Relatives Of Colorectal Cancer Patients Research Articles

Screening for colorectal cancer by full colonoscopy in first-degree relatives of colorectal cancer patients: a multicentric study by the Italian League for the Fight against Cancer.

Colorectal cancer currently presents the third-highest incidence of cancers worldwide, making secondary prevention through screening programs for colorectal cancer, usually by Fecal Occult Blood Testing, an essential preventive medicine intervention. First-degree relatives of colorectal cancer patients are a particularly at-risk group, with indications to consider direct screening by full colonoscopy. Colonoscopy is considered the gold standard for diagnosing colorectal cancer, as it has high sensitivity and specificity, and is both a diagnostic and therapeutic tool. However, it requires significant organizational and financial resources, and has a small but relatively higher risk of complications as opposed to fecal occult blood testing. The present study aimed to assess the appropriateness of a screening program without age restrictions of CRC by full colonoscopy in asymptomatic, first-degree adult relatives of patients with colorectal cancer, aiming both to actively increase screening coverage and to determine the detection rate of precancerous lesions and colorectal cancer in this population. Uncontrolled interventional study - colorectal cancer screening by full colonoscopy for at-risk population. The Italian League for the Fight against Cancer started a colorectal cancer screening program by full colonoscopy for first-degree relatives of colorectal cancer patients in 1998 in the province of Latina, Lazio Region, Italy. The program was expanded to the provinces of Rieti, Lazio Region, and Sassari, Sardinia Region, in 2014 and 2016 respectively, and was concluded in 2018. Subjects were actively and voluntarily recruited by the study's working group. Subjects that had already been subjected to a full colonoscopy in the preceding 5 years were excluded from this study. Identified neoplastic lesions were treated either directly or referred to the Day Hospital setting, and histologically diagnosed following World Health Organization guidelines. In total, 2,288 subjects (age range 15-88, mean 52.3 yrs, M/F = 946/1,204) were screened by colonoscopy, of which 103 (4.5%) were incomplete and 2,173 (95.0%) complete, with data on colonoscopy performance missing for 12 participants. Out of 468 positive outcomes on colonoscopy, diagnosis for 422 (204M/173F), 19.4% of total subjects, was adenomatous polyps and 46 (20M/20F), 2.1% of total subjects, was colorectal cancer. Female sex was a protective factor against a positive test outcome, with a 35% reduction compared to male sex, with OR=0.64 95%CI (0.52-0.80). On the other hand, being over 50 years of age was found to be a risk factor, making a positive outcome more than twice as likely, with OR=2.3 95%CI (1.8-2.9). Subjects over 50 also had significantly more instances of multiple adenomas being found, however the size distribution of found adenomas was not significantly different between subjects under and over 50, despite size being a predictor of risk of neoplastic progression. Given the high detection rate of precancerous lesions and colorectal cancer in the studied population, it is our opinion that guidelines should continue to recommend earlier and more frequent screening in first-degree relatives of patients with colorectal cancer, and, barring the introduction of more cost-effective and/or lower risk procedures with a similar efficacy profile, maintain the use of colonoscopy as the main screening option.

Factors affecting colonoscopy screening among first-degree relatives of colorectal cancer patients: A mixed-method systematic review.

First-degree relatives (FDRs) of colorectal cancer (CRC) patients have a higher risk of developing CRC than the general population. Ensuring that these at-risk populations receive colonoscopy screening is an effective strategy for reducing the increased risk, but the rates remain low. Colonoscopy screening behavior is influenced by factors at multiple levels. However, most previous reviews failed to review them and their interactions systematically. To explore factors influencing FDRs' colonoscopy screening behavior according to the ecological model. A mixed-method systematic review was performed in accordance with The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline. A comprehensive literature search was conducted using eight bibliographic databases (Medline, EMBASE, PubMed, the Cochrane Library, Scopus, China National Knowledge Infrastructure, Wan Fang Data, and China Biology Medicine) for the period from January 1995 to February 2023. The Joanna Briggs Institute critical appraisal checklists were applied to assess studies qualities. A convergent integrated approach was used for data synthesis and integration. In total, 24 articles reporting on 23 studies were included. Only one study was rated low quality, and the other 22 studies were rated moderate to high quality. The findings revealed that certain factors and their interactions affected FDRs' colonoscopy screening behaviors according to the ecological model, including misconceptions about CRC and colonoscopy, concerns about the procedure, perceived susceptibility to developing CRC, health motivation, fear of CRC, fatalism, the recommendation from CRC patients, and recommendations from physicians, colonoscopy schedules, cancer taboo, health insurance and cost of colonoscopy. Family communication-centered multilevel interventions are recommended to promote colonoscopy screening behavior among FDRs of CRC patients.

