Colorectal screening patterns and perceptions of risk among African-American users of a community health center

Colorectal Cancer Risk Perceptions Among Black Men in Florida

PURPOSE

We examined colorectal cancer (CRC) risk perceptions among Black men in relation to socio-demographic characteristics, disease prevention factors, and personal/family history of CRC.

METHODS

A self-administered cross-sectional survey was conducted in five major cities in Florida between April 2008 and October 2009. Descriptive statistics and multivariable logistic regression were performed.

RESULTS

Among 331 eligible men, we found a higher proportion of CRC risk perceptions were exhibited among those aged ≥ 60 years (70.5%) and American nativity (59.1%). Multivariable analyses found men aged ≥ 60 had three times greater odds of having higher CRC risk perceptions compared to those ≤ 49 years (95% CI = 1.51-9.19). The odds of higher CRC risk perception for obese participants were more than four times (95% CI = 1.66-10.00) and overweight were more than twice the odds (95% CI = 1.03-6.31) as compared to healthy weight/underweight participants. Men using the Internet to search for health information also had greater odds of having higher CRC risk perceptions (95% CI = 1.02-4.00). Finally, men with a personal/family history of CRC were ninefold more likely to have higher CRC risk perceptions (95% CI = 2.02-41.79).

CONCLUSION

Higher CRC risk perceptions were associated with older age, being obese/overweight, using the Internet as a health information source, and having a personal/family history of CRC. Culturally resonate health promotion interventions are sorely needed to elevate CRC risk perceptions for increasing intention to screen among Black men.

Patient and provider factors associated with colorectal cancer screening among average risk health plan enrollees in the US, 2015-2018

BACKGROUND

To assess patient and primary care provider (PCP) factors associated with adherence to American Cancer Society (ACS) and United States Preventive Services Task Force (USPSTF) guidelines for average risk colorectal cancer (CRC) screening.

METHODS

Retrospective case-control study of medical and pharmacy claims from the Optum Research Database from 01/01/2014 - 12/31/2018. Enrollee sample was adults aged 50 - 75 years with ≥ 24 months continuous health plan enrollment. Provider sample was PCPs listed on the claims of average-risk patients in the enrollee sample. Enrollee-level screening opportunities were based on their exposure to the healthcare system during the baseline year. Screening adherence, calculated at the PCP level, was the percent of average-risk patients up to date with screening recommendations each year. Logistic regression modelling was used to examine the association between receipt of screening and enrollee and PCP characteristics. An ordinary least squares model was used to determine the association between screening adherence among the PCP's panel of patients and patient characteristics.

RESULTS

Among patients with a PCP, adherence to ACS and USPSTF screening guidelines ranged from 69 to 80% depending on PCP specialty and type. The greatest enrollee-level predictors for CRC screening were having a primary/preventive care visit (OR = 4.47, p < 0.001) and a main PCP (OR = 2.69, p < 0.001).

CONCLUSIONS

Increased access to preventive/primary care visits could improve CRC screening rates; however, interventions not dependent on healthcare system contact, such as home-based screening, may circumvent the dependence on primary care visits to complete CRC screening.

Predictors of CRC Stage at Diagnosis among Male and Female Adults Participating in a Prospective Cohort Study: Findings from Alberta's Tomorrow Project

Colorectal cancer (CRC) is a leading cause of morbidity and mortality in Canada. CRC screening and other factors associated with early-stage disease can improve CRC treatment efficacy and survival. This study examined factors associated with CRC stage at diagnosis among male and female adults using data from a large prospective cohort study in Alberta, Canada. Baseline data were obtained from healthy adults aged 35–69 years participating in Alberta’s Tomorrow Project. Factors associated with CRC stage at diagnosis were evaluated using Partial Proportional Odds models. Analyses were stratified to examine sex-specific associations. A total of 267 participants (128 males and 139 females) developed CRC over the study period. Among participants, 43.0% of males and 43.2% of females were diagnosed with late-stage CRC. Social support, having children, and caffeine intake were predictors of CRC stage at diagnosis among males, while family history of CRC, pregnancy, hysterectomy, menopausal hormone therapy, lifetime number of Pap tests, and household physical activity were predictive of CRC stage at diagnosis among females. These findings highlight the importance of sex differences in susceptibility to advanced CRC diagnosis and can help inform targets for cancer prevention programs to effectively reduce advanced CRC and thus improve survival.

Failure of Colonoscopy Knowledge to Predict Colonoscopy Uptake

Despite an increase in colorectal cancer screening uptake, a substantial minority of individuals over 50 years of age remains unscreened. In the context of an RCT evaluating three educational interventions to increase CRC screening uptake, we examined the relationship of baseline colonoscopy knowledge and both intention to receive a colonoscopy and documented receipt of colonoscopy. Colonoscopy knowledge score, generally high, was positively associated with intention to receive colonoscopy but not with receipt of colonoscopy within 1 year post-randomization. Knowledge score was, however, positively associated with certain perceived barriers to colonoscopy: embarrassment and having to take a powerful laxative.

CONCLUSION

Knowledge is not sufficient to trigger colonoscopy uptake. If CRC screening promotion campaigns fail to acknowledge and address patients' emotional barriers to colonoscopy, CRC screening rates will not improve.

CLINICAL TRIALS

gov: Identifier: NCT02392143.

Perceptions of cancer risk and cause of cancer risk in korean adults

PURPOSE

The aims of the present study were to assess the prevalence of perceived risk for cancer; to explore associations between sociodemographics and family history of cancer and perceived cancer risk; to identify perceived cause of cancer risk; and to examine the associations between sociodemographics and family history of cancer and perceived cause of cancer risk.

MATERIALS AND METHODS

This cross-sectional study was conducted among 1,009 participants aged 30-69 years, selected from a population-based database in October 2009 through multiple-stratified random sampling. Information was collected about the participants' perceived cancer risk and perceived cause of cancer risk.

RESULTS

Overall, 59.5% of the respondents thought they had the chance of developing cancer. Female sex, younger age, lower income, and family history of cancer were positively associated with perceived cancer risk. The most important perceived cause of cancer risk was stress. There was a difference between sociodemographics and family history of cancer and perceived cause of cancer risk.

CONCLUSION

Factors affecting perceptions of cancer risk and cause of cancer risk need to be addressed in risk communications. The results provide important directions for the development of educational strategies to promote awareness and self-appraisal of cancer risk and risk factors.

