Predictors Of Colorectal Cancer Screening Research Articles

Prevalence and predictors of colorectal cancer screening in the United States: evidence from the HINTS database 2018 to 2020.

The incidence of colorectal cancer (CRC) and CRC-related mortality among young adults (< 50years) has been on the rise. The American Cancer Society (ACS) reduced the CRC screening age to 45 in 2018. Few studies have examined the barriers to CRC screening among young adults. Analyses were conducted using data from 7,505 adults aged 45-75years who completed the 2018 to 2020 Health Information National Trends Survey. We examined the sociodemographic characteristics associated with CRC screening overall and by age group using separate multivariable logistic regression models. 76% of eligible adults had received screening for CRC. Increasing age, Black racial group [OR 1.45; 95% CI (1.07, 1.97)], having some college experience, a college degree or higher [OR 1.69; 95% CI (1.24, 2.29)], health insurance coverage [OR 4.48; 95% CI (2.96, 6.76)], primary care provider access [OR 2.48; 95% CI (1.91, 3.22)] and presence of a comorbid illness [OR 1.39; 95% CI (1.12, 1.73)] were independent predictors of CRC screening. Current smokers were less likely to undergo CRC screening [OR 0.59; 95% CI (0.40, 0.87)]. Among adults aged 50-64years, being of Hispanic origin [OR 0.60; 95% CI (0.39, 0.92)] was associated with a lower likelihood of CRC screening. CRC screening rates among adults 45-49years are low but are increasing steadily. Odds of CRC screening among Blacks is high which is encouraging while the odds among current smokers is low and concerning given their increased risk of developing CRC.

Uptake patterns and predictors of colorectal cancer screening among adults resident in Spain: A population-based study from 2017 to 2020.

Although population screening has improved the early diagnosis of colorectal cancer (CRC), most cases are diagnosed in symptomatic patients. This study aimed to estimate the prevalence and evolution over time of uptake patterns to fecal immunochemical test (FIT) as a screening test for CRC among individuals aged 50-69 in Spain, and to determine the predictive factors for uptake patterns to this type of screening based on sociodemographic, health, and lifestyle characteristics. A cross-sectional study with 14,163 individuals from the 2017 Spanish National Health Survey and the 2020 European Health Survey was performed, including as the main variable uptake pattern to FIT screening within the last 2 years, with which we analyzed sociodemographic factors, health status and lifestyle habits. 38.01% of participants had undergone FIT in the previous 2 years, and from 2017 to 2020, a significant increase in the uptake rate for CRC was observed (2017: 32.35%, 2020: 43.92%, p < 0.001). The positive predictors to FIT uptake pattern included factors such as being between 57 and 69 years, having a higher educational level or a higher social class, having at least one chronic illness, frequent contact with the primary care physician, alcohol consumption and physical activity, while immigration and smoking habit were negative predictors. In Spain, although the evolution of FIT uptake pattern over time is positive, the prevalence of FIT uptake is still low (38.01%), not reaching the level considered as acceptable in the European guidelines. Moreover, there are disparities in CRC screening uptake among individuals.

Predictors of Colorectal Cancer Screening among Average and High-Risk Saudis Population.

Colorectal cancer (CRC) screening intention is one of the most important elements influencing the longstanding effectiveness of community-based CRC screening programs. The primary purpose of this study is to generate and validate a predictive screening model that investigates the influence of Saudis’ demographics, CRC knowledge, and beliefs on intention to undergo CRC screening via fecal occult blood test (FOBT). Convenience sampling was used to recruit 600 average and high-risk participants from multiple primary health care centers in three major Saudi provinces. A valid and reliable self-administered online survey was used to collect data from March 2021 to October 2021. The final modified screening prediction model explained 57.35% of the variance in screening intention. Intention to screen was significantly influenced by seven factors in which the perceived barriers factor (β = −0.55, p < 0.001) was the strongest predictor. Those who had lower perceived barriers and greater levels of knowledge (β = 0.36, p < 0.001), health motivation (β = 0.35, p < 0.001), perceived benefits of screening (β = 0.35, p < 0.001), severity (β = 0.29, p < 0.001), and susceptibility (β = 0.28, p < 0.001) were more likely to become involved in screening practices. Health care practitioners and various media forms could benefit from the prediction model playing a significant role in raising awareness, reducing perceived barriers, and enhancing Saudi screening rates.