Implementing a tailored communication intervention to increase colonoscopy screening rates among first-degree relatives of people with colorectal cancer: Lessons learned

PurposeTo report the process evaluation of a tailored communication intervention for first-degree relatives of colorectal cancer patients in a randomized controlled trial. MethodBased on the MRC process evaluation framework, the process of delivering a two-arm RCT intervention were evaluated on 3 themes: (1) implementation, (2) mechanism, and (3) contextual factors. Implementation data were collected through a logbook, online tool platform feedback, and questionnaire surveys. Subgroup analysis was conducted for implementation outcomes. The mechanism and contextual factors were analyzed by mediation and moderation analysis. ResultsFrom March 2019 to May 2019, 188 (57%) eligible participants were recruited to participate in this study in Shenzhen, China. In the intervention group, 68 (72.3%) participants received written and verbal sessions. Relatively high satisfaction rates (77.6%–100%) were achieved. The mediating effect was found for perceived barriers (95%CI = −0.880, −0.133) and cues to action (95%CI = 0.043, 0.679). No moderators were identified. People who received the first two sessions are more likely to receive a colonoscopy, whereas the time spent on intervention did not influence the colonoscopy uptake. ConclusionsPotential strategies to enlarge the tailored effect were identified, including tailoring communication on the perceived barriers and cues to action and reinforcing patients’ compliance in the first written and verbal sessions. To accomplish the difficult task of recruiting at-risk family members, direct approaches and adequate records on contact information of at-risk family members are suggested when the cancer cases were identified for the first time.

Birinci Derece Yakınlarında Kolorektal Kanser Tanısı Olan ve Olmayan Bireylerin Hastalık Algılarının Karşılaştırılması

Aim: This study aimed to evaluate and compare the knowledge and attitudes of relatives of patients with colorectal cancer and those who do not have colorectal cancer. Methods: The study was conducted with the relatives of colorectal cancer patients who applied to the Oncology outpatient clinic and the patients who did not have colorectal cancer in the family who applied to the Family Medicine outpatient clinic. In the data collection, the questionnaire prepared by the researcher to determine the personal characteristics of the individuals participating in the study and the 'Health Belief Model Scale for Colorectal Cancer Prevention' to determine the health beliefs were used. Results: The mean age of the 120 participants was 36.59 ± 12.7 years, 55.8% (n = 67), women, 65.8% (n=79) is married and 69.2% (n=83) live in the city. Colorectal cancer screening rate was significantly higher in the case group (p=0.004). The most frequently reported barriers to get colorectal cancer screening tests were not knowing colorectal cancer and screening tests (38.3%). The confidence benefit perception score average of the control group was significantly higher than the average score of the case group (p = 0.018). Conclusion: In our study, the level of the perception of trust and benefit was lower in the patients whose first-degree relatives had CRC compared to those who had not in their family. Although the expectation of early diagnosis, using CRC screening, was higher in the patients with CRC in their first-degree relatives, there was no significant difference between the two groups. This fact reveals the necessity of evaluating the risks for the individuals while providing counseling to them for colorectal cancer screening as well as updating the training.

Effectiveness of a tailored communication intervention on colonoscopy uptake for firstdegree relatives of colorectal cancer patients: A randomized controlled trial

ObjectiveTo evaluate the effect of a WeChat tailored communication intervention on colonoscopy uptake and health beliefs in Chinese first-degree relatives (FDRs) of colorectal cancer patients. MethodsThis study employed a single-blinded randomized controlled trial. A total of 188 eligible FDRs were recruited and randomly assigned to the tailored intervention group or control group. Health beliefs were assessed at 1 (T1) and 3 months (T2) postintervention. The colonoscopy uptake was verified by medical records at T2. Data were analyzed using binary logistic regression and generalized estimating equation models. ResultsCompared with the participants in the control group, those in the intervention group had a significant improvement in terms of colonoscopy uptake (OR = 2.752, 95% CI: 1.428–5.303, P ​< ​0.01), perceived susceptibility (T1: β ​= ​0.298, 95% CI: ​0.052–0.402, P ​< ​0.05; T2: β ​= ​0.251, 95% CI: ​0.078–0.424, P ​< ​0.001) and cues to action (T1: β ​= ​0.0.264, 95% CI: ​0.138–0.389, P ​< ​0.001; T2: β ​= ​0.327, 95% CI: ​0.195–0.459, P ​< ​0.001) and a significant reduction in perceived barriers (T1: β ​= ​−0.237, 95% CI: ​−0.360−0.115, P ​< ​0.01; T2: β ​= ​−0.196, 95% CI: ​−0.331−0.062, P ​< ​0.01). ConclusionsThis study broadens the application of tailored communication using novel channels in the context of screening in the at-risk Chinese population. The results provide insights on how to improve the intervention by modifying its components and communication channels.