Perceptions of risk among childhood and young adult cancer survivors who smoke

PURPOSE

Despite the fact that childhood and young adult cancer survivors are at increased risk for chronic health problems as a result of their cancer treatment, many use tobacco, thereby increasing their risks. Perceptions of risk related to tobacco use can be targeted for interventions aimed at improving health behaviors for childhood, adolescent, and young adult cancer survivors. Understanding the covariates of perceptions of health risks among young adult survivors who smoke will help to determine targets for intervention.

METHOD

Three hundred seventy-four participants who were diagnosed with cancer prior to age 35, currently between 18 and 55 years of age, and current smokers were recruited as part of a larger smoking cessation study, Partnership for Health-2 (PFH-2). Data were collected by telephone survey.

RESULTS

Overall, women had the highest perception of risk for serious health problems, a second cancer, and heart problems. Additionally, those participants who were dependent on nicotine endorsed that they were at higher risk of serious health problems and second cancers, but not heart problems. Finally, Hodgkin lymphoma survivors reported that they were at increased risk for second cancers and heart problems compared to their “healthy” peers.

CONCLUSION

Young adult cancer survivors who smoke correctly perceived some of their increased health risks. Additional motivation and education is needed for those young adult cancer survivors who perceive their increased health risks yet continue to smoke. Further education is needed for young survivors so they have a fully appropriate sense of risk, especially as it relates to their tobacco use.

Perceived cancer risk and risk attributions among African-American residents of a low-income, predominantly African-American neighborhood

OBJECTIVE

In some national surveys, African-Americans have had lower scores on perceived cancer risk items than whites. Our goals were to confirm low perceptions of cancer risk in an African-American community sample and explore participants' attributions for their perceived cancer risk.

DESIGN

Data were from three cross-sectional surveys. We report levels of perceived absolute and comparative cancer risk in a community sample of African-Americans (N = 88), and African-Americans (Ns = 655, 428) and whites (Ns = 5262, 1679) from two nationally representative Health Information National Trends Surveys (HINTS). We analyzed the content of spontaneously-provided explanations for perceived risk from the community sample.

RESULTS

Perceived absolute and comparative cancer risk were lower in the community and national samples of African-Americans than in the national sample of whites. Participants' spontaneous attributions for low or lower than average risk included not having family history or behavioral risk factors, classes of attributions noted elsewhere in the literature. However, participants also explained that they wanted to avoid wishing cancer on themselves (positive affirmations) and hoped their risk was low (wishful thinking), responses rarely reported for majority-white samples.

CONCLUSIONS

Results provide further evidence that cancer risk perceptions are lower among African-Americans than whites. Some participant explanations for low perceived risk (wishful thinking, affirmations) are inconsistent with behavioral scientists' assumptions about perceived risk questions. Results reveal a need to expand cancer risk attribution typologies to increase applicability to diverse populations, and may indicate that perceived cancer risk questions have lower validity in African-American populations.

Correlates of colorectal cancer screening among residents of Ohio Appalachia

There is an excess burden of colorectal cancer (CRC) in the Appalachian region of the United States, which could be reduced by increased uptake of CRC screening tests. Thus, we examined correlates of screening among Appalachian residents at average-risk for CRC. Using a population-based sample, we conducted interviews with and obtained medical records of Appalachian Ohio residents 51-75 years between September 2009 and April 2010. Using multivariable logistic regression, we identified correlates of being within CRC screening guidelines by medical records. About half of participants were within CRC screening guidelines. Participants who were older (OR = 1.04, 95 % CI 1.01, 1.07), had higher income ($30,000-$60,000, OR = 1.92, 95 % CI 1.29, 2.86; ≥$60,000, OR = 1.80, 95 % CI 1.19, 2.72), a primary care provider (OR = 4.22, 95 % CI 1.33, 13.39), a recent check-up (OR = 2.37, 95 % CI 1.12, 4.99), had been encouraged to be screened (OR = 1.57, 95 % CI 1.11, 2.22), had been recommended by their doctor to be screened (OR = 6.68, 95 % CI 3.87, 11.52), or asked their doctor to order a screening test (OR = 2.24, 95 % CI 1.36, 3.69) had higher odds of being screened within guidelines in multivariable analysis. Findings suggest that access to and utilization of healthcare services, social influence, and patient-provider communication were the major factors associated with CRC screening. Researchers and healthcare providers should develop and implement strategies targeting these barriers/facilitators to improve CRC screening rates and reduce the CRC burden among residents of Appalachia.

Decision Aid to Technologically Enhance Shared decision making (DATES): study protocol for a randomized controlled trial

BACKGROUND

Clinicians face challenges in promoting colorectal cancer screening due to multiple competing demands. A decision aid that clarifies patient preferences and improves decision quality can aid shared decision making and be effective at increasing colorectal cancer screening rates. However, exactly how such an intervention improves shared decision making is unclear. This study, funded by the National Cancer Institute, seeks to provide detailed understanding of how an interactive decision aid that elicits patient's risks and preferences impacts patient-clinician communication and shared decision making, and ultimately colorectal cancer screening adherence.

METHODS/DESIGN

This is a two-armed single-blinded randomized controlled trial with the target of 300 patients per arm. The setting is eleven community and three academic primary care practices in Metro Detroit. Patients are men and women aged between 50 and 75 years who are not up to date on colorectal cancer screening. ColoDATES Web (intervention arm), a decision aid that incorporates interactive personal risk assessment and preference clarification tools, is compared to a non-interactive website that matches ColoDATES Web in content but does not contain interactive tools (control arm). Primary outcomes are patient uptake of colorectal cancer screening; patient decision quality (knowledge, preference clarification, intent); clinician's degree of shared decision making; and patient-clinician concordance in the screening test chosen. Secondary outcome incorporates a Structural Equation Modeling approach to understand the mechanism of the causal pathway and test the validity of the proposed conceptual model based on Theory of Planned Behavior. Clinicians and those performing the analysis are blinded to arms.

DISCUSSION

The central hypothesis is that ColoDATES Web will improve colorectal cancer screening adherence through improvement in patient behavioral factors, shared decision making between the patient and the clinician, and concordance between the patient's and clinician's preferred colorectal cancer screening test. The results of this study will be among the first to examine the effect of a real-time preference assessment exercise on colorectal cancer screening and mediators, and, in doing so, will shed light on the patient-clinician communication and shared decision making 'black box' that currently exists between the delivery of decision aids to patients and subsequent patient behavior.

TRIAL REGISTRATION

ClinicalTrials.gov ID NCT01514786.