Predictors of Colorectal Cancer Screening Among African American Men Living with HIV.

African American men living with HIV are at high risk of colorectal cancer (CRC). Screening to detect CRC is associated with a reduced risk of CRC mortality. However, little is known about CRC screening predictors in this population. This study examined the relation of self-efficacy, a potential mediator of screening that interventions could target, to CRC screening. It also investigated several variables that might identify subpopulations of African American men non-adherent to CRC screening recommendations. We report a secondary analysis on baseline data from a randomized controlled trial of a health promotion intervention for African American men living with HIV. Before their intervention, they completed measures of CRC screening, self-efficacy, marital status, age, education, and adherence to physical activity guidelines and were assessed for obesity. A total of 270 African American men aged 45 to 88 (Mean = 55.07; SD = 6.46) living with HIV participated. About 30% reported CRC screening in the past six months. Multiple logistic regression revealed greater CRC screening self-efficacy and meeting physical activity guidelines were associated with receiving CRC screening. Obese men and men reporting higher education were less likely to report screening. Age and marital status were unrelated to screening. The results of this study suggest CRC screening rates may be low among African American men living with HIV, and interventions targeting self-efficacy may improve their screening uptake. Moreover, public-health efforts to increase screening should prioritize interventions with subpopulations of African American men living with HIV who are physically inactive and obese.

Response: Commentary: Predictors of Colorectal Cancer Screening in Two Underserved U.S. Populations: A Parallel Analysis.

Response: Commentary: Predictors of Colorectal Cancer Screening in Two Underserved U.S. Populations: A Parallel Analysis.

Commentary: Predictors of Colorectal Cancer Screening in Two Underserved U.S. Populations: A Parallel Analysis.

Commentary: Predictors of Colorectal Cancer Screening in Two Underserved U.S. Populations: A Parallel Analysis.

A Cross-sectional Study of Knowledge, Attitude and Barriers to Colorectal Cancer Screening among Cancer Survivors.

Introduction:Understanding behaviour of cancer survivors is imperative as they are at risk of recurrence or second cancers. Colorectal cancer (CRC) is one of the most common cancers globally. We aim to determine the uptake rate, barriers and predictors of CRC screening among cancer survivors. Methods:Within a public hospital in Singapore, 150 non-CRC survivors were enrolled. Questionnaire on knowledge, screening behaviour, motivators and barriers towards CRC screening was administered. Results:Majority were survivors of breast (69.3%), prostate (7.3%), endometrial (4%) and ovarian (4%) cancers. More than half had high knowledge scores for CRC symptoms, screening tests and risk factors. About a third had received physician’s recommendation on CRC screening. Approximately half had undergone screening. The most common barriers to CRC screening were lack of symptoms and physician’s recommendation. Cancer survivors with higher education, higher household income, family history and those who perceived “great need” or “some need” were more likely to have undergone screening (56.4% vs 30.6%, p=0.003; 62.2% vs 41.9%, p=0.022; 70.6% vs 45.1%, p=0.048; 70.8% vs 27.4%, p<0.001). Physician’s recommendation (76.4% vs 31.6%, p<0.001) and high CRC symptom knowledge (55.8% vs 34.5%, p=0.012) were associated with increased likelihood of screening.On multivariate analysis, physician’s recommendation, higher household income and survivors’ perceived need to undergo screening remained strong predictors for CRC screening (p<0.001; p=0.010; p<0.001). Conclusion:The uptake rate of CRC screening among non-CRC survivors was modest. Physicians need to be more active in discussing CRC screening with cancer survivors as part of the survivorship care plan.

Predictors of Colorectal Cancer Screening in Two Underserved U.S. Populations: A Parallel Analysis.

