; .001) had higher odds of being at a more advanced stage for colonoscopy. Compared to participants with incomes less than $15,000, those with incomes greater than $30,000 (OR = 0.46, p = .005) had higher odds of being at an earlier stage of adoption for colonoscopy. Conclusion: Enhancing self-efficacy and encouragements from family and friends may be important components of interventions to promote CRC screening among Black Americans. Healthcare providers can utilize knowledge of the characteristics associated with stage of adoption to educate and motivate their primary care Black American patients to complete CRC screening tests. Citation Format: Hsiao-Lan Wang, Shannon M. Christy, Celette S. Skinner, Victoria L. Champion, Victoria L. Champion, Jeffrey K. Springston, Susan M. Perkins, Susan M. Perkins, Yan Tong, Connie Krier, Netsanet Gebregziabher, Susan M. Rawl, Susan M. Rawl. Colorectal cancer screening in nonadherent black Americans. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B65. doi:10.1158/1538-7755.DISP13-B65

OC-046 Do Patients With A Previous Normal Colonoscopy Within The United Kingdom Bowel Cancer Screening Program Who Subsequently Have A Positive Fobt Require Repeat Colonoscopy?

IntroductionPatients within the UK Bowel Cancer Screening Programme (BCSP) who have a normal colonoscopy are re-invited invited for Faecal Occult Blood test (FOBt) on a 2-yearly interval. If FOBt is...

Tu1022 Do Patients With a Previous Normal Colonoscopy Within the United Kingdom Bowel Cancer Screening Program Who Subsequently Have a Positive FOBT Require Repeat Colonoscopy?

Introduction Patients within the UK Bowel Cancer Screening Programme (BCSP) who have a normal colonoscopy are re-invited invited for Faecal Occult Blood test (FOBt) on a 2-yearly interval. If FOBt is positive, they are invited to have a repeat colonoscopy. The general polyp ‘miss rate’ is up to 22% in colonoscopy. Factors contributing to this include poor bowel preparation, rapid withdrawal time and endoscopist inexperience. However, endoscopists within the BCSP are highly skilled and selected following a rigid assessment process and poor bowel preparation is rare. Therefore, we hypothesised that patients who have previously had a normal colonoscopy within the BCSP who subsequently have a positive FOBt are unlikely to have a high-risk polyp or bowel cancer. Excluding these patients may avoid unnecessary invasive investigations and reduce the burden on an ever-stretching BCSP waiting list. We aimed to assess the detection of pathology in patients who have had a previous normal colonoscopy within the BCSP who subsequently have a positive FOBt and attend for repeat colonoscopy. Methods Patients with a previous normal colonoscopy between 2007–2010 who re-attended within the BCSP for colonoscopy after repeat positive FOBt were identified from the UCLH ‘in-house’ BCSP database. The results of the colonoscopy and outcomes were then scrutinised. Results A total of 1137 patients have had a normal colonoscopy to date within the BCSP and have subsequently been invited to have a repeat FOBt in 2 years time. From the patients who decided to participate in the second round of recruitment, 77 (6.7%) tested positive on FOBt and were invited for repeat colonoscopy. 8 declined another procedure. 6 patients (8%) had low risk adenomas (range 3–6 mm in size, 4 in right colon, 1 in sigmoid and 1 in left colon), all of who were discharged back to 2-yearly FOBt. 3 patients (4%) had hyperplastic polyps, 2 (3%) had inflammatory bowel disease and 58 (85%) had normal examinations. No patients had bowel cancer identified on repeat colonoscopy. Conclusion No cases of bowel cancer were detected in FOBt positive patients who have previously undergone a normal colonoscopy within the BCSP. Only 8% of patients undergoing repeat colonoscopy had a low-risk adenoma detected mainly from the right colon. Discharging patients with a normal colonoscopy in the BCSP from further screening would reduce pressure on endoscopy screening units and any potential morbidity associated with the procedure. From this study, excluding such patients could have avoided 20 colonoscopy screening lists (approximately 80 procedures) over 3 years in our unit. If findings are similar in other centres, current national guidelines should be changed. Disclosure of Interest None Declared.

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.