Exploration of risk taking behaviors and perceived susceptibility of colorectal cancer among Malaysian adults: a community based cross-sectional study

BACKGROUND

Perceived susceptibility to an illness has been shown to affect Health-risk behavior. The objective of the present study was to determine the risk taking behaviors and the demographic predictors of perceived susceptibility to colorectal cancer in a population-based sample.

METHODS

A cross-sectional study was carried out among 305 Malaysian adults in six major districts, selected from urban, semi-urban, and rural settings in one state in Malaysia. A self-administered questionnaire was used in this study. It was comprised of socio-demographics, risk-taking behaviors, and validated domains of the Health Belief Model (HBM).

RESULTS

The mean (± SD) age of the respondents was 34.5 (± 9.6) and the majority (59.0%) of them were 30 years or older. Almost 20.7% of the respondents felt they were susceptible to colorectal cancer. Self-reported perceived susceptibility mirrored unsatisfactory screening behaviors owing to the lack of doctors' recommendation, ignorance of screening modalities, procrastination, and the perception that screening was unnecessary. Factors significantly associated with perceived susceptibility to colorectal cancer were gender (OR = 1.8, 95% CI 1.0-3.3), age (OR = 2. 2, 95% CI 1.2-4.0), ethnicity (OR = 0. 3, 95% CI 0.2-0.6), family history of colorectal cancer (OR = 3. 2, 95% CI 1.4-7.4) and alcohol intake (OR = 3.9, 95% CI 2.1-7.5).

CONCLUSION

The present study revealed that screening behavior among respondents was unsatisfactory. Hence, awareness of the importance of screening to prevent colorectal cancers is imperative.

American Indian perceptions of colorectal cancer screening: viewpoints from adults under age 50

Colorectal cancer (CRC) mortality rates have decreased in the general US population; however, CRC mortality rates are increasing among American Indians (AI). AI CRC screening rates remain low when compared to other ethnic groups. Our team investigated CRC screening education prior to recommended age for screening to better understand screening perceptions among AI community members. Our research team conducted 11 focus groups with AI men and women aged 30-49 (N = 39 men and N = 31 women) in Kansas and Missouri. The results revealed that community members (1) have little knowledge of CRC, (2) do not openly discuss CRC, and (3) want additional CRC education. Variations existed among men and women's groups, but they agreed that preventive measures need to be appropriate for AI communities. Thus, AI CRC screening interventions should be culturally tailored to better meet the needs of the population.

Colon cancer screening in women

Colorectal cancer is the third leading cause of cancer-related deaths in women. Colorectal cancer is a preventable disease with accepted screening modalities that have been proven to save lives. As women are more likely than men to develop right-sided colon cancers, colonoscopy is the preferred screening test in women. Currently, women are less likely to undergo colorectal cancer screening than men. Frank discussions addressing the fear or embarrassment of endoscopic screening are important in helping women overcome these barriers. Enhanced education of both practitioners and patients targeted to improve colorectal cancer screening adherence will improve early diagnosis and patient survival.

Overweight and obese patients do not seem to adequately recognize their own risk for colorectal cancer

Being overweight is a risk factor for colorectal cancer; patients' adequate perception of their risk may lead to better involvement in management. The purpose of this study was to measure perception of risk for colorectal cancer in overweight and obese patients. A consecutive sample of overweight adult patients (n = 195) attending to nutritional counseling was submitted to clinical questionnaire addressing personal and family data, awareness about colorectal cancer risk factors, health status, and estimates of their own risk. Only 32% identified obesity among CCR risk factors. For 57% of participants, their own current BMI status did not confer any increased risk for CRC. Also, for half (46%) of the patients, their BMI status will not lead to an increased risk during lifetime. For 36%, an increased risk was accurately estimated as two or more. Accurate estimates tend to be made by older patients (p = 0.033), those with GI complaints (p = 0.040), or with familial history (p = 0.016). Even among patients attending to a nutritional consultation, only a third of patients seem to adequately consider their own overweight as a potential risk for colorectal cancer during lifetime.

PRACTICE IMPLICATIONS

health education programs concerning obesity must include colorectal cancer as a potential outcome for overweight patients.

Attitudes to colorectal cancer screening after reading the prevention information

Some of the biggest barriers to increase colorectal cancer screening are negative attitudes to screening tests. These negative attitudes might be evoked through reading cancer prevention information and impede the decision to get screened. Forty-two adults aged ≥50 years completed a 12-item attitude questionnaire after reading colorectal cancer prevention information. African-Americans perceived that others had higher cancer risk than themselves whereas Caucasians did not show the difference. Regardless of ethnicity and adherence to screening guidelines, no participants had strong feelings of fear and embarrassment. However, non-adherent Caucasians had higher anxiety than adherent Caucasians. The degree of negativity was not associated with intention to get screened in non-adherent participants. Adequate health literacy of participants may account for flat responses in negative attitudes. Further research in individuals with limited health literacy is recommended. Moreover, additional education about self-relevance of cancer risk is considered necessary to increase cancer awareness in African-Americans.

Perceived risk for cancer in an urban sexual minority

Lesbians, gay men, and bisexuals are a sexual minority experiencing elevated cancer risk factors and health disaparites, e.g., elevated tobacco use, disproportionate rates of infection with human immunodeficiency virus. Little attention has been paid to cancer prevention, education, and control in sexual minorities. This study describes cancer risk perceptions and their correlates so as to generate testable hypotheses and provide a foundation for targeting cancer prevention and risk reduction efforts in this high risk population. A cross-sectional survey of affiliates of a large urban community center serving sexual minority persons yielded a study sample of 247 anonymous persons. The survey assessed demographics, absolute perceived cancer risk, cancer risk behaviors, desired lifestyle changes to reduce cancer risk, and psychosocial variables including stress, depression, and stigma. Univariate and multivariate nonparametric statistics were used for analyses. The sample was primarily white non-Hispanic, middle-aged, and > 80% had at least a high school education. Mean values for absolute perceived cancer risk (range 0-100% risk), were 43.0 (SD = 25.4) for females, and for males, 49.3 (SD = 24.3). For females, although the multivariate regression model for absolute perceived cancer risk was statistically significant (P < .05), no single model variable was significant. For men, the multivariate regression model was significant (P < .001), with endorsement of "don't smoke/quit smoking" to reduce personal cancer risk (P < .001), and greater number of sexual partners (P = .054), positively associated with absolute perceived risk for cancer. This study provides novel data on cancer risk perceptions in sexual minorities, identifying correlates of absolute perceived cancer risk for each gender and several potential foci for cancer prevention interventions with this at-risk group.