Colorectal Cancer in Pakistan: Is prevention possible?

Dear Madam, Among malignancies, colorectal cancer (CRC) has the third- largest incidence Globally. (1) Even though Pakistan is considered as a low-risk area, in 2018, Idrees et a. l reported a 4% to 6.8% incidence. (2) This number is itself significant considering that underreporting remains a grave problem. The aetiology of CRC is vastly based on genetics, but is dietary intake is another major factor to consider. A 2017 meta-analysis shows that the inflammatory extent of diet, measured by the Dietary Inflammation Index, is associated with a 40% increased risk of CRC. (3) Evidence suggests that a diet rich in proinflammatory foods like proteins and fats affects gut microbiota, increases metabolite formation and enhances the risk of CRC. On the contrary, the increased fibre in the diet is shown to have anti-inflammatory effects and reduce this risk. (4). Due to our constraints in resources, healthcare facilities must use aforementioned knowledge to tackle the disease at all fronts. First degree relatives of CRC patients and high-risk individuals can be counselled about life style and dietary modifications at family healthcare facilities. They should be provided with a complete list of foods containing the above-mentioned components. This is especially important in the red-meat consuming areas of Northern Pakistan. This approach of prevention before treatment surpasses the major limitation of costly screening procedures and can be a great benchmark for mass campaigns. A good foundation for our campaigns can be established by taking notes from the CDC’s Screen for Life organization (SFL). In September 2018, through their search engine marketing and digital advertising efforts, SFL garnered more than 360 million impressions and 2 million clicks to web pages. (5) Similar avenues need to be explored in Pakistan to reach the general public. Raising awareness about CRC, the related lifestyle changes and pro-inflammatory foods can be achieved through pamphlets, advertisements, and social media platforms. Funding from such campaigns can also aid further research into CRC, specific to the Pakistani community. The aim should be to promote a more centred knowledge of risk factors prevalent in our society and target them. Considering the inaccessibility of screening methods, this approach of modifying dietary intake in first degree relatives leaves much room to be explored and has a potential to be a cost-effective solution. Further research on this approach, centred on the Pakistani population, is required.

RETRACTED ARTICLE: Compliance of Blood Relatives of Colorectal Cancer Patients to Colorectal Screening Guidelines.

There is a wide range of options for colorectal cancer (CRC) screening in the average-risk population. However, screening tests for CRC vary regarding the degree of supporting evidence. Colonoscopy, Satisfaction, and Safety Questionnaire based on patients' experience (CSSQP). To study the compliance of blood relatives of patients with colorectal cancer to colorectal cancer screening. This cross-sectional study included 134 participants of blood relatives of CRC patients undergoing colonoscopy following primary care or secondary care referrals, after exclusion of those who refused to take part, and subjects already having or had cancer elsewhere. This work was conducted in Internal Medicine Department, Zagazig University Hospitals. All participants in this study completed a questionnaire, which comprised a pre-procedure questionnaire that included name, age, residence, history of smoking, history of bleeding problems, history of colonoscopy, and family history of colon cancer. The age of the studied cases ranged from 19 to 66years with a mean of 44.08years. Regarding the sex distribution, 53% were male. Most of the study group were married (84.3%). More than half of the studied group were educated (57.2%). The most frequent occupations were professional (29.1%). Of the studied cases, 60.4% had enough income and 47.8% were smokers. The study group had no history of other malignancy or previous colonoscopy. All the studied cases refused colonoscopy for screening, but 91% of them accepted CRC genetic tests and all of them accepted any other tests like stool analysis or CT scan. Regarding advising others to do a colonoscopy, 66.4% advised cases with symptoms to do a colonoscopy. Finally, 82.8% of the studied group preferred medical treatment if they had symptoms. There was a statistically significant increase in the frequency of acceptance of CRC genetic tests among educated compared to non-educated and among those who had enough income compared to those who did not have enough income. Providing non-invasive screening choices can augment participation in programs for colorectal cancer screening. The success of a screening program depends on having tests with acceptable performance, but also on the willingness of the target population to take part. This study showed that offering non-invasive tests, options significantly increase compliance to colorectal cancer screening.

