Need For Colorectal Cancer Screening Research Articles

Abstract A012: Perceptions about the need for colorectal cancer screening among male refugees in Salt Lake City

Abstract Background: Colorectal Cancer (CRC) disproportionately affects Blacks in the United States (US) with an incidence rate >20% compared with Whites. In addition, Blacks are diagnosed at an earlier age and with more advanced disease. The population of migrants from Africa and the Middle East increased about four-fold over the past three decades. Therefore, increasing the uptake of CRC screening in this population may be critical in reducing the disparities in cancer-related morbidity and mortality in the US in the future. This study was therefore designed to elicit the perceptions of immigrants about the need for CRC screening. Methods: Twenty-three willing participants who identified as refugees from Africa or the Middle East who arrived within the past 2 years were recruited into three Focus Group Discussion (FGD) sessions in Salt Lake City. The discussions were audio-taped, transcribed and coded using the Dedoose software. Inter-observer variability was 74%. Results: Nineteen respondents (82%) reported awareness of the existence of CRC screening possibilities. Ten (43%) indicated that they will be willing to do the test if readily offered. Five major themes were identified: (1) Mistrust- Distrust of the system due to unfulfilled promises as refugees (2) Fear- fear of cancer based on past experiences (3) Fatalism-the belief that screening cannot lead to cure of cancer and (4) Doubts- doubts about whether Western culture can truly manage cancer. Conclusion: Perceptions about the need for CRC screening are accompanied by myths based on past experiences. There is also a need to explore targeted CRC prevention education with culture or religion specific inputs to improve CRC screening uptake among this population. Citation Format: Olanrewaju Onigbogi, Kebba Kah. Perceptions about the need for colorectal cancer screening among male refugees in Salt Lake City [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A012.

Development of a Computer-Tailored Intervention/Decision Aid To Increase Colorectal Cancer Screening in Health Systems.

BackgroundNon-compliance with scheduled colonoscopy is common among patients, especially in underserved populations. High no-show and late cancelation rates result in wasted resources, increased costs, and missed opportunities for colorectal cancer (CRC) screening. Among the barriers to colonoscopy is a lack of knowledge about the benefits, fears, and limited time for patient counseling.MethodologyWe produced a digital video disc and a website program to enhance awareness about CRC screening and address patient barriers in a population with low screening adherence.ResultsPatients can be educated via an interactive computer-tailored intervention with both DVD and web versions. It details the benefits and need for CRC screening, different methods of screening, and addresses patient-related barriers.ConclusionsPatient education is crucial to increase CRC screening among eligible individuals. Because online engagement is affected by attention, interest, and affect, content should be concise but comprehensive.

Early detection of colorectal neoplasia: application of a blood-based serological protein test on subjects undergoing population-based screening.

Blood-based biomarkers used for colorectal cancer screening need to be developed and validated in appropriate screening populations. We aimed to develop a cancer-associated protein biomarker test for the detection of colorectal cancer in a screening population. Participants from the Danish Colorectal Cancer Screening Program were recruited. Blood samples were collected prior to colonoscopy. The cohort was divided into training and validation sets. We present the results of model development using the training set. Age, sex, and the serological proteins CEA, hsCRP, TIMP-1, Pepsinogen-2, HE4, CyFra21-1, Galectin-3, ferritin and B2M were used to develop a signature test to discriminate between participants with colorectal cancer versus all other findings at colonoscopy. The training set included 4048 FIT-positive participants of whom 242 had a colorectal cancer. The final model for discriminating colorectal cancer versus all other findings at colonoscopy had an AUC of 0.70 (95% CI: 0.66-0.74) and included age, sex, CEA, hsCRP, HE4 and ferritin. The performance of the biomarker signature in this FIT-positive screening population did not reflect the positive performance of biomarker signatures seen in symptomatic populations. Additional biomarkers are needed if the serological biomarkers are to be used as a frontline screening test.

Barriers of colorectal cancer screening test among adults in the Saudi Population: A Cross-Sectional study.