Causal attribution among cancer survivors of the 10 most common cancers

In an attempt to understand and cope with their diagnosis, individuals with cancer may develop beliefs about the cause of their illness and these causal attributions may impact psychosocial adjustment. Connecticut participants (N = 775) from the American Cancer Society's Study of Cancer Survivors-I completed a self-administered questionnaire assessing beliefs of the cause of their cancer and if they had contemplated the question "why me?" regarding their diagnosis. Written causal belief responses were coded into thematic categories and defined as either in (modifiable) or out (fixed) of an individual's control. Using logistic regression, the authors examined associations between sociodemographic, clinical, and psychosocial measures and identifying modifiable causal attributions, as well as contemplating "why me." Most cancer survivors (78.2%) identified one or more causes. Lifestyle and biological factors were most common, whereas psychological factors were least common, with some variation by cancer type. After multivariate adjustment, only cancer type was associated with identifying modifiable causes. Participants who contemplated "why me" (47.5%) were more likely to be younger and reported a greater number of cancer-related problems. In conclusion, the majority of cancer survivors reported specific causal attributions, and many had contemplated "why me." Understanding and assessing causal attributions and more general existential questions regarding diagnosis could aid in our understanding of survivors' adjustment and psychosocial well-being. Additional research in large populations is also needed to determine if other characteristics are associated with identifying modifiable causal attributions and asking "why me."

Preferences for genetic and behavioral health information: the impact of risk factors and disease attributions

Increased availability of genetic risk information may lead the public to give precedence to genetic causation over behavioral/environmental factors, decreasing motivation for behavior change. Few population-based data inform these concerns. We assess the association of family history, behavioral risks, and causal attributions for diseases and the perceived value of pursuing information emphasizing health habits or genes. 1,959 healthy adults completed a survey that assessed behavioral risk factors, family history, causal attributions of eight diseases, and health information preferences. Participants' causal beliefs favored health behaviors over genetics. Interest in behavioral information was higher than in genetic information. As behavioral risk factors increased, inclination toward genetic explanations increased; interest in how health habits affect disease risk decreased. Those at greatest need for behavior change may hold attributions that diminish interest in information for behavior change. Enhancing understanding of gene-environment influences could be explored to increase engagement with health information.

Evaluating the impact of an educational intervention to increase CRC screening rates in the African American community: a preliminary study

BACKGROUND

Despite the acknowledged importance of colorectal cancer (CRC) screening and its proven prognostic benefit, African American men and women simultaneously possess the highest rates of CRC-related incidence and mortality (Swan et al. in Cancer 97(6):1528-1540, 2003) and lowest screening rates in the United States (Polite et al. in Med Clin N Am 89(4):771-793, 2005). Effective, targeted interventions that promote CRC screening for this community are therefore critical. The current study evaluated the impact of a print-based educational intervention on screening behavior and associated patient-based factors, including cancer-related knowledge, fatalism, worry, and decisional balance (pros-cons).

METHODS

One hundred and eighteen individuals (mean age = 56.08, SD = 5.58) who had not undergone screening were recruited from two health clinics in New York City. Each participant received educational print materials regarding the need for screening, the process of undergoing screening, and the benefits of regular CRC screening.

RESULTS

One in four individuals had undergone post-intervention screening at a three-month follow-up. Whereas all participants reported a decrease in cancer-related worry (p < .05), it was a decrease in fatalism (p < .05) and an increase in decisional balance (p < .05) that was associated with post-intervention screening behavior.

DISCUSSION

These preliminary results suggest that fatalistic beliefs and an individual's assessment of the benefits and barriers of screening may be critical in the decision to undergo CRC screening. Future interventions to increase CRC-screening rates for this community may be improved by focusing on these patient-based factors.

Resident physicians' perceptions of barriers and facilitators to colorectal cancer screening for African Americans

BACKGROUND

African Americans experience disproportionately higher morbidity and mortality from colorectal cancer (CRC), yet they complete screening at lower rates than Caucasians. While studies have identified barriers and facilitators to CRC screening among African Americans, no study has examined physician perceptions of these barriers.

OBJECTIVE

The purpose of this study was to determine how resident physicians view barriers and facilitators to CRC screening among their African American patients, and to compare residents' perceptions with barriers and facilitators that have been reported in studies with African Americans.

DESIGN

Both quantitative and qualitative data were obtained during in-depth interviews with 30 upper-year residents from an urban academic internal medicine program.

RESULTS

Residents recognized the low levels of awareness of CRC that have been reported among African American patients. The most common barriers reported by residents were lack of knowledge, fears, personal/social circumstances, and colonoscopy-specific concerns. Residents reported a need for increased education, increased public awareness, and easier scheduling as facilitators for screening. Residents failed to appreciate some key perceptions held by African Americans that have been documented to either impede or facilitate CRC screening completion, particularly the positive beliefs that could be used to overcome some of the perceived barriers.

CONCLUSIONS

Residents may be missing opportunities to more effectively communicate about CRC screening with their African American patients. Residents need more explicit education about African Americans' perceptions to successfully promote screening behaviors in this high-risk population.

Effectiveness of a patient- and practice-level colorectal cancer screening intervention in health plan members: design and baseline findings of the CHOICE trial

BACKGROUND

: Evidence-based interventions have been found effective in increasing colorectal cancer (CRC) screening. Translating these successful interventions into real world settings, such as health plans, can be challenging.

METHODS

: CHOICE (Communicating Health Options through Information and Cancer Education) is a controlled trial to test the effectiveness of a patient- and practice-level intervention to increase use of recommended CRC screening tests. The patient-level intervention was a patient decision aid and stage-targeted brochures, mailed to eligible health plan members, to provide information about CRC, available screening tests, and how to obtain CRC screening at their physicians' practices. The practice-level intervention was academic detailing to prepare practices to facilitate CRC testing once the patient was activated by the decision aid. Surveys and claims data will be used to assess CRC screening test completion.

RESULTS

: Thirty-two primary care practices in Florida and Georgia participated. The authors recruited 443 participating health plan members for the trial; 211 were patients in intervention practices, and 232 were in usual care practices. Study participants reflected an insured population; the majority were white and aged <60 years. The authors also mailed the intervention to 343 people from intervention practices who did not respond to the eligibility or baseline survey. Receipt of screening in that group will be compared with screening among 319 people from usual care practices who did not respond to these surveys using claims data.