Psychological distance: a qualitative study of screening barriers among first-degree relatives of colorectal cancer patients

BackgroundColorectal cancer screening can reduce the incidence and mortality through early detection. First-degree relatives (FDRs) of patients with colorectal cancer are at high risk for colorectal cancer and therefore require colonoscopy. However, despite the high risk, screening adherence among FDRs remains low and the barriers to undergoing screening among FDRs in China are not clear. We explored the reasons why FDRs refused screening.MethodsIn this qualitative study, 28 semistructured, in-depth interviews were conducted face-to-face. Participants were recruited at two hospitals (an urban tertiary hospital and a community health center) in Guangzhou, South China. We used qualitative content analysis to analyze transcripts based on audio recordings and identify major themes and subthemes.ResultsThree major themes emerged related to FDRs’ low screening participation. First, the emotional distance between FDRs and medicine was pulled away by uncomfortable feelings approaching hospitals and misunderstanding of cancer. Second, they confirmed their health state and minimized cancer risk if they had no signs in routine health examination, no symptoms and maintained a healthy, happy life. Third, they considered screening far from their daily life from the perspective of spatial distance and priority. Therefore, screening was not necessary in their view.ConclusionsHealthcare professionals should narrow psychological distance between people and screening when promoting screening technology.

Endoscopic management of Lynch syndrome and of familial risk of colorectal cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline.

ESGE recommends that individuals with Lynch syndrome should be followed in dedicated units that practice monitoring of compliance and endoscopic performance measures.Strong recommendation, low quality evidence, level of agreement 100 %.ESGE recommends starting colonoscopy surveillance at the age of 25 years for MLH1 and MSH2 mutation carriers and at the age of 35 years for MSH6 and PMS2 mutation carriers.Strong recommendation, moderate quality evidence, level of agreement 100 %. ESGE recommends the routine use of high-definition endoscopy systems in individuals with Lynch syndrome. Strong recommendation, high quality evidence, level of agreement 100 %. ESGE suggests the use of chromoendoscopy may be of benefit in individuals with Lynch syndrome undergoing colonoscopy; however routine use must be balanced against costs, training, and practical considerations.Weak recommendation, moderate quality evidence, level of agreement 89 %.ESGE recommends definition of familial risk of colorectal cancer as the presence of at least two first-degree relatives with colorectal cancer or at least one first-degree relative with colorectal cancer before the age of 50 years.Strong recommendation, moderate quality evidence, level of agreement 92 %.ESGE recommends colonoscopy surveillance in first-degree relatives of colorectal cancer patients in families that fulfill the definition of familial risk of colorectal cancer.Strong recommendation, moderate quality evidence, level of agreement 100 %.

Difference of Opinion: Spousal Influence on Cancer Risk-reducing Behavior.

Objective: Marriage is consistently associated with better health outcomes. Spouses' attempts to influence partners' lifestyle and general health behaviors may contribute to this effect, although partners may not be aware of this influence. Spousal worry of a cancer diagnosis for an at-risk partner may factor into attempts to influence. An examination of spousal worry and influence on lifestyle choices, general health behaviors, and cancer screening adherence for partners at higher risk of colorectal cancer may shed light on spousal influence and partners' perceptions of influence. Methods: A mixed-method design assessed cancer worry and spousal influence for risk-reducing behavior in first-degree relatives of colorectal cancer patients following personalized genetic counseling. Couples discussed current and future ways to reduce risk. Results: Both the at-risk partner and the spouses had moderately high cancer worries. Spouses reported exerting influence for healthier behavior and cancer screening adherence but at-risk partners did not always recognize it. Qualitative data demonstrated partners' perceptions of spousal influence toward better health decisions, and against better health decisions. Conclusions: Future research should examine how and when spouses choose to exert influence, type of influence, what strategies they use, and to what effect.

Viewpoints of the target population regarding barriers and facilitators of colorectal cancer screening in the Czech Republic.