Colorectal cancer (CRC) is the third most common cancer and the second most common cause of cancer death worldwide. CRC can be completely cured if detected at an early stage with screening. However, many barriers to screening have been reported. This study aimed to identify the potential barriers to CRC screening among the Saudi population aged ≥45years. A cross-sectional study of randomly selected adults (aged ≥45years) attending primary care clinics at KKUH in Saudi Arabia was conducted. A self-administered questionnaire was used to collect data. A total of 448 participants were included. In general, the most commonly reported barrier to CRC screening was a lack of physician recommendation (77.1%). Moreover, fear of painful colonoscopy procedures and a lack of knowledge regarding the availability of the fecal occult blood test (FOBT) were reported by 51.6% and 57.8% of patients, respectively. Significant gender differences were observed, with females reporting more barriers to CRC screening than males (general barriers [p<0.001] and colonoscopy-specific barriers [p=0.003]). Participants who had not undergone any previous CRC screening reported significantly more barriers compared to those who had undergone a previous CRC screening (general barriers [p=0.015], colonoscopy-specific barriers [p=0.006], and FOBT specific barriers [p=0.024]). Because a lack of physician recommendation was the most commonly reported general barrier, we recommend that physicians emphasize the need for CRC screening, particularly to high-risk patients. Extensive campaigns and programs must be launched to raise awareness about the importance of screening for CRC. Additionally, gender-specific strategies need to be formulated to promote CRC screening in females.

Realizing the need for colorectal cancer screening in Pakistan.

Realizing the need for colorectal cancer screening in Pakistan.

Colorectal Cancer Screening in Black Men: Recommendations for Best Practices

Screening for colorectal cancer has been demonstrated to reduce colorectal cancer mortality. Blacks have a higher mortality from this malignancy, particularly men, yet screening rates in this population are often found to be lower than in whites. A modest literature demonstrates effective interventions that can increase screening rates in blacks; however, results are not consistent and ongoing work is required. Most work has not addressed specific barriers to screening in black men. Given the lack of studies on black men only, this study evaluated the state of research in the black population using a PubMed search. The authors provide commentary that proposes increased (1) state and local government support for collaborative programs with healthcare organizations, including patient navigation; (2) augmented community-organizing efforts to generate more attention to the need for colorectal cancer screening in the black community, with a focus on black men; and (3) federal research funding to promote investigation into new interventions and evaluation of existing ones. Specific recommendations for black men include lowering the screening age to 45years, increasing access to health care, the use of patient navigators, and improved reporting and monitoring of colorectal cancer screening rates. SUPPLEMENT INFORMATION: This article is part of a supplement entitled African American Men's Health: Research, Practice, and Policy Implications, which is sponsored by the National Institutes of Health.

Use of Colorectal Cancer Screening Among People With Mobility Disability.

We aimed to assess use of colorectal cancer screening (CRCS) as per United States Preventive Task Force guidelines among people with mobility disability using a nationally representative data set. Individuals with mobility disability have decreased access to health care services, but the impact of mobility disability on CRCS has not been investigated. Data from the 2013 National Health Interview Survey were used to estimate sociodemographic characteristics of adults with mobility disability, prevalence of CRCS, and odds of CRCS given mobility disability among Americans aged 50 to 75. In total, 56.8% of the entire sample (n=81,953,585) were up-to-date with CRCS. Mobility disability was not associated with CRCS status on univariable analysis but was significantly associated after adjustment for covariates including age and comorbidities, with an inverse relationship between the degree of mobility disability and odds of CRCS. Odds ratio for CRCS given progressively severe disability were 0.78 (0.66 to 0.93), 0.71 (0.53 to 0.94), 0.65 (0.31 to 1.19). The present study indicates reduced CRCS among people with mobility disability and highlights the need for CRCS to be especially targeted toward this group. Future research should identify the specific systemic, social, and/or physical barriers to CRCS for this subgroup so that they can be addressed.