Despite declining colorectal cancer (CRC) incidence and mortality rates in the U.S., significant geographic and racial disparities in CRC death rates remain. Differences in guideline-concordant CRC screening rates may explain some of these disparities. We aim to assess individual and neighborhood-level predictors of guideline-concordant CRC screening within two cohorts of individuals located within CRC mortality geographic hotspot regions in the U.S. A total of 36,901 participants from the Southern Community Cohort Study and 4,491 participants from the Ohio Appalachia CRC screening study were included in this study. Self-reported date of last CRC screening was used to determine if the participant was within guidelines for screening. Logistic regression models were utilized to determine the association of individual-level predictors, neighborhood deprivation, and residence in hotspot regions on the odds of being within guidelines for CRC screening. Lower household income, lack of health insurance, and being a smoker were each associated with lower odds of being within guidelines for CRC screening in both cohorts. Area-level associations were less evident, although up to 15% lower guideline adherence was associated with residence in neighborhoods of greater deprivation and in the Lower Mississippi Delta, one of the identified CRC mortality hotspots. These results reveal the adverse effects of lower area-level and individual socioeconomic status on adherence to CRC guideline screening.

Social networks as predictors of colorectal cancer screening in African Americans.

BackgroundEarly detection can reduce colorectal cancer (CRC) mortality by 15%–33%, and screening is widely recommended for average-risk adults beginning at age 50 years. Colorectal cancer mortality rates are higher in African Americans than in whites, while screening rates are somewhat lower. Individual social networks can reduce emotional and/or logistical barriers to health-promoting but distasteful procedures such as CRC screening. The aim of this study was to examine social network interactions, and their impact on CRC screening among African Americans. We hypothesized a positive association between social network index (SNI) scores and CRC screening.MethodsIn a community intervention trial with four arms, we previously demonstrated the efficacy of a small group educational intervention to promote CRC screening among African Americans. This intervention outperformed a one-on-one educational intervention, a reduced out-of-pocket expense intervention, and a control condition. In the present analysis, we compared the SNI scores for participants in the small group intervention cohort with a comparison group comprised of the other three cohorts. Social networks were assessed using the Social Network Index developed by Cohen.ResultsSmall group participants had a significantly higher network diversity score (Mean difference 0.71; 95% CI, 0.12–1.31; p=0.0017) than the comparison group. In the second component of the SNI score – the number of people talked to over a two week period – the small group intervention cohort also scored significantly higher than the comparison group. (Mean difference, 9.29; 95% CI, 3.963–14.6266; p=0.0004).ConclusionsThe findings suggest that social interaction and support was at least partially responsible for the relatively high post-intervention screening rate in the small group intervention participants. Education in small groups could foster strong social networks. Strong and positive network diversity and a large number of people in social networks may enhance CRC screening rates among African Americans.

The Association Between Education and Colorectal Cancer Screening among United States Veterans Aged 50-75 Years Old

Introduction: Colorectal cancer (CRC) is the third most common cause of cancer in the United States (US) and represents 9% of all cancers within the Veteran Health Administration. CRC screening (CRCS) is recommended between ages 50-75. There is a paucity of data on the predictors of CRCS among veterans. This study examines the association between education and CRCS among US veterans 50-75 years old. Methods: The 2012 Behavioral Risk Factor Surveillance System data is used for this study. The population examined is veterans' aged 50-75 with valid responses for CRCS and educational attainment (n=32,536). Bivariate analyses and survey adjusted and population weighted-multivariable logistic regression analyses are conducted to analyze the association between CRCS and education while adjusting for sex, race/ethnicity, income, health insurance coverage, having a primary care provider, employment status, and medical cost impeding care. Results: An estimated 6.5% of participants have less than a high school (HS) education, 30.5% are HS graduates, 37.0% have some college and 26.1% have a college degree or more. Seventy-three percent of individuals with less than HS, 77% of HS graduates, 84% of those with some college and 87% of those with a college degree or more have obtained CRCS. Given the adjusted model, education level and income level show a statistically significant trend (p Conclusion: CRCS is significantly linked to education and income. Given this trend, prevention programs should target veterans with low income and education to improve CRCS.