CONCLUSIONS

: The CHOICE study will demonstrate the effect of 2 combined evidence-based interventions on CRC screening test completion among health plan members. Cancer 2010. (c) 2010 American Cancer Society.

Population-based prevalence estimates of history of colonoscopy or sigmoidoscopy: review and analysis of recent trends

BACKGROUND

Lower GI endoscopy, such as colonoscopy or sigmoidoscopy, is thought to have a substantial impact on colorectal cancer incidence and mortality through detection and removal of precancerous lesions and early cancers. We aimed to review prevalence estimates of history of colonoscopy or sigmoidoscopy in the general population and to analyze recent trends.

METHODS

A systematic review of the medical literature, including MEDLINE (1966 to August 2008) and EMBASE (1980 to August 2008), was undertaken, supplemented by searches of the European Health Interview & Health Examination Surveys database and bibliographies. Detailed age-specific and sex-specific prevalence estimates from the United States were obtained from the Behavioral Risk Factor Surveillance System surveys 2002, 2004, and 2006.

RESULTS

The search yielded 55 studies that met our inclusion criteria. The majority of the reports (43) originated from the United States. Other countries of origin included Australia (2), Austria (2), Canada (5), France (1), Germany (1), and Greece (1). Estimates from the United States were generally increasing over time up to 56% (2006) for lifetime use of colonoscopy or sigmoidoscopy in people aged 50 years and older. Analysis of national survey data showed higher prevalences among men aged 55 years and older than for women of the same age. Prevalences were highest for people aged 70 to 79 years.

CONCLUSION

Data from outside the United States were extremely limited. Prevalence estimates from the United States indicate that a considerable and increasing proportion of the population at risk has had at least 1 colonoscopy or sigmoidoscopy in their lives, although differences between age and sex groups persist. Prevalences of previous colonoscopy or sigmoidoscopy need to be taken into account in the interpretation of time trends in, and variation across, populations of colorectal cancer incidence and mortality.

Beliefs about the causes of breast and colorectal cancer among women in the general population

OBJECTIVE

To describe and compare the causal beliefs and attributions about breast and colorectal cancer among unaffected women in the general population.

METHODS

A total of 439 unaffected women in the general population were recruited to complete a web-based survey assessing causal beliefs for either breast (n = 211) or colorectal cancer (n = 228).

RESULTS

Heredity was ranked as the most important causal factor, followed by diet or eating habits for both cancer sites. Women endorsed the following causes of breast or colorectal cancer, respectively: heredity (84.4, 78.5%), diet or eating habits (46.4, 69.7%), pollution in the environment (57.6, 40.3%), aging (48.8, 57.5%), alcohol (29.9, 40.8%), smoking (58.3, 50.8%), stress (27.5, 29.4%), and lack of exercise (35.7, 44.3%). Other factors such as prior surgery on the breast (23.7%) and colon (32.9%) or changes in one's immune system (60.6%-breast; 59.2%-colon) were also endorsed by some women. Significant differences in the degree of endorsement for various causes of breast and colorectal cancer were identified.

CONCLUSIONS

Both genetic and environmental causes for breast and colorectal cancer are endorsed by unaffected women. Misconceptions about the causes of these cancers are important targets for public education and risk communication efforts.

Perceived risk for gastric cancer among the general Korean population: a population-based survey

OBJECTIVE

We measured the perceived risk for developing gastric cancer and investigated how a range of socio-demographic, lifestyle, health, and psychological factors were associated with risk perception in a population-based sample in Korea.

METHODS

This study was based on the 2006 Korean National Cancer Screening Survey conducted by the National Cancer Center, in which trained interviewers met face-to-face with participants selected by a nationally representative random sampling. The participants included 1673 adults, aged 40 years or older, who had not previously been diagnosed with cancer. Simple and multiple ordinal regression were used to determine the associations between perceived risk and socio-demographic, lifestyle, health, and psychological factors.

RESULTS

Almost half of the subjects (48.3%) thought their chance of developing gastric cancer was lower than that of other men or women of the same age. A higher level of worry concerning gastric cancer was strongly associated with a higher perceived risk for gastric cancer development. Those who drink alcohol two or more days per week, and who are unmarried all perceived their risk as being higher. However, those without a previous gastric cancer screening, a personal history of gastric disease, or a good overall health status had a lower perceived risk for gastric cancer development.

CONCLUSION

This study found comparative optimism about the risk for developing gastric cancer in a Korean population. It is necessary to increase people's ability to accurately perceive their risk for cancer.

Knowledge and barriers related to prostate and colorectal cancer prevention in underserved black men

OBJECTIVES

This qualitative study examined underserved black males' perspectives about prostate and colorectal cancer screening.

METHODS

Black male residents of Newark, NJ, > or =18 years of age, were recruited to participate in focus groups. Two groups were conducted with a total of 24 participants. Transcripts were analyzed using an immersion/crystallization approach.

RESULTS

Three major themes were identified, while men reflected on their experiences with prostate and colorectal cancer screening: (1) motivation for seeking screening; (2) fear associated with screenings: and (3) healthcare system barriers (e.g., patient-doctor relationships, insurance and mistrust of healthcare professionals). Participants also gave recommendations on how to increase preventive screening.

DISCUSSION

Fear and past experiences with healthcare serve as motivators and demotivators of preventive screening behavior. Interventions that address motivation and fear are recommended to increase preventive screening among this population.

Barriers to screening colonoscopy for low-income Latino and white patients in an urban community health center

BACKGROUND

Colonoscopy is a screening modality for the early detection of colonic polyps and cancers but is underutilized, particularly among minorities.

OBJECTIVE

To identify potential barriers to screening colonoscopy among low income Latino and white non-Latino patients in an urban community health center. DESIGN, PARTICIPANTS, AND APPROACH: We conducted semistructured interviews with a convenience sample of patients 53 to 70 years old, eligible for colorectal cancer screening that spoke English or Spanish. Open-ended questions explored knowledge, beliefs, and experience with or reasons for not having screening colonoscopy. We performed content analysis of transcripts using established qualitative techniques.

RESULTS

Of 40 participants recruited, 57% were women, 55% Latino, 20% had private health insurance, and 40% had a prior colonoscopy. Participants described a wide range of barriers categorized into 5 major themes: (1) System barriers including scheduling, financial, transportation, and language difficulties; (2) Fear of pain or complications of colonoscopy and fear of diagnosis (cancer); (3) Lack of desire or motivation, including "laziness" and "procrastination"; (4) Dissuasion by others influencing participants' decision regarding colonoscopy; and (5) Lack of provider recommendation including not hearing about colonoscopy or not understanding the preparation instructions.