High cancer mortality for US-born Latinos: evidence from California and Texas

BackgroundLatinos born in the US, 36 million, comprise 65% of all US Latinos. Yet their cancer experience is nearly always analyzed together with their foreign-born counterparts, 19 million, who constitute a steady influx of truly lower-risk populations from abroad. To highlight specific cancer vulnerabilities for US-born Latinos, we compare their cancer mortality to the majority non-Latino white (NLW) population, foreign-born Latinos, and non-Latino blacks.MethodsWe analyzed 465,751 cancer deaths from 2008 to 2012 occurring among residents of California and Texas, the two most populous states, accounting for 47% of US Latinos. This cross-sectional analysis, based on granular data obtained from death certificates on cause of death, age, race, ethnicity and birthplace, makes use of normal standardization techniques and negative binomial regression models.ResultsWhile Latinos overall have lower all-cancers-combined mortality rates than NLWs, these numbers were largely driven by low rates among the foreign born while mortality rates for US-born Latinos approach those of NLWs. Among Texas males, rates were 210 per 100,000 for NLWs and 166 for Latinos combined, but 201 per 100,000 for US-born Latinos and 125 for foreign-born Latinos. Compared to NLWs, US-born Latino males in California had mortality rate ratios of 2.83 (95% CI: 2.52–3.18) for liver cancer, 1.44 (95% CI: 1.30–1.61) for kidney cancer, and 1.25 (95% CI: 1.17–1.34) for colorectal cancer (CRC). Texas results showed a similar site-specific pattern.ConclusionsSpecific cancer patterns for US-born Latinos, who have relatively high cancer mortality, similar overall to NLWs, are masked by aggregation of all Latinos, US-born and foreign-born. While NLWs had high mortality for lung cancer, US-born Latinos had high mortality for liver, kidney and male colorectal cancers. HCV testing and reinforcement of the need for CRC screening should be a priority in this specific and understudied population. The unprecedented proximity of overall rates between NLWs and US-born Latino populations runs counter to the prevailing narrative of Latinos having significantly lower cancer risk and mortality. Birthplace data are critical in detecting meaningful differences among Latinos; these findings merit not only clinical but also public health attention.

Predictors of colorectal cancer screening awareness among people working in a hospital environment

BackgroundCompliance rates for colorectal cancer (CRC) screening are much lower than those desired. Appropriate information on CRC risks and screening methods is supposed to stimulate motivation for screening. We aimed to identify parameters associated with the decision for CRC screening and colonoscopy in a population expected to have high awareness of disease prevention.MethodsIn a single-center, cross-sectional study, we used an anonymous questionnaire (AQ) to record the demographics, habits and screening behavior for cancers and other common diseases of all employees older than 50 years in our hospital.ResultsAmong 287 active employees, 83% (n=237) answered the AQ (age 55±4 years). Thirty percent (n=70) underwent colonoscopy while 17% (n=40) underwent CRC screening (39/40) colonoscopy). Comparatively, among women 97% had a Pap-smear, 92% a mammography, while among men 83% had been tested for serum prostate-specific antigen. Age, male sex, alcohol consumption and university education correlated positively with CRC screening (P<0.05 for all). After multivariate analysis, university education remained an independent determinant of CRC screening (OR 2.488, 95%CI 1.096-5.648; P=0.029). Among subjects who had not undergone colonoscopy in the past, ignorance of the need for CRC screening (OR 0.360, 95%CI 0.150-0.867; P=0.023) and indifference to undergo such a procedure (OR 0.188, 95%CI 0.066-0.537; P=0.002) were independent determinants for not planning a future screening colonoscopy.ConclusionsEducation was the most important factor in the decision to undergo CRC screening. Colonoscopy was the preferred screening method. Ignorance of and indifference to CRC risks were the major obstacles for a future screening colonoscopy.

Acromegaly: is there a need for colorectal cancer screening?

Acromegaly: is there a need for colorectal cancer screening?

Free Fecal Immunochemical Test Disbursement in Eight Family Physician Offices

Colorectal cancer (CRC) is the second leading cause of cancer death. CRC screening with a fecal immunochemical test (FIT) is important as occult blood may be detected. To offer Iowa Research Network members in family physician offices the opportunity to provide FITs at no charge to patients in need and determine how many of the tests would be handed out to patients and how many would be returned to the office. Eight family physician offices agreed to participate and 50 two-day FITs were provided, potentially providing 400 patients a CRC screening test. One hundred and eighty (45%) of the 400 FITs were handed out to patients. Of the 92 (51%) patients who returned at least one card, 77 (84%) had negative results, 13 (14%) were positive, and 2 (2 %) were indeterminate. Of 13 patients with a positive result, 11 (85%) had a follow-up colonoscopy. Providing 400 FITs at no charge to the offices was an expensive endeavor. Implementing this forced a change in office routine and the type of fecal occult blood test used. Less than half of the FITs were given out to patients and of those given out, about half of the patients returned a FIT. For those who returned FITs and had positive findings, 85% followed-up with a colonoscopy. Office nurses implementing the CRC screening need to be included in the planning of the type of fecal occult blood test used and receptive to the project.

Understanding colorectal screening behaviors and factors associated with screening in a community hospital setting.