Abstract B94: Social networks as predictors of colorectal cancer screening in African Americans

Abstract Background: Early detection can reduce colorectal cancer (CRC) mortality by 15%–33%, and screening is widely recommended for average-risk adults beginning at age 50 years. However, African Americans have disproportionately low screening rates compared to whites. Factors that seem to facilitate CRC screening include higher income, higher education, older age, and male sex, strong social ties and supportive relationships. Individual social networks reduce emotional and/or logistical barriers to colorectal cancer screening participation. The aim of this study was to examine social network interactions, and its impact on colorectal cancer screening among African Americans. We hypothesized that a positive association is expected between social network index scores and colorectal cancer screening. Methods: Our preliminary published literature (Blumenthal Daniel S; Smith Selina A; Majett Charlye D; Alema-Mensah Ernest. A trial of 3 interventions to promote colorectal cancer screening in African Americans. Cancer, Feb2010;116(4): 922-9) showed that small groups (4-15 participants trained with CRC educational resources from the National Cancer Institute and the American Cancer Society) were significantly more likely to have CRC screening. Three hundred sixty-nine African-American men and women aged 50 years and above were enrolled in this randomized, controlled community intervention trial. Social networks were assessed using the Social Network Index (SNI) based on the index developed by Berkman (1979) [28]. The SNI consists of four domains: marriage or partnership, friends and relatives, religious activity, and voluntary associations. Categories were scored as follows: married (married = 1, widowed, divorced, separated, or never married = 0); contact with friends and relatives (≥156 contacts per year = 1, &amp;lt;156 contacts per year = 0); frequency of church or religious service attendance (attended four or more services per year = 1, attended less than four = 0); group (such as church groups, unions, fraternal or athletic groups, or school groups) participation (yes = 1, no = 0). Scores were summed for the four dichotomized variables with a range of 0 to 4. Scores of 0 and 1 indicate the fewest ties and a score of 4 the most ties. Cronbach's alpha for the SNI scale was 0.25 in this study. Descriptive statistics and bivariate analyses were run. T-test statistics was used to determine differences between the small group (intervention) and other groups (control, financial incentive and one on one). Results: There was a statistically significant difference in the network diversity among the groups. Small group participants had a higher network diversity score (Mean difference 0.71; 95% CI, 0.12-1.31; p=0.0017) compared to the other groups. Total number of people in social network score was significantly higher among the small group than the other groups (Mean difference, 9.29; 95% CI, 3.96-14.62; p=0.0004). Conclusions: Group education in small groups could foster strong social networks which may improve CRC screening rates among African Americans. Strong and positive network diversity and optimal number of people in social networks may enhance CRC screening rates. However, the screening rate of less than 35% in a group of individuals who participated in an educational program through multiple sessions over a period of several weeks indicated that there still are barriers to overcome. Citation Format: Ernest Alema-Mensah, Selina Smith, Mechelle Claridy, Victor Ede, Benjamin Ansa, Daniel Blumenthal. Social networks as predictors of colorectal cancer screening in African Americans. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B94.

Diabetes Status and Being Up-to-Date on Colorectal Cancer Screening, 2012 Behavioral Risk Factor Surveillance System.

IntroductionAlthough screening rates for colorectal cancer are increasing, 22 million Americans are not up-to-date with recommendations. People with diabetes are an important and rapidly growing group at increased risk for colorectal cancer. Screening status and predictors of being up-to-date on screening are largely unknown in this population.MethodsThis study used logistic regression modeling and data from the 2012 Behavioral Risk Factor Surveillance System to examine the association between diabetes and colorectal cancer screening predictors with being up-to-date on colorectal cancer screening according to criteria of the US Preventive Services Task Force for adults aged 50 or older. State prevalence rates of up-to-date colorectal cancer screening were also calculated and mapped.ResultsThe prevalence of being up-to-date with colorectal cancer screening for all respondents aged 50 or older was 65.6%; for respondents with diabetes, the rate was 69.2%. Respondents with diabetes were 22% more likely to be up-to-date on colorectal cancer screening than those without diabetes. Among those with diabetes, having a routine checkup within the previous year significantly increased the odds of being up-to-date on colorectal cancer screening (odds ratio, 1.90). Other factors such as age, income, education, race/ethnicity, insurance status, and history of cancer were also associated with up-to-date status.ConclusionRegardless of diabetes status, people who had a routine checkup within the past year were more likely to be up-to-date than people who had not. Among people with diabetes, the duration between routine checkups may be of greater importance than the frequency of diabetes-related doctor visits. Continued efforts should be made to ensure that routine care visits occur regularly to address the preventive health needs of patients with and patients without diabetes.