CONCLUSIONS

Understanding of the range of barriers to colorectal cancer screening can help develop multimodal interventions to increase colonoscopy rates for all patients including low-income Latinos. Interventions including systems improvements and navigator programs could address barriers by assisting patients with scheduling, insurance issues, and transportation and providing interpretation, education, emotional support, and motivational interviewing.

Promotion of cancer family history awareness: Jameslink Cancer Risk Assessment Tool at community health fairs

This article examines the impact of providing personalized familial cancer risk assessments with the Jameslink Cancer Risk Assessment Tool. Users of the Jameslink (N = 166) at eight community health fairs completed a survey including demographic, psychosocial and behavioral variables to better understand responses to the Jameslink. No differences were found between whites and those of other races for variables of interest, indicating suitability of the Jameslink for diverse populations. Those with higher Jameslink-assessed risk had higher perceived risk of cancer. Approximately half (53.8%) reported that they would speak to their physician about their Jameslink-assessed risk. A regression found Jameslink-assessed risk, cancer worry, and perceived risk of cancer predicted intentions to speak to a physician about their risk. In addition, open-ended data provided suggestions to improve the Jameslink. Changes in content and format were suggested; however most were happy with the program and encouraged its promotion. The lack of findings for differences as a function of race bolsters the use of computerized Cancer Risk Assessment Tools in diverse communities. The positive feedback of users and the close association between cancer risk assessment, perceived risk, and intention to speak to a physician are supportive of continued use and development of Cancer Risk Assessment Tools in the community to promote awareness of cancer risk.

Accuracy of self-reported cancer-screening histories: a meta-analysis

BACKGROUND

Survey data used to study trends in cancer screening may overestimate screening utilization while potentially underestimating existing disparities in use.

METHODS

We did a literature review and meta-analysis of validation studies examining the accuracy of self-reported cancer-screening histories. We calculated summary random-effects estimates for sensitivity and specificity, separately for mammography, clinical breast exam (CBE), Pap smear, prostate-specific antigen testing (PSA), digital rectal exam, fecal occult blood testing, and colorectal endoscopy.

RESULTS

Sensitivity was highest for mammogram, CBE, and Pap smear (0.95, 0.94, and 0.93, respectively) and lowest for PSA and digital rectal exam histories (0.71 and 0.75). Specificity was highest for endoscopy, fecal occult blood testing, and PSA (0.90, 0.78, and 0.73, respectively) and lowest for CBE, Pap smear, and mammogram histories (0.26, 0.48, and 0.61, respectively). Sensitivity and specificity summary estimates tended to be lower in predominantly Black and Hispanic samples compared with predominantly White samples. When estimates of self-report accuracy from this meta-analysis were applied to cancer-screening prevalence estimates from the National Health Interview Survey, results suggested that prevalence estimates are artificially increased and disparities in prevalence are artificially decreased by inaccurate self-reports.

CONCLUSIONS

National survey data are overestimating cancer-screening utilization for several common procedures and may be masking disparities in screening due to racial/ethnic differences in reporting accuracy.

Evaluation of claims, medical records, and self-report for measuring fecal occult blood testing among medicare enrollees in fee for service

BACKGROUND

There is no agreement on the best data source for measuring colorectal cancer (CRC) screening. Medicare claims have been used to measure CRC testing but the validity of using claims to measure fecal occult blood tests (FOBT) has not been established.

METHODS

We compared ascertainment of FOBT among three data sources: self-reports, Medicare claims, and medical records. Data were collected on FOBT use during the study window (1/1/1998 - 12/31/2002). Our study was conducted with North Carolina Medicare enrollees (N = 561) who had previously responded to a telephone survey on CRC tests. FOBT information was abstracted from respondents' physician office medical records and compared with self-reported FOBT use and Medicare claims for FOBT. Data sources were assessed for accuracy and completeness of FOBT reporting using sensitivity, specificity, positive predictive value, negative predictive value, and agreement.

RESULTS

Reporting of FOBT use in the prior year in medical records and Medicare claims agreed 82% of the time [95% confidence interval (95% CI), 79-85%]. FOBT 1-year use rates from self-report agreed with test use found in medical records 70% of the time (95% CI, 66-74%). The lowest agreement was between self-reported 1-year FOBT use and Medicare claims, which agreed 67% of the time (95% CI, 63-71%).

CONCLUSIONS

No data source could be established as providing complete and valid information about FOBT use among Medicare enrollees, showing the difficulty of ascertaining test use rates for noninvasive, low-cost procedures conducted in multiple settings. Caution should be used when attempting to measure FOBT use with self-report, Medicare claims, or medical records.

Validity of four self-reported colorectal cancer screening modalities in a general population: differences over time and by intervention assignment

Little is known about the validity of self-reported colorectal cancer screening. To date, few published studies have validated all four screening modalities per recommended guidelines or included a general population-based sample, and none has assessed validity over time and by intervention condition. To estimate the validity of self-reported screening, a random sample of 200 adults, ages > or =50 years, was selected from those completing annual surveys on screening behavior as part of an intervention study. Approximately 60% of the validation sample authorized medical record review. Sensitivity, specificity, and positive and negative predictive values were calculated for baseline and year 1 follow-up reports for each test and for overall screening adherence. Sensitivity at baseline ranged from 86.9% (flexible sigmoidoscopy) to 100% (colonoscopy). Sensitivity at follow-up was slightly lower. Adjusting for validity measures, the sample overreported screening prevalence at baseline for each of the four modalities. At follow-up, overreporting was greatest for fecal occult blood test (13.0%). Overreporting across intervention conditions was highest for fecal occult blood test (10.8% for control; 24.8% for the most intense intervention) and overall screening adherence (10.9% for control; 14.3% for the most intense intervention). Sensitivity and specificity of self-reported colorectal cancer screening compared with medical records were high; however, adjusting self-reported screening rates based on relative error rates reduced screening prevalence estimates. Those exposed to more intense interventions to modify screening behavior seemed more likely to overestimate their screening rates compared with those who were not exposed.

Validation of self-reported colorectal cancer screening behavior from a mixed-mode survey of veterans

OBJECTIVE

The aim of the study was to validate self-reported colorectal cancer (CRC) screening using the National Cancer Institute Colorectal Cancer Screening questionnaire.