BACKGROUNDPublic awareness of colorectal cancer (CRC) and uptake of CRC screening remain challenges. The viewpoints of the target population (asymptomatic individuals older than 50) regarding CRC screening information sources and the reasons for and against participation in CRC screening are not well known in the Czech Republic. This study aimed to acquire independent opinions from the target population independently on the health system.AIMTo investigate the viewpoints of the target population regarding the source of information for and barriers and facilitators of CRC screening.METHODSA survey among relatives (aged 50 and older) of university students was conducted. Participants answered a questionnaire about sources of awareness regarding CRC screening, reasons for and against participation, and suggestions for improvements in CRC screening. The effect of certain variables on participation in CRC screening was analyzed.RESULTSOf 498 participants, 478 (96%) respondents had some information about CRC screening and 375 (75.3%) had participated in a CRC screening test. General practitioners (GPs) (n = 319, 64.1%) and traditional media (n = 166, 33.3%) were the most common information sources regarding CRC screening. A lack of interest or time and a fear of colonoscopy or positive results were reported as reasons for non-participation. Individuals aged > 60 years [adjusted odds ratio (aOR) = 2.30, 95% confidence interval (CI) (1.42-3.71), P = 0.001], females (aOR = 1.95, 95%CI (1.26-3.01) P = 0.003), and relatives of CRC patients (aOR = 4.17, 95%CI (1.82-9.58) P = 0.001) were more likely to participate in screening. Information regarding screening provided by physicians - GPs: (aOR = 8.11, 95%CI (4.90-13.41), P < 0.001) and other specialists (aOR = 4.19, 95%CI (1.87-9.38), P = 0.001) increased participation in screening. Respondents suggested that providing better explanations regarding screening procedures and equipment for stool capturing could improve CRC screening uptake.CONCLUSIONGPs and other specialists play crucial roles in the successful uptake of CRC screening. Reduction of the fear of colonoscopy and simple equipment for stool sampling might assist in improving the uptake of CRC screening.

Uncovering the barriers to undergoing screening among first degree relatives of colorectal cancer patients: a review of qualitative literature.

First degree relatives (FDRs) of colorectal cancer (CRC) patients are at higher risks of developing the disease, but screening rates amongst this group remains dismal. We undertook a systematic review of qualitative studies to identify the barriers surrounding CRC screening among FDRs from both the FDRs' and the healthcare professionals' perspectives. A comprehensive search of major bibliographic databases from January 2000 till February 2017 was performed to answer the above research questions. Pre-determined inclusion and exclusion criteria were applied. Thematic analysis was used to derive the commonalities across the studies. COREQ checklist was used to evaluate the quality of the included studies. Eight qualitative studies were included. Some of the barriers reported by FDRs included the fear of diagnosis of cancer and socio-cultural barriers. The most important barrier was the FDRs' negative perceptions towards screening test such as discomfort, embarrassment, cost of procedure and accessibility to healthcare resources. Likewise, the lack of awareness amongst FDRs that they are at increased risk of developing CRC was also found to be a barrier. On the other hand, healthcare providers are keen for patients themselves to be advocates for CRC screening of their family members as constraints posed by their daily workload impede their time to advocate screening. Lack of knowledge of the physicians on CRC screening guidelines is another notable barrier. A lack of awareness of being at higher risk of developing CRC coupled with negative attitude towards colonoscopy are the main barriers faced by the FDRs of CRC patients. Healthcare providers are more comfortable with patients being the advocates of screening among their family members.

Appropriateness and yield of surveillance colonoscopy in first-degree relatives of colorectal cancer patients: A 5-year follow-up population-based study

Background and aimsThere are few prospective data about the use of surveillance colonoscopy and the risk of recurrent neoplasia in first degree relatives (FDRs) of colorectal cancer (CRC) patients. We examined the use and yield of surveillance colonoscopy in a population-based screening program (Trentino, Italy) Methods1252 FDRs have been included in this study. We calculated compliance (percentage of FDRs who underwent surveillance colonoscopy among those eligible), appropriateness of colonoscopy (appropriate if performed within 6 months of the guidelines recommended interval) and diagnostic yield for neoplasia. We compared these data with those of 765 individuals without a family history (FH) of CRC who underwent screening colonoscopy in the same period (controls). ResultsCompliance and appropriateness were higher in FDRs than in controls (93.0% vs. 48.0%; p < 0.001; 59.6% vs. 18.8%; p < 0.0001, respectively). Younger age, female sex, FH of CRC and both non-advanced adenomas (nAA) and advanced adenomas (AA) at screening colonoscopy were predictors of appropriate surveillance. The cumulative incidence of nAA and AA was similar in FDRs and controls (31.7% and 4.9% in FDRs, including three invasive cancers; 32.4% and 5.8% in controls, respectively). ConclusionFH does not increase the risk of AA in a 5-year follow-up; appropriate surveillance practices in FDRs could be highly expected in an organized screening program.