Improving Colorectal Cancer Screening in Family Medicine: An Oklahoma Physicians Resource/Research Network (OKPRN) Study

The purpose of this study was to describe colorectal cancer screening (CRCS) practices across a variety of primary care clinics and identify the methods used by primary care physicians (PCPs) with higher rates of CRCS ("exemplars"). Physician questionnaires, structured interviews, medical record abstractions, and practice observations were conducted for 48 PCPs in 25 practices within a regional practice-based research network followed by secondary in-depth interviews to further investigate the practices of PCPs in the top quartile of CRCS rates ("exemplars"). We abstracted 3596 medical records (mean of 75 records per PCP). Overall, exemplars had higher CRCS rates (median, 57.2% vs. 27.6%; P < .001). Patients of exemplars had higher screening rates for fecal occult blood testing (FOBT) and colonoscopy but not for flexible sigmoidoscopy or double-contrast barium enemas. Exemplars adopted few of the system-based innovations proposed by researchers to improve CRCS. Colonoscopy was promoted as the preferred CRCS method. FOBT was recommended for patients who could not afford or did not want colonoscopy. Flexible sigmoidoscopy or barium enemas were rarely recommended. Exemplars used brief CRCS promotion scripts that informally paralleled theory-driven counseling techniques. Experienced PCPs use brief CRCS promotion scripts including counseling techniques that improve CRCS performance. Future research should be directed toward whether these techniques can be used to create an intervention aimed at PCPs to improve CRCS.

What influences the decision to participate in colorectal cancer screening with faecal occult blood testing and sigmoidoscopy?

IntroductionUptake is an important determinant of the effectiveness of population-based screening. Uptake of colorectal cancer (CRC) screening generally remains sub-optimal. AimTo determine factors influencing the decision whether to participate or not among individuals invited for faecal occult blood test (FOBT) or flexible sigmoidoscopy (FS) screening. MethodsA questionnaire was sent to a stratified random sample of individuals aged 50–74, previously invited for a randomised CRC screening trial offering FOBT or FS, and a reference group from the same population not previously invited (screening naïve group). The questionnaire assessed reasons for (non)-participation, individuals’ characteristics associated with participation, knowledge, attitudes and level of informed choice. ResultsThe response rate was 75% (n=341/452) for CRC screening participants, 21% (n=676/3212) for non-participants and 38% (n=192/500) for screening-naïve individuals. The main reasons for FOBT and FS participation were acquiring certainty about CRC presence and possible early CRC detection. Anticipated regret and positive attitudes towards CRC screening were strong predictors of actual participation and intention to participate in a next round. The main reason for non-participation in FOBT screening was lack of abdominal complaints. Non-participation in FS screening was additionally influenced by worries about burden. Eighty-one percent of participants and 12% of non-participants made an informed choice on participation. ConclusionOnly 12% of non-participants made an informed choice not to participate. These results imply that governments and/or organizations offering screening should focus on adequately informing and educating target populations about the harms and benefits of CRC screening. This may impact uptake of CRC screening.

An Analysis of Colorectal Cancer Screening Behavior among Overweight and Obese Participants in a National Survey

Purpose: To determine the relationship between being overweight or obese and being up-to-date with CRC screening. Methods: We used the 2007 Health Information National Trends Survey (HINTS) to evaluate participants' compliance to CRC screening guidelines for fecal occult blood test (FOBT) and endoscopy (sigmoidoscopy or colonoscopy). Our analytic cohort included 4,234 respondents without a personal history of CRC who were at least 50 years old, reported their current weights and heights and answered questions regarding their use of CRC screening modalities. We used logistic regression analyses to examine the association of being overweight or obese with being current with CRC screening (FOBT within one year, sigmoidoscopy within five years, or colonoscopy within 10 years). We used survey weights and variance estimation procedures to account for the complex survey design. We calculated odds ratios (OR) and 95% confidence interval (CI). Results: The mean age of participants was 65.1 years, 59.6% female, 81.6% white, 8.6% black, 92.8 % had health insurance and 65.9% were overweight or obese. Overall, 65.3% of participants were up-to-date with CRC screening regardless of the screening modality. After adjusting for age, sex, income, health insurance, marital status and education level, BMI was not associated with being up-to-date with CRC screening (Table).Table: Up to date with CRC screening by modalityConclusion: Colorectal cancer screening compliance does not explain the greater risk of CRC associated with being overweight or obese. Maintenance of healthy weight should be recommended for all.

OC-116 Bowel screening wales—first round report

IntroductionThis report describes the first round of Bowel Screening Wales (BSW). It is the first overview showing the entire performance of the national bowel screening programme in Wales.MethodsThe first round...