MATERIALS AND METHODS

890 patients, ages 50 to 75 years, from the Minneapolis Veterans Affairs (VA) Medical Center were surveyed by mail. Phone administration was attempted with mail nonresponders. VA and non-VA records were combined for the reference standard. Sensitivity, specificity, concordance, and report-to-records ratio (R2R) were estimated for overall and test-specific CRC adherence among respondents providing complete medical records. Secondary analyses examined variation in estimates by patient characteristics, treatment of missing and uncertain responses, and whether a strict or liberal time interval was used for assessing concordance.

RESULTS

Complete medical records were available for 345 of the 686 survey responders. For overall adherence, sensitivity was 0.98, specificity was 0.59, concordance was 0.88, and R2R was 1.14. Sensitivity was 0.82 for fecal occult blood test (FOBT), 0.75 for sigmoidoscopy, 0.97 for colonoscopy, and 0.63 for double-contrast barium enema (DCBE). Specificity was 0.89 for FOBT, 0.76 for sigmoidoscopy, 0.72 for colonoscopy, and 0.85 for DCBE. Concordance was >0.80 for all tests other than sigmoidoscopy (0.76). R2R was 1.31 for FOBT, 1.33 for sigmoidoscopy, 1.42 for colonoscopy, and 6.13 for DCBE. The R2R was lower for a combined sigmoidoscopy and colonoscopy measure. Overreporting was more pronounced for older, less-educated individuals with no family history of CRC. Sensitivity and R2R improved using a liberal interval and treating uncertain responses as nonadherent (versus missing), but differences were not statistically significant.

CONCLUSIONS

Self-reported CRC screening validity is generally acceptable and robust across definitional decisions, but varies by screening test and patient characteristics.

Has the surge in media attention increased public awareness about colorectal cancer and screening?

The Centers for Disease Control and Prevention's Screen for Life campaign in March 1999 followed by the creation of National Colorectal Cancer Awareness Month in March 2000 heralded a surge in media attention to promote awareness about CRC and stimulate interest in screening. Our objective was to assess whether these campaigns have achieved their goal of educating the public about CRC and screening. The study sample was comprised of mostly unscreened, average-risk, English-speaking patients aged 50-75 years seen in an urban primary care setting. Knowledge was assessed using a 12-item true/false questionnaire based primarily on the content of key messages endorsed by the National Colorectal Cancer Roundtable (Cancer 95:1618-1628, 2002) and adopted in many of the media campaigns. Multiple linear regression was performed to identify demographic correlates of knowledge. A total of 356 subjects (83% <age 65, 58% female, 60% Black, 7% Hispanic, 60% <or=high school degree, 31% prior FOBT ) were surveyed. Most respondents (>or=67%) were aware of who gets CRC, age to initiate screening, the goals of screening and potential benefits. Fewer were aware that removing polyps can prevent CRC and that both polyps and CRC may be asymptomatic. Knowledge scores were lower among Blacks and those with a high school degree or less. Race and education were independent correlates of knowledge. These data suggest that recent media campaigns have been effective in increasing public awareness about CRC risk and screening but important gaps in knowledge remain.

Prevalence of colorectal cancer testing and screening in a multiethnic primary care population

Colorectal cancer (CRC) screening is strongly supported by evidence and widely recommended, but remains underutilized. This study reports the prevalence of CRC diagnostic testing and CRC screening in three racial/ethnic groups attending the same primary care clinic. A cross-sectional survey was conducted to elicit past history of CRC testing, including test type, indication and timing. A comparable number of African American, Hispanic and non-Hispanic white patients aged 50-80 were recruited. 560 surveys were completed: mean age was 63.4 years, 64% reported minority race/ethnicity, and 96.8% had insurance. Overall, 62.5% [95% CI: 58.5%, 66.5%] of patients were current with any type of CRC test, when diagnostic and screening procedures were included. However, 48.6% [95% CI: 44.5%, 52.7%] of the sample was current with CRC screening, when only procedures performed for screening in asymptomatic patients were included. Patients least likely to be current with testing were those of minority race/ethnicity (48.2% of Hispanics, 56.7% of African Americans and 67.5% of non Hispanic whites, p < 0.05), younger age, (57.6% of those aged 50-64, and 71.4% of those aged 65-80, p < 0.005), and those with private insurance alone (56.0% private, 67.7% public and 68.1% mixed, p < 0.05). Our findings indicate that racial/ethnic and age related disparities in CRC screening exist even in a patient population that has the same source of health care and no differences in insurance status. These results underline the need for providers to emphasize CRC screening in their practices to minority patients and those younger than 65 years of age.

Workplace colorectal cancer-screening awareness programs: an adjunct to primary care practice?

Although regular screening can decrease morbidity and mortality from colorectal cancer, screening rates nationwide are suboptimal due to a lack of organized screening programs. Since workplace colorectal cancer-awareness programs can potentially mitigate both patient and physician barriers to screening, we assessed the workplace as a venue for implementing a colorectal cancer screening-awareness program. In this cross-sectional study, 3756 members of the Toronto Police Service attended an education session about colorectal cancer; 965 of these members gave their informed consent and completed a 5-item colorectal cancer risk-assessment questionnaire. Nearly one-third (30.9%, or 298/965) of this relatively young population (83.1%, or 802/965, < 50 years of age) were at average or above-average risk for colorectal cancer. In the Toronto Police Service population, the workplace was a useful adjunct to reliance on primary care physicians to raise awareness about this important public health issue. These findings should encourage the development of further Canadian workplace colorectal cancer-screening awareness programs.

Perceived risk of colorectal cancer: sources of risk judgments

Perceived risk of disease plays a key role in health behaviors, making it an important issue for cancer-preventive behavior research. This study describes studies using complimentary methodologies to investigate the determinants of perceived risk of developing colorectal cancer. In study 1, questionnaires were mailed to a community sample of 1,056 adults ages 45 to 65 years. They assessed risk factors for colorectal cancer and perceived risk of colorectal cancer and asked respondents to explain why they had rated their risk as they had. Consistent with previous studies, risk factors for colorectal cancer were significantly correlated with perceived risk, although associations were relatively weak. The most frequently cited reasons for risk judgments were diet, family history, and symptoms/general health. Not surprisingly, correlations between each risk factor and perceived risk were stronger among participants who had attributed their risk to that factor. Study 2 used semi-structured interviews to explore individuals' explanations for their perceived risk of colorectal cancer. Adults (n = 18) ages 60 to 63 years volunteered a variety of explanations, but their experiences of cancer seemed to be most salient to their risk estimates. These studies suggest that attributions people make for their risk judgments are important in understanding how they conceptualize risk, but appreciation of experiential and affective influences may be useful in fully understanding perceptions of risk.