Colorectal cancer (CRC) is the third most commonly diagnosed cancer and the second leading cause of cancer death in the United States. More than 2,000 Kentuckians are diagnosed with CRC annually, and more than 800 die from the disease. Little research has been conducted in Kentucky to better understand why individuals are not screened for CRC and what strategies might encourage them to do so. The purpose of this study was to evaluate the efficacy of educational materials mailed to participants supporting the need for CRC screening on the decision to complete screening post-hospital discharge. An additional focus was to identify the characteristics of individuals screened and not screened. A quasi-experimental study was conducted on 167 adult patients discharged from a 383-bed Magnet-designated hospital. An investigator-designed, semistructured telephone interview was conducted to collect data on research-based factors identified to influence CRC screening rates. Although not statistically significant, slightly more patients who remembered receiving educational materials in the mail completed screening. Future educational efforts should focus on the importance of screening and financial resource availability.

Increasing late stage colorectal cancer and rectal cancer mortality demonstrates the need for screening: a population based study in Ireland, 1994-2010.

BackgroundThis paper describes trends in colorectal cancer incidence, survival and mortality from 1994 to 2010 in Ireland prior to the introduction of population-based screening.MethodsWe examined incidence (National Cancer Registry Ireland (NCRI) and mortality (Central Statistics Office) from 1994 to 2010. Age standardised rates (ASR) for incidence and mortality have been calculated, weighted by the European standard population. Annual percentage change was calculated in addition to testing for linear trends in treatment and case fraction of early and late stage disease. Relative survival was calculated considering deaths from all causes.ResultsThe colorectal cancer ASR was 63.7 per 100,000 in males and 38.7 per 100,000 in females in 2010. There was little change in the ASR over time in either sex, or when colon and rectal cancers were considered separately; however the number of incident cancers increased significantly during 1994-2010 (1752 to 2298). The case fractions of late stage (III/IV) colon and rectal cancers rose significantly over time. One and 5 year relative survival improved for both sexes between the periods 1994-2008. Colorectal cancer mortality ASRs decreased annually from 1994-2009 by 1.8% (95% CI -2.2, -1.4). Rectal cancer mortality ASRs rose annually by 2.4% (95% CI 1.1, 3.6) and 2.8% (95% CI 1.2, 4.4) in males and females respectively.ConclusionsIncreases in late-stage disease and rectal cancer mortality demonstrate an urgent need for colorectal cancer screening. However, the narrow age range at which screening is initially being rolled-out in Ireland means that the full potential for reductions in late-stage cancers and incidence and mortality are unlikely to be achieved. While it is possible that the observed increase in rectal cancer mortality may be partly an artefact of cause of death misclassification, it could also be explained by variations in treatment and adherence to best practice guidelines; further investigation is warranted.

Recruiting patients into the CDC's Colorectal Cancer Screening Demonstration Program

In 2005, the Centers for Disease Control and Prevention (CDC) funded 5 sites as part of the Colorectal Cancer Screening Demonstration Program (CRCSDP) to provide colorectal cancer screening to low-income, uninsured, and underinsured individuals. Funded sites experienced unexpected challenges in recruiting patients for services. The authors conducted a longitudinal, qualitative case study of all 5 sites to document program implementation, including recruitment. Data were collected during 3 periods over the 4-year program and included interviews, document review, and observations. After coding and analyzing the data, themes were identified and triangulated across the research team. Patterns were confirmed through member checking, further validating the analytic interpretation. During early implementation, patient enrollment was low at 4 of the 5 CRCSDP sites. Evaluators found 3 primary challenges to patient recruitment: overreliance on in-reach to National Breast and Cervical Cancer Early Detection Program patients, difficulty keeping colorectal cancer screening and the program a priority among staff at partnering primary care clinics responsible for patient recruitment, and a lack of public knowledge about the need for colorectal cancer screening among patients. To address these challenges, site staff expanded partnerships with additional primary care networks for greater reach, enhanced technical support to primary care providers to ensure more consistent patient enrollment, and developed tailored outreach and education. Removing financial barriers to colorectal cancer screening was necessary but not sufficient to reach the priority population. To optimize colorectal cancer screening, public health practitioners must work closely with the health care sector to implement evidence-based, comprehensive strategies across individual, environmental, and systems levels of society.