Support and negation of colorectal cancer risk prevention behaviors: analysis of spousal discussions

The shared social context created in a marriage may be important in motivating engagement in health behaviors, but spousal influence may not be uniformly applied. Our goal was to examine how spouses discuss health behaviors relevant for colorectal cancer (CRC) risk-reduction to better understand how spouses exert or fail to exert influence. In this pilot study, first degree relatives of CRC patients and their spouses completed demographic and self-reported health questionnaires. After a genetic counseling session regarding risk and risk reduction, couples engaged in a semi-structured discussion task to discuss lifestyle choices they currently undertake or could undertake to reduce risk. Demographic and health data was analyzed using descriptive statistics. Using a directed content analysis based on the transtheoretical model of behavior change, we coded discussion transcripts for depth and direction of talk for seven behavioral CRC risk factors. Spouses engaged in several strategies to reduce their risk for CRC, and problem-solved together to increase these preventative efforts. All couples mentioned diet and exercise as important factors in CRC risk; however, other risk factors received less attention. Despite evidence of support and encouragement, spouses ignored, minimized, or negated the importance of some health behaviors. Spousal influence could be an important tool to improve participation in health behaviors, but more guidance may be necessary to hold couples accountable to evidence-based guidelines to reduce risk. Health care providers should address couples as a unit to assess and address health behaviors.

PHS89 - Attitude And Willingness To Participate on Screening of First-Degree Relatives of Colorectal Cancer Patients

PHS89 - Attitude And Willingness To Participate on Screening of First-Degree Relatives of Colorectal Cancer Patients

Abstract 2556: Family history of colorectal cancer in half-siblings as important as in siblings

Abstract Background: None of population-based epidemiological studies to date have investigated the familial risk of colorectal cancer (CRC) in half-siblings. We aimed to compare lifetime (0-79 years) cumulative risk (LCR) and relative risk of CRC between siblings and half-siblings of patients with CRC. Methods: A nationwide cohort of first-degree relatives and half-siblings of CRC patients diagnosed in 1958-2012 were extracted from the Swedish Family-Cancer Database, the world's largest of its kind, with &amp;gt;15.7 million individual records. LCR as a tangible measure of absolute risk was also calculated. Standardized incidence ratios (SIRs) were adjusted for age, sex, period at diagnosis, and socioeconomic status. All family histories reported below are exclusive, meaning that risk reported for one affected half-sibling does not include those with both an affected half-sibling and any other first/second-degree relatives. Results: The overall LCR of CRC in siblings of a patient with CRC was 7.2% (8.3% in men; 6.0% in women), which represents 1.8-fold (95%CI = 1.7-1.1.9, n = 1333) increase over the risk in those without any family history of CRC (men 4.5%; women 3.4%). Similarly, significantly increased LCR (5.9%) was found among half-siblings of CRC patients (SIR = 1.7, 95%CI = 1.3-2.0, n = 88; maternal half-sibling: 1.6, 95%CI = 1.1-2.1; paternal half-sibling: 1.7, 95%CI = 1.3-2.3). If a parent and a half-sibling both had CRC, the risk in other half-siblings (SIR = 4.4, 95%CI = 2.8-6.5, n = 24) was closer to that of those with both an affected parent and an affected sibling (SIR = 3.2, 95%CI = 2.9-3.6, n = 281) rather than an affected parent alone (SIR = 1.6, 95%CI = 1.5-1.7, n = 4250). Highly increased risk of CRC was also found in those with two (SIR = 2.4, 95%CI = 1.8-3.1, n = 59) or three (SIR = 9.8, 95%CI = 5.1-17, n = 12) affected siblings, in twin brothers (SIR = 4.0, 95%CI = 2.2-6.6, n = 14), and presumably in men with two affected half-siblings (SIR = 5.3, 95%CI = 1.1-16, n = 3). Other second-degree relatives such as grandparents (SIR = 1.2, 95%CI = 1.1-1.3, n = 318), aunts/uncles (SIR = 1.3, 95%CI = 1.0-1.5, n = 107) without an affected first-degree relative showed minor contributions to the familial risk of CRC, but we found higher risks for those with both an affected first-degree relative and a grandparent (SIR = 3.2, 95%CI = 2.3-4.2, n = 46) or an aunt/uncle (SIR = 2.3, 95%CI = 1.2-4.0, n = 13). Conclusions: This study provides novel information, which is useful for the genetic counseling. In the cancer risk estimation for relatives of CRC patients, a family history of CRC in a half-sibling (even in the absence of an affected first-degree relative) is as important as a family history of CRC in a sibling. Citation Format: Mahdi Fallah, Elham Kharazmi, Kristina Sundquist, Hermann Brenner, Kari Hemminki. Family history of colorectal cancer in half-siblings as important as in siblings. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 2556.