A novel, cost-effective strategy for the screening of colorectal cancer with higher patient compliance.

407 Background: Routine screening methods for colorectal cancer (CRC) have poor patient compliance and low sensitivity for early stages. The sensitivity rates are 19, 71, 76, and 83% for Fecal Occult Blood test (FOBT), stool DNA test, colonoscopy/sigmoidoscopy, and double-contrast barium enema; respectively. Biological markers have also been tested including CEA (sensitivity of 38.7%); however, its utility in CRC screening is limited due to low sensitivity. Onko-Sure is an FDA-cleared blood test for monitoring of CRC treatment/recurrence. It measures the accumulation of Fibrin/Fibrinogen Degradation products in the serum using anti-DR-70 antibody. The objective was to determine whether DR-70 and CEA combination can improve the sensitivity such that it can be used as a cost-effective alternative to current screening methods yet with a higher patient compliance. Methods: A total of 564 serum samples were retrospectively obtained from a serum bank in two arms: confirmed healthy control (n=298) and biopsy-confirmed CRC (n=266) groups. The samples were tested for DR-70 and CEA. Results: The results showed sensitivity of 58.2% and specificity of 59.83% for DR-70 and CEA combined. The sensitivity for the combined test was 55.5% higher than that of CEA alone. A consistent improvement of sensitivity for the combined usage relative to CEA alone was observed with an increase of 73%, 108%, 58% and 18% in CRC stage I, II, III and IV; respectively. The sensitivity of the combined test was 48%, 47%, 57% and 98% for stages I, II, III and IV. Conclusions: Combining DR-70 and CEA tests showed a significant clinical advantage in CRC screening over using each marker alone. The sensitivity improvement was highest for stages I/II, which has important implications in patient treatment options, prognosis and survival rate due to this early detection. With a 3 times higher sensitivity for early stage CRC compared to using FOBT, this approach should improve the CRC early stage diagnosis. Such early stage detection is less likely using routine approaches for CRC screening because of low sensitivity and low patient compliance.

Preventive services in veterans in relation to disability

Veterans with disabilities are at an increased risk of secondary impairments and may have difficulty accessing preventive services; accessibility may differ between Veterans who do and do not receive care at Department of Veterans Affairs (VA) facilities. We used data from the 2003 and 2004 Behavioral Risk Factor Surveillance System surveys to evaluate associations between disability and receipt of preventive services in Veterans. Veterans with a disability were more likely to have received influenza vaccinations (VA users and nonusers), pneumococcal vaccinations (VA nonusers: p < 0.001; VA users: p = 0.073), weight management counseling (VA nonusers: p < 0.001; male VA users: p < 0.001), lower gastrointestinal (GI) endoscopy (VA nonusers: 50-64 yr, p = 0.03; VA users: ≥65 yr, p = 0.085), mammography (VA users: p = 0.097), and serum cholesterol screening (VA nonusers: p < 0.001). Receipt was similar by disability status for fecal occult blood test (FOBT), lower GI endoscopy (VA users: 50-64 yr), human immunodeficiency virus testing, and cervical cancer screening. For no measure was there significantly lower receipt in those with versus without a disability, although there was marginal evidence in VA nonusers for overall colorectal cancer screening (i.e., lower GI endoscopy or FOBT: p = 0.063). Among Veterans, having a disability did not appear to be a barrier to receiving appropriate preventive care.

Preferences for colorectal cancer screening tests and screening test use in a large multispecialty primary care practice

The purpose of this study was to identify factors associated with colorectal cancer (CRC) screening test preference and examine the association between test preference and test completed. Patients (n = 1224) were 50-70 years, at average CRC risk, and overdue for screening. Outcome variables were preference for fecal occult blood test (FOBT), colonoscopy (COL), sigmoidoscopy (SIG), or barium enema (BE), measured by telephone survey, and concordance between test preference and test completed assessed using medical records. Thirty-five percent preferred FOBT, 41.1% COL, 12.7% SIG, and 5.7% BE. Preference for SIG or COL was associated with having a physician recommendation, greater screening readiness, test-specific self-efficacy, greater CRC worry, and perceived pros of screening. Preference for FOBT was associated with self-efficacy for doing FOBT. Participants who preferred COL were more likely to complete COL compared with those who preferred another test. Of those screened, only 50% received their preferred test. Those not receiving their preferred test most often received COL (52%). Lack of concordance between patient preference and test completed suggests that patients' preferences are not well incorporated into screening discussions and test decisions, which could contribute to low screening uptake. Physicians should acknowledge patients' preferences when discussing test options and making recommendations, which may increase patients' receptivity to screening.