Deliberative and intuitive risk perceptions as predictors of colorectal cancer screening over time.

Cancer risk perceptions may involve intuitions-including both affect as well as gut-level thoughts about risk-and deliberative risk magnitudes. Yet, little research has examined the potentially diverse relations between risk perceptions and behavior across time. A highly diverse primary care sample (N=544, aged ≥50) was utilized to compare how deliberative and intuitive perceptions of risk relate to chart-confirmed colorectal cancer screening at cross-sectional and prospective time points. At baseline, deliberative and intuitive risk perceptions were negatively associated with chart-confirmed colorectal cancer screening adherence in bivariable but not multivariable analyses. Among those who were non-adherent with colorectal cancer screening at baseline, deliberative and intuitive risk perceptions were positively associated with prospective uptake of chart-confirmed colorectal cancer screening adherence at 12-months in bivariable analyses; only deliberative risk perceptions remained significant in the multivariable model. This study indicates that diverse risk perceptions are differentially important for screening at different time points.

Longitudinal predictors of colorectal cancer screening among participants in a randomized controlled trial

ObjectiveFew studies use longitudinal data to identify predictors of colorectal cancer screening (CRCS). We examined predictors of (1) initial CRCS during the first year of a randomized trial, and (2) repeat CRCS during the second year of the trial among those that completed FOBT in Year 1. MethodsThe sample comprised 1247 participants of the Systems of Support to Increase Colorectal Cancer Screening (SOS) Trial (Group Health Cooperative, August 2008 to November 2011). Potential predictors of CRCS were identified with logistic regression and included sociodemographics, health history, and validated scales of psychosocial constructs. ResultsPrior CRCS (OR 2.64, 95% CI 1.99–3.52) and intervention group (Automated: OR 2.06 95% CI 1.43–2.95; Assisted: OR 4.03, 95% CI 2.69–6.03; Navigated: OR 5.64, 95% CI 3.74–8.49) were predictors of CRCS completion at Year 1. For repeat CRCS at Year 2, prior CRCS at baseline (OR 1.97, 95% CI 1.25–3.11), intervention group (Automated: OR 9.27, 95% CI 4.56–18.82; Assisted: OR 11.17, 95% CI 5.44–22.94; Navigated: OR 13.10, 95% CI 6.33–27.08), and self-efficacy (OR 1.32, 95% CI 1.00–1.73) were significant predictors. ConclusionSelf-efficacy and prior CRCS are important predictors of future screening behavior. CRCS completion increased when access barriers were removed through interventions.

Rates and predictors of colorectal cancer screening by race among motivated men participating in a prostate cancer risk assessment program

Screening by fecal occult blood test and lower endoscopy has lowered colorectal cancer (CRC) mortality, but compliance gaps persist. Of concern are possible disparities in uptake of CRC screening between white and African American men. The goal of this study was to assess for disparities in uptake of CRC screening among men participating in a high-risk prostate cancer clinic. If present, such disparities could support hypotheses for further research examining racial differences in awareness and patient preferences in undergoing CRC screening. Baseline data on a racially diverse cohort of men aged 50 to 69 years at increased risk of prostate cancer collected via the Prostate Cancer Risk Assessment Program at Fox Chase Cancer Center were analyzed. Predictors of uptake of CRC screening were assessed using multivariate logistic regression. Compared with whites, African American men had statistically significantly lower uptake of fecal occult blood testing (African American 49.0% vs white 60.7%, P = .035), lower endoscopy (African American 44.1% vs white 58.5%, P = .011), and any CRC screening (African American 66.2% vs white 76.3%, P = .053). Predictors of uptake of lower endoscopy among African American men included older age (odds ratio [OR], 3.61; 95% confidence interval [CI], 1.87-6.97), family history of CRC (OR, 3.47; 95% CI, 1.30-9.25), and insurance status (OR, 1.90; 95% CI, 1.04-3.46). Despite awareness of cancer risk and motivation to seek prostate cancer screening through a specialized prostate cancer risk assessment program, evidence supporting compliance gaps with CRC screening among men was found. Tailored messages to younger African American men with and without a family history of CRC are needed.