Association Between Socioeconomic Status and Participation in Colonoscopy Screening Program in First Degree Relatives of Colorectal Cancer Patients.

BackgroundApproximately 15% to 25% of colorectal cancer (CRC) cases have positive family history for disease. Colonoscopy screening test is the best way for prevention and early diagnosis. Studies have found that first degree relatives (FDRs) with low socioeconomic status are less likely to participate in colonoscopy screening program. ObjectivesThe aim of this study is to determine the association between socioeconomic status and participation in colonoscopy screening program in FDRs.Patients and MethodsThis descriptive cross-sectional, study has been conducted on 200 FDRs who were consulted for undergoing colonoscopy screening program between 2007 and 2013 in research institute for gastroenterology and liver disease of Shahid Beheshti University of Medical Sciences, Tehran, Iran. They were interviewed via phone by a valid questionnaire about socioeconomic status. For data analysis, chi-square, exact fisher and multiple logistic regression were executed by SPSS 19.ResultsThe results indicated 58.5% participants underwent colonoscopy screening test at least once to the time of the interview. There was not an association between participation in colonoscopy screening program and socioeconomic status to the time of the interview in binomial analysis. But statistical significance between intention to participate and educational and income level were found. We found, in logistic regression analysis, that high educational level (Diploma and University degree in this survey) was a predictor to participate in colonoscopy screening program in FDRs.ConclusionsAccording to this survey low socioeconomic status is an important factor to hinder participation of FDRs in colonoscopy screening program. Therefore, planned interventions for elevation knowledge and attitude in FDRs with low educational level are necessary. Also, reducing colonoscopy test costs should be a major priority for policy makers.

Abstract B12: To screen or not to screen: Examining components of the Extended Parallel Process Model in a tailored-risk communication intervention to promote colorectal cancer screening