Early initiation of colorectal cancer screening in individuals with affected first-degree relatives

BACKGROUND

Several guidelines recommend initiating colorectal cancer screening at age 40 for individuals with affected first-degree relatives, yet little evidence exists describing how often these individuals receive screening procedures.

OBJECTIVES

To determine the proportion of individuals in whom early initiation of colorectal cancer screening might be indicated and whether screening disparities exist.

DESIGN

Population-based Supplemental Cancer Control Module to the 2000 National Health Interview Survey.

PARTICIPANTS

Respondents, 5,564, aged 40 to 49 years were included within the analysis.

MEASUREMENTS

Patient self-report of sigmoidoscopy, colonoscopy, or fecal occult blood test.

RESULTS

Overall, 279 respondents (5.4%: 95% C.I., 4.7, 6.2) reported having a first-degree relative affected with colorectal cancer. For individuals with a positive family history, 67 whites (27.9%: 95% C.I., 21.1, 34.5) and 3 African American (9.3%: 95% C.I., 1.7, 37.9) had undergone an endoscopic procedure within the previous 10 years (P-value = .03). After adjusting for age, family history, gender, educational level, insurance status, and usual source of care, whites were more likely to be current with early initiation endoscopic screening recommendations than African Americans (OR = 1.38: 95% C.I., 1.01, 1.87). Having an affected first-degree relative with colorectal cancer appeared to have a stronger impact on endoscopic screening for whites (OR = 3.21: 95% C.I., 2.31, 4.46) than for African Americans (OR = 1.05: 95% C.I., 0.15, 7.21).

CONCLUSIONS

White participants with a family history are more likely to have endoscopic procedures beginning before age 50 than African Americans.

Colorectal cancer prevention: adherence patterns and correlates of tests done for screening purposes within United States populations

BACKGROUND

Studies exploring CRC testing prevalence and correlates within US populations have provided limited and sometimes conflicting information. The most recent national-level reports have described US usage of CRC tests but none have considered only those tests done specifically for screening reasons as an outcome variable.

METHODS

Using the NHIS 2000 sample of >or=50 year-old, we assessed screening behavior using an outcome variable accounting for (1) any combination of recommended tests (2) done within their respective time guidelines, and (3) specifically for screening purposes.

RESULTS

Only 25.8% (95% CI: 24.9-26.7%) of the population reported getting a test done for screening purposes within the recommended time. Most (>85%) of the FOBTs and only about 60% of endoscopies were done for screening. Among those who had an endoscopy within the recommended time, Blacks were more likely than Whites to report screening as the purpose of the test. Hispanics had the lowest test usage irrespective of test time, reason or type. Hispanics were 50% (p<0.001) less likely to be adherent, and Blacks approximately 22% (p<0.01) less likely to be adherent, than Whites. After multivariate adjustment, differences between Whites and Blacks disappeared; Hispanics remained less likely. Increasing education predicted higher adherence among Whites but only undergraduate completion did so among Blacks. Male gender predicted adherence only among Blacks and insurance only among Hispanics.

CONCLUSIONS

Preventive screening for CRC is lower than estimates from previous studies. Future studies should consider accounting for test purpose. Our findings need confirmation through studies based on objective data.

Gastroenterologists utilize the referral for EGD to enhance colon cancer screening more effectively than primary care physicians

BACKGROUND

Colorectal cancer screening rates among patients with upper gastrointestinal symptoms undergoing oesophagogastroduodenoscopy have not been previously established. We hypothesize that gastroenterologists seize this opportunity more frequently than primary care providers.

AIMS

To assess colorectal cancer screening rates at the time of direct access oesophagogastroduodenoscopy and gastrointestinal clinic evaluation for upper gastrointestinal symptoms. To compare rates in the 6 months following the oesophagogastroduodenoscopy in both cohorts of patients.

METHODS

Retrospective review. primary care physician group: direct access oesophagogastroduodenoscopy (n = 247) vs. gastrointestinal group (n = 278). Multivariable regression analysis utilized to assess predictors of screening outcome.

RESULTS

Colorectal cancer screening at the time of referral was 54%. Among the 243 unscreened patients, an additional 29% in the primary care physician group vs. 59% in the gastrointestinal group completed colorectal cancer screening in 6 months of follow-up. Nearly 60% patients evaluated in gastrointestinal clinic for upper symptoms had documented discussion, and 99% of those patients underwent colonoscopy (P < 0.001). Gastrointestinal consultation increased the probability of colorectal cancer screening completion eightfold (95% CI 3.69-18.96).

CONCLUSIONS

At the time of evaluation for upper symptoms, half of patients were not current with colorectal cancer screening recommendations. Referrals for the direct access oesophagogastroduodenoscopy and, more importantly, the gastroenterology consult represent key opportunities for colorectal cancer screening education and improved compliance.

Physician and patient influences on the rate of colorectal cancer screening in a primary care clinic

BACKGROUND

Colorectal cancer (CRC) screening rates remain low, despite widespread recommendations. The study purpose was to ascertain whether lack of CRC screening is attributable to physicians' failure to address CRC screening or to patients' failure to comply with physician recommendation. This relationship was also examined over time.

METHODS

Retrospective chart review of 400 preventive health visits.

RESULTS

Physicians appropriately addressed screening 16.5% of the time during 1998-1999 and 51% of the time during 2002-2003 (P <or= .001). The rate of test completion by patients was 53% in 1998-1999 and 31% in 2002-2003, resulting in completed CRC screening rates of 5% and 16.5%, respectively (P <or= .001).

CONCLUSIONS

Further education is needed, especially to target patient barriers to CRC screening test completion.

Predictors of perceived risk for colon cancer in a national probability sample in the United States

This study examines potential predictors of perceived risk for colon cancer in a U.S. sample of 2,949 individuals aged 45 and older with no colon cancer history. We examined perceived comparative risk for colon cancer as the outcome in ordinal regression analyses, and perceived absolute risk for colon cancer in linear regression analyses. Potential predictors included demographics, current risk behaviors, self-reported health, family and personal cancer history, emotion variables (colon cancer worry, general anxiety, and fear of positive screening findings), general cancer beliefs (causes, lack of preventability, information overload), and cancer information seeking. Those who had poorer self-reported health, a family cancer history, and increased colon cancer worry had higher perceived comparative and absolute colon cancer risk (all ps < .05). Those who were younger, interviewed in Spanish, had increased anxiety, and information overload had higher comparative