Predictors of Colorectal Cancer Screening Variation Among Primary-Care Providers and Clinics

Colorectal cancer (CRC) screening is underutilized. To effect change, we must understand reasons for underuse at multiple levels of the health-care system. We evaluated patient, provider, and clinic factors that predict variation in CRC screening among primary-care clinics and primary-care providers (PCPs). We analyzed electronic medical record (EMR) data for 34,319 adults eligible for CRC screening, 19 clinics, and 97 PCPs in a large, academic physician group. Detailed data on potential patient, provider, and clinic predictors of CRC screening were obtained from the EMR. PCP perceptions of CRC screening barriers were measured via survey. The outcome was completion of CRC screening at the patient level. Multivariate logistic regression with clustering on clinics obtained adjusted odds ratios and 95% confidence intervals for potential predictors of CRC screening at each level. Seventy-one percentage of patients completed CRC screening. Variation in screening rates was seen among clinics (51-80%) and among PCPs (51-82%). Significant predictors of completing CRC screening were identified at all levels: patient (older age, white race, being married, primarily English-speaking, having commercial insurance plans vs. Medicare or Medicaid, and higher health-care resource utilization), provider (larger panel size of patients eligible for CRC screening), and clinic (hospital-owned, shorter distance to nearest optical colonoscopy center). Variation in CRC screening exists among primary-care clinics and providers within a single clinic. Predictors of variation can be identified at patient, provider, and clinic levels. Quality improvement interventions addressing CRC screening need to be directed at multiple levels of the health-care system.

Abstract A9: Patients’ perspectives on immunochemical fecal occult blood test (I-FOBT or FIT): Not your father's FOBT

Abstract Purpose: A promising strategy to increase colorectal cancer (CRC) screening includes the use of new generation high sensitivity-high specificity immunochemical fecal occult blood test (I-FOBT or FIT) among patients receiving primary care in Federally Qualified Health Centers (FQHC). This approach was recognized by the Tampa Bay Community Cancer Network (TBCCN) Community Network Program Center (CNPC) as a highly feasible method for impacting cancer health disparities in our community. Despite physician recommendations to increase screening uptake, finding effective ways to increase patients’ awareness about different types of CRC screening (CRCS) is needed. This study reports qualitative findings from focus groups with patients in FQHCs to inform the development of a low literacy DVD and photonovella booklet to prepare patients for provider discussions about CRCS, particularly I-FOBT use. Methods: Six focus groups were conducted with men and women, of diverse background (ages 50–75 years) with no diagnosis of CRC. In collaboration with our community partners who identified a need to increase CRCS and using community-based participatory research (CBPR) methodology to develop a focus group guide and recruitment materials, participants were recruited from partnering FQHCs in Hillsborough County, FL. The focus group guide assessed patients’ knowledge and perceptions about CRC and screening, particularly I-FOBT and colonoscopy, as well as participants’ views about in clinic CRCS preparatory education process and factors that impede CRCS uptake. All focus groups were audio taped, transcribed verbatim and reviewed by two independent coders. Thematic coding, using a crystallized-immersion framework was conducted. A combination of hand-coding and Atlas TI software were employed using content from the patient focus group guide as priori codes. Results: Thirty-nine patients participated in focus groups to date (51% male; 59% black; 36% white; 5% Hispanic/Latino; mean age = 56.18 years). Seventeen reported being up-to-date on CRCS per recommendations and 22 were not current. Consistent with previous studies, we found poor knowledge and awareness about CRC risks and different screening modalities. Commonly reported barriers included: 1) no doctor recommendation; 2) cost; 3) fear of the test or abnormal findings; and 4) a lack of symptoms. While all participants had heard of colonoscopy and traditional FOBT, very few were aware of I-FOBT. Concerns about colonoscopy included a dislike of the test prep and affordability. Most men reported feelings of embarrassment, personal invasion, and threatened masculinity regarding the colonoscopy procedure itself. Upon learning about I-FOBT the majority felt the test seemed to be simple, easy to do, and private. Most participants who had prior FOBT screening reported use of the older 3-card home test or office-based guaiac test. Reported limitations to the older version of FOBT included diet restrictions, dislike of “handling” one's own feces during sample collection and the complexity of multiple test applications. Doctor recommendation was the main reason participants completed CRCS tests. Conclusions: Our findings suggest patients’ overall receptivity to I-FOBT, and provide a basis for developing educational content for an intervention that addresses test specific barriers, and promotes the more patient-friendly IFOBT. Results also show support for a preparatory education intervention that will educate patients in clinic before their provider visit about the need for CRCS. Such preparatory materials are expected to enhance patients’ awareness about CRCS, facilitate patient-provider communication, and contribute to the overall uptake of CRCS. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A9.