Trends in colorectal cancer test use among vulnerable populations in the United States.

Evaluating trends in colorectal cancer (CRC) screening use is critical for understanding screening implementation, and whether population groups targeted for screening are receiving it, consistent with guidelines. This study examines recent national trends in CRC test use, including among vulnerable populations. We used the 2000, 2003, 2005, and 2008 National Health Interview Survey to examine national trends in CRC screening use overall and for fecal occult blood test (FOBT), sigmoidoscopy, and colonoscopy. We also assessed trends by race/ethnicity, educational attainment, income, time in the United States, and access to health care. During 2000 to 2008, significant declines in FOBT and sigmoidoscopy use and significant increases in colonoscopy use and in the percentages of adults up-to-date with CRC screening occurred overall and for most population subgroups. Subgroups with consistently lower rates of colonoscopy use and being up-to-date included Hispanics; people with minimal education, low income, or no health insurance; recent immigrants; and those with no usual source of care or physician visits in the past year. Among up-to-date adults, there were few subgroup differences in the type of test by which they were up-to-date (i.e., FOBT, sigmoidoscopy, or colonoscopy). Although use of CRC screening and colonoscopy increased among U.S. adults, including those from vulnerable populations, 45% of adults aged 50 to 75-or nearly 35 million people-were not up-to-date with screening in 2008. Continued monitoring of CRC screening rates among population subgroups with consistently low utilization is imperative. Improvement in CRC screening rates among all population groups in the United States is still needed.

Primary care physician compliance with colorectal cancer screening guidelines

To assess self-reported compliance to colorectal cancer (CRC) screening guidelines among primary care physicians (PCPs) and to assess physician and practice characteristics associated with reported compliance. Survey data from 984 PCPs in Arizona were used. Self-reported CRC screening practices, recommendations, and compliance with guidelines were assessed. Physician and practice characteristics associated with guideline compliance were also evaluated. While 77.5% of physicians reported using national screening guidelines, only 51.7% reported recommendations consistent with the guidelines. Younger physicians were significantly more likely to report compliance with screening guidelines (OR = 1.50, 95% CI = 1.07-2.10) as were female clinicians (OR = 1.46, 95% CI = 1.11-1.92). Physicians practicing in solo (OR = 0.33, 95% CI = 0.19-0.58), group (OR = 0.36, 95% CI = 0.21-0.62), or community health centers (OR = 0.37, 95% CI = 0.17-0.81) were significantly less likely to report following guidelines as compared to those in academic practice. Guideline compliance was higher for fecal occult blood test (FOBT) (65.0%) than colonoscopy (56.7%); overuse of screening for these modalities was reported among 34.4% of physicians. PCPs are not adequately following CRC screening guidelines. Further studies are needed to clarify the reasons for this lack of compliance, especially as guidelines become more complex.

Trends in self-reported health care provider recommendations for colorectal cancer screening by race

Objective To examine whether a racial difference exists in self-reported recommendations for colorectal cancer screening from a health care provider, and whether this difference has changed over time. Method Secondary analysis of the 2002, 2004, 2006, and 2008 Maryland Cancer Surveys, cross-sectional population-based random-digit-dial surveys on cancer screening. Participants were 11,368 White and 2495 Black Maryland residents age ≥ 50 years. Results For each race, recommendations for colonoscopy/sigmoidoscopy increased over time (67%–83% for Whites, 57%–74% for Blacks; p < 0.001 for both), but the race difference remained approximately 10% at each survey. Among respondents without a colonoscopy in the last 10 years (n = 5081), recommendations for fecal occult blood test (FOBT) in the past year decreased over time for Whites (37%–24%, p < 0.001) and for Blacks (36–28%, p = 0.05), with no difference by race in any year. In multivariable analysis, the effect of race on the odds of reporting a provider recommendation did not vary significantly across time for either test (p = 0.80 for colonoscopy/sigmoidoscopy, p = 0.24 for FOBT for effect modification by year). Conclusion Whites were more likely than Blacks to report ever receiving a provider recommendation for colonoscopy/sigmoidoscopy. Although the proportion of patients receiving recommendations for colonoscopy/sigmoidoscopy increased over time, the gap between races remained unchanged.