The impact of Asian race on colorectal cancer screening (CRCS).

381 Background: While research shows that African Americans and Hispanics frequently receive less CRCS than Whites, few studies have focused on CRCS among Asians. The aims of the current analysis were to 1) compare CRCS between Asians and Whites in a large U.S. population, 2) evaluate for other clinical predictors of CRCS, and 3) examine the impact of health insurance coverage, place of birth and English proficiency on potential racial disparities. Methods: From the 2007 California Health Interview Survey, we identified all Asian (N=2,108) and White (N=23,237) average-risk respondents aged ≥50 years who were eligible for CRCS. Logistic regression was performed to evaluate for differences in CRCS between Asians and Whites. We used stratified and interaction analyses to examine whether associations between race and CRCS were modified by insurance status (insured vs uninsured), birthplace (U.S. vs non-U.S.) or language skills (good vs poor English), while controlling for other confounders. Results: Baseline characteristics were similar between Asians and Whites: mean age was 64 years in both groups; 45% and 47% were male; and 47% and 50% were employed, respectively. Only 58% of Asians and 66% of Whites reported undergoing up-to-date CRCS (p&lt;0.001). In multivariate analyses, female gender and those living in rural areas were less likely to receive CRCS (OR 0.84, 95%CI 0.76-0.93, p=0.001 and OR 0.88, 95%CI 0.81-0.98, p=0.015, respectively).When compared to Whites, Asians also had decreased odds of CRCS (OR 0.82, 95%CI 0.71-0.95, p=0.008), even after adjusting for confounders such as education and income. Stratified analyses revealed that this disparity existed mainly in the insured (OR 0.83, 95%CI 0.72-0.96, p=0.014), but not in the uninsured (OR 0.94, 95%CI 0.43-2.06, p=0.873). The relationship between race and CRCS was not modified by place of birth or English proficiency. Conclusions: Despite its ability to reduce mortality, CRCS is suboptimal in our U.S. population-based cohort of Asians when compared to Whites. The racial disparity was more evident within the insured subset, suggesting that factors unrelated to healthcare access, such as patient preference, physician discretion or patient-physician rapport, may be more important drivers of CRCS among Asians. No significant financial relationships to disclose.

Abstract B15: Feasibility and acceptability of promoting colorectal cancer screening in an Internet weight loss community through narratives and navigational guidance