Colorectal Cancer Screening and Surveillance in the Elderly Patient

Colorectal cancer (CRC) is the third leading cause of cancer-related deaths in the United States. Older age is associated with a rise in colorectal cancer and adenomas, necessitating the need for CRC screening in older patients. However, decisions about CRC screening and surveillance in older adults are often difficult and challenging. The decision requires an individualized assessment that incorporates factors unique to performing colonoscopy in older adults in order to weigh the risks and benefits for each patient according to their overall health and preferences. This review addresses the factors unique to colorectal cancer and performing colonoscopy in older adults that are relevant in weighing the risks and benefits of screening and surveillance in this population.

Programas de cribado del cáncer colorrectal en la población de riesgo medio en la Unión Europea y España

There is broad international consensus on the need for colorectal cancer screening in men and women aged 50 years old or older with no personal or familial history of adenoma or colorectal cancer. The main problem is the disagreement among the various screening guidelines on the best screening method. The European Union (2003) extended the recommendation of implanting colorectal cancer screening using the fecal occult blood test (FOBT) in the population aged between 50 and 74 years. Seventy percent of the member states are introducing a program but there is wide heterogeneity. In Spain, 2-yearly FOBT is recommended in the target population aged 50 to 69 years. Currently, three autonomous communities have developed pilot programs and are extending the program to the entire population. Many other communities have announced they will commence programs shortly.

A Population Based Study Examining Language as a Predictor of Colorectal Cancer Screening Among Overweight and Obese Hispanic Adults in the United States

Objective: Colorectal cancer (CRC) is one of the top two leading causes of cancer deaths in Hispanic/Latino adults living in the U.S., and CRC risk increases in people who are overweight. As the U.S. Hispanic population increases along with a growing prevalence of overweight and obesity, studies are needed to determine if overweight Hispanic adults suffer from disparities in their rates of CRC screening. Our study was able to examine the correlation between a preference for using the Spanish language and rates of screening for CRC using national survey data. Design: 4,730 Hispanic participants, > 50 years, with a BMI > 25 kg/m 2 from the 2006 Behavioral Risk Factor Surveillance System were stratified by survey language choice (English, n = 3,499; or Spanish, n = 1,231). Using adjusted logistic regression models, differences in receiving the recommended Fecal Occult Blood Test (F.O.B.T.) and/or either a colonoscopy or sigmoidoscopy were determined by language preference groups. Results: Men who chose surveys in Spanish were significantly less likely to have received F.O.B.T. (0.29 O.R.; 0.13-0.64 95% C.I.), sigmoidoscopy/colonoscopy (0.49 O.R.; 0.28-0.84 95% C.I.) or either test (0.46 O.R.; 0.27-0.79 95% C.I.) within the recommended time frames, compared to men choosing English. No significant differences were found among women. Conclusions: Findings suggest that men with an elevated BMI who choose Spanish to complete a survey are less likely to receive the recommended CRC screening. Public health programs designed to improve access to CRC screening need to target this population in order to reduce the morbidity and mortality related to colorectal cancer.

Factors Influencing Choices for Colorectal Cancer Screening Among Previously Unscreened African and Caucasian Americans: Findings from a Triangulation Mixed Methods Investigation

We investigated factors that influence choice of colorectal cancer (CRC) screening test and assessed the most- and least-preferred options among fecal occult blood testing (FOBT), flexible sigmoidoscopy, colonoscopy, and double contrast barium enema among adults with varied race, gender, and geographic region demographics. Mixed methods data collection consisted of 10 focus group interviews and a survey of the 93 focus group participants. Participants were >or=50 years of age and reported not having been screened for colorectal cancer in the last ten years. Analyses examined differences by race, gender, and geographic location. Participants had modest knowledge about CRC and there were fewer correct answers to knowledge questions by African Americans. Participants recognized value of early detection, and identified health symptoms and their doctor's recommendation as influential for obtaining CRC screening. They chose colonoscopy and FOBT as the most preferred tests, while barium enema was least preferred. The analysis revealed intra-group variations in preference, though there were no significant differences by race, gender, or location. Openness of discussing this sensitive topic, lack of knowledge about colorectal cancer and screening costs, and diversity of preferences expressed within study groups suggest the importance of patient-physician dialogue about colorectal cancer screening options. New approaches to promoting colorectal cancer screening need to explore methods to facilitate patients establishing and expressing preferences among the screening options.