Abstract The Extended Parallel Process Model (EPPM) has been effectively used to promote healthy behaviors, but less is known about the effectiveness of the EPPM in promoting screening adherence in individuals at familial risk for colorectal cancer (CRC). The original EPPM model posits that an additive relationship exists between the constructs perceived severity and susceptibility (“threat”) and between perceived self- and response efficacy (“efficacy”). However, this model may not be as effective in predicting message acceptance in the context of CRC screening as these constructs may independently contribute to the model. For example, with CRC threat, there may be little variance in the perceived severity score as perceptions of cancer severity have been shown to be universally high. Likewise, one may have high levels of response efficacy (“Colonoscopy can save my life”) but low self-efficacy (“Without insurance I can't pay for a colonoscopy”) thus influencing efficacy scores. To determine the effectiveness of the EPPM in promoting CRC screening, we used data from the Family Colorectal Cancer Awareness and Risk Education Project (Family CARE), that tested a remote tailored-risk communication intervention aimed at individuals with familial risk for CRC. Intention-to-screen and medical record-verified colonoscopy (CS) were collected on 218 participants who received the personalized intervention. Using structural equation modeling (SEM), we examined associations of CRC threat and efficacy with greater message acceptance in a full additive model, and in an apriori alternative model in which perceived severity, susceptibility, self-efficacy and response efficacy acted as independent predictors. We considered indicators of good fit to be Root Mean Square Error of Approximation (RMSEA) &amp;lt;.08, Standardized Root Mean Residual (SRMR) &amp;lt;.08, and Comparative Fit Index (CFI) &amp;gt;.90. We compared the two models based on model fit indices, Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC), with the preferred model having lower AIC and BIC. SEM results indicated poor fit for the full additive EPPM model (RMSEA=0.109; SRMR=0.137; CFI 0.800) while the alternative model showed good fit (RMSEA=0.068; SRMR=0.063; CFI=0.933). Additionally, comparison of the two models indicated that the alternative model was a better fit than the full additive model (RMSEA=0.071; SRMR=0.108; CFI 0.918; AIC=11021; BIC=11332). Further, we found perceptions of susceptibility (B =0.321, p &amp;lt;.001) and self-efficacy (B=0.365, p&amp;lt;0.001) to be significantly associated with intention to screen, while severity (B=0.059, p=0.454) and response efficacy (B=-0.189, p=0.101) showed no significant association. Importantly, intention to screen was significantly associated with medically verified CS behavior (B=0.728, p&amp;lt;0.001). Relatives of CRC patients are at increased risk for the disease, yet screening rates remain low among these individuals despite the effectiveness of CS in both early detection and cancer prevention. Theory-based communication such as the EPPM that addresses multiple determinates of behavior may help promote CRC screening yet few studies have tested conceptual models with regard to an intervention's effect on psychosocial pathways and actual cancer screening behavior. Our results indicate that focusing on individuals' perceptions of CRC susceptibility and screening self-efficacy may more effectively contribute to CRC screening behavior. Noteworthy, we measured both intentions to screen and actual screening behavior. These findings uniquely contribute to the literature by providing evidence of the underlying theoretical psychosocial pathways of how a personalized health promotion intervention works in motivating CRC screening among individuals at increased familial risk. Citation Format: Wendy C. Birmingham, Man Hung, Watcharaporn Boonyasiriwat, Scott T. Walters, Antoinette M. Stroup, Marc D. Schwartz, Jeremy D. Franklin, Anita Y. Kinney. To screen or not to screen: Examining components of the Extended Parallel Process Model in a tailored-risk communication intervention to promote colorectal cancer screening. [abstract]. In: Proceedings of the Thirteenth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2014 Sep 27-Oct 1; New Orleans, LA. Philadelphia (PA): AACR; Can Prev Res 2015;8(10 Suppl): Abstract nr B12.

Effectiveness of the extended parallel process model in promoting colorectal cancer screening.

Relatives of colorectal cancer (CRC) patients are at increased risk for the disease, yet screening rates still remain low. Guided by the Extended Parallel Process Model, we examined the impact of a personalized, remote risk communication intervention on behavioral intention and colonoscopy uptake in relatives of CRC patients, assessing the original additive model and an alternative model in which each theoretical construct contributes uniquely. We collected intention-to-screen and medical record-verified colonoscopy information on 218 individuals who received the personalized intervention. Structural equation modeling showed poor main model fit (root mean square error of approximation (RMSEA) = 0.109; standardized root mean residual (SRMR) = 0.134; comparative fit index (CFI) = 0.797; Akaike information criterion (AIC) = 11,601; Bayesian information criterion (BIC) = 11,884). However, the alternative model (RMSEA = 0.070; SRMR = 0.105; CFI = 0.918; AIC = 11,186; BIC = 11,498) showed good fit. Cancer susceptibility (B = 0.319, p < 0.001) and colonoscopy self-efficacy (B = 0.364, p < 0.001) perceptions predicted intention to screen, which was significantly associated with colonoscopy uptake (B = 0.539, p < 0.001). Our findings provide support of the utility of Extended Parallel Process Model for designing effective interventions to motivate CRC screening in persons at increased risk when individual elements of the model are considered. Copyright © 2015 John Wiley & Sons, Ltd.

Colorectal cancer in Iran: Molecular epidemiology and screening strategies.

e12513 Background: The increasing incidence of colorectal cancer (CRC) in the past three decades in Iran has made it a major public health burden. This study aimed to report its epidemiologic features, molecular genetic aspects, survival, heredity and screening pattern in Iran. Methods: A comprehensive literature review was conducted to identify the relevant published articles. We used medical subject headings, including: colorectal cancer, molecular genetics, KRAS and BRAF mutations, screening, survival, epidemiologic study, and Iran. Results: Age Standardized Incidence Rate of Iranian CRCs was 11.6 and 10.5 for men and women, respectively. Overall five-year survival rate was 41%, and the proportion of CRC among the younger age group was higher than that of western countries. Depending on ethnicity, geographical region, dietary and genetic predisposition, mutation genes were considerably diverse and distinct among CRCs across Iran. The high occurrence of CRC in records of relatives of CRC patients showed...