Abstract Because obesity increases the risk for colorectal cancer (CRC), efficient and sustainable interventions are needed to promote colorectal cancer screening (CRCS) among obese individuals. A novel approach would be to empower members of Internet weight loss communities to promote CRCS screening among other members by sharing personal narratives about CRCS experiences or providing navigational guidance through the healthcare system to undergo CRCS. However, feasibility and acceptability of this strategy have not been evaluated. Therefore, we conducted an online survey of members of an Internet weight loss community who were eligible for CRCS to assess: CRCS status (colonoscopy within 10 years, sigmoidoscopy within 5 years, or fecal occult blood test within 1 year was considered up-to-date with CRCS); predictors of CRCS; stage of change for CRCS; attitudes towards CRCS (4-point Likert-type items — strongly agree, agree, disagree, strongly disagree); and interest in an intervention featuring narratives or navigation. The 2508 respondents were primarily female (92%) and white (90%). Sixty-eight percent were up-to-date with CRCS, mostly by colonoscopy. Being up-to-date with CRCS was associated with male gender, older age, lower body mass index, being married, Bachelor's degree education, healthcare provider's CRCS recommendation, other cancer screening in the past year, primary care visit in the past year, health insurance, and non-smoking. Among those not up-to-date with CRCS, taking steps to be screened for CRC (compared to earlier stages) was associated with a one point increase in scores for social influence of others (OR = 7.5, 95% CI: 4.5-12.6), perceived salience of CRCS (OR = 5.1, 95% CI: 3.1-8.5), self-efficacy for navigating the healthcare system (OR = 3.8, 95% CI: 2.3-6.2), self-efficacy for CRCS (OR = 2.0, 95% CI: 1.4-2.9), and perceived susceptibility to CRC (OR = 1.9, 95% CI: 1.2-3.1). Considering CRCS within 6 months or taking steps to be screened (compared to earlier stages) was associated with a one point increase in scores for social influence of others (OR = 12.2, 95% CI: 7.8-19.1), perceived salience of CRCS (OR = 5.8, 95% CI: 4.1-8.3), self-efficacy for navigating the healthcare system (OR = 3.7, 95% CI: 2.6-5.3), perceived susceptibility to CRC (OR = 2.5, 95% CI: 1.7-3.5), perceived efficacy of CRCS (OR = 2.2, 95% CI: 1.6-3.0), self-efficacy for CRCS (OR = 1.5, 95% CI: 1.2-2.0), and CRC worries (OR = 1.3, 95% CI: 1.1-1.6). Among those not up-to-date, 63% were interested in learning about other members’ CRCS narratives and 36% were interested in receiving navigational guidance for undergoing CRCS. Among those who were up-to-date, 39% were interested in promoting CRCS by sharing narratives and 37% by providing navigational guidance. In conclusion, leveraging social relationships within Internet weight loss communities may be a feasible and acceptable strategy for promoting CRCS among obese individuals. Results inform how we could tailor the intervention according to demographic characteristics and healthcare experiences; target specific attitudes; and utilize narratives and navigational guidance. Citation Information: Cancer Prev Res 2010;3(12 Suppl):B15.

Abstract B104: Disparities in colorectal cancer screening among motivated men participating in a prostate cancer risk assessment program

Abstract Background: In 2010, more than 145,000 new cases of colorectal cancer (CRC) will be diagnosed. While those with localized disease have very high survival rates, those with locally advanced and metastatic disease have poorer outcomes, and many will die of CRC. Incidence and death rates from CRC remain higher for African Americans (AA) as compared to Caucasian Americans (CA). However, CRC screening rates among AA men have lagged behind those of CA men. AA men are also at increased risk for prostate cancer (PCA), and many AA men are motivated to seek PCA risk assessment and screening which is an ideal time to motivate AA men to perform CRC screening. This study was performed to assess self-reported CRC screening rates and predictors among men at high-risk for PCA (AA men and men with a family history of PCA) who are motivated to enroll in a PCA risk assessment program in order to understand CRC screening behaviors and predictors to pursue CRC screening. Methods: The Prostate Cancer Risk Assessment Program (PRAP) at Fox Chase Cancer Center is a PCA screening, risk counseling, and research program for men at high risk for PCA. Eligibility criteria include any man between 35-69 years with (1) at least 1 first-degree relative with PCA, (2) at least 2 second-degree relatives with PCA on the same side of the family or (3) any AA man regardless of family history of PCA. CRC screening information was self-reported by participants on standard PRAP health history questionnaires. Frequency and differences in CRC screening methods (fecal occult blood testing [FOBT], colonoscopy/sigmoidoscopy) by race were assessed using chi-squared tests and predictors of CRC screening was assessed using multivariate logistic regression (SAS version 9.1). Results: 740 PRAP participants were analyzed, of whom 62% were AA. Overall, AA men had statistically significant lower rates of any CRC screening measure compared to CA PRAP participants (46% vs 58% respectively, p=0.0015). Among PRAP participants age &amp;gt;50 years, AA men reported significantly lower FOBT (p=0.03), colonoscopy/ sigmoidoscopy (p=0.01), and any CRC screening test (p=0.04) compared to CA men. On multivariate logistic regression analysis among 704 PRAP participants with complete socioeconomic and demographic data, race remained a significant predictor of any CRC screening test after adjusting for age (p=0.007), but was not significant after adjusting for marital status, education, and income. For colonoscopy/sigmoidoscopy, race remained a significant predictor after adjusting for age (p=0.0013), education (p=0.0085), and marital status (p=0.0013) and was borderline significant after adjusting for income (p=0.051). Conclusion: Even among motivated AA men participating in a PCA screening program, screening for CRC remains suboptimal. These results highlight an opportunity to intervene for AA men seeking PCA screening to discuss and pursue CRC screening to lower mortality from CRC. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B104.

T2020 Frequency and Predictors of Colorectal Cancer Screening Among Average Risk American Indians/Alaskan Natives Utilizing the Indian Health Services from 1996 to 2004

Guaiac based fecal occult blood test (gFOBT) is the only screening tool with high-quality evidence obtained from randomised controlled trials (RCTs) demonstrating its efficacy to reduce colorectal cancer (CRC) mortality. However, it has some drawbacks, one is the requirement for frequent testing, which may limit compliance and thereby effectiveness. Aim: to assess the short term outcomes of the 2nd round of a biennial gFOBT CRC screening program. Methods: Comparison of the outcomes of the 1st and 2nd rounds (R1 and R2) of the organized CRC screening program with Hemoccult II implemented in the Haut-Rhin, a French administrative area, since 2003 (Denis B et al Gut 2007;56:1579-84). Results: Main outcomes are presented in the table. The crude participation rate decreased from 49.0% to 45.0%. 57.0% of excluded people had a recent < 5 years colonoscopy and 37.5% were at increased CRC risk. 28.4% of people who had participated in R1 did not participate in R2 and conversely, 25.4% of people who participated in R2 had not participated in R1. 83.9% of the completed gFOBTs were provided by general practitioners (GPs) and 12.1% by direct mailing in R2 and respectively 78.6% and 15.5% in R1 (p<0.001). 93.7% of people who received a gFOBT from their GP actually completed it in R2 vs. 81.6% in R1 (p<0.001). The rate of ≥ 10 mm adenomas did not differ between R1 (32.9%) and R2 (30.5%). The positive predictive value for advanced neoplasia was significantly lower in R2 (28.3%, p= 0.04) and in people who had a previous negative gFOBT result (27.2%, p=0.01) than in R1 (31.1%). The rate of invasive cancers limited to the colorectal wall was not different between R2 (59.3%) and R1 (69.4%). Conclusion: Participation and diagnostic yield deteriorated with time in our organized population-based gFOBT CRC screening program. Despite an increasing involvement of GPs, more than a quarter of eligible people did not repeat screening in the 2nd round. This deterioration was not observed in previous RCTs on gFOBT screening and may question the reproducibility of their effectiveness on the reduction of CRC mortality in the real world.

Predictors of colorectal cancer screening from patients enrolled in a managed care health plan

Despite the growing recognition of the importance of colorectal cancer (CRC) screening in reducing cancer mortality, national screening rates are low, indicating a critical need to understand the barriers and remedies for underutilization of CRC screening tests. Using results from independent cross-sectional telephone surveys with patients aged>or=50 years performed before (2000; n=498) and after (2003; n=482) a quality improvement intervention for CRC screening within a large managed care health plan, the trends and predictors of CRC screening with fecal occult blood test (FOBT) and/or endoscopy (flexible sigmoidoscopy/colonoscopy) were examined from a patient perspective. In 2000, patient reported screening rates within guidelines were 38% for any test, 23% for endoscopy, and 22% for FOBT. In 2003, screening rates increased to 50% for any test, 39% for endoscopy, and 24% for FOBT. Having discussed CRC with a doctor significantly increased the odds of being screened (FOBT: odds ratio [OR], 2.09 [95% confidence interval (95% CI), 1.47-2.96]; endoscopy: OR, 2.33 [95% CI, 1.67-3.26]; and any test: OR, 2.86 [95% CI, 2.06-3.96]), and reporting barriers to CRC in general decreased the odds of being screened (FOBT: OR, 0.76 [95% CI, 0.60-0.95]; endoscopy: OR, 0.74 [95% CI, 0.60-0.92]; and any test: OR, 0.66 [95% CI, 0.54-0.80]). Although screening rates increased over the 3-year period, evidence was found of ongoing underutilization of CRC screening. The 2 strongest determinants of obtaining CRC screening were provider influence and patient barriers related to CRC screening in general, pointing to the need for multilevel interventions that target both the provider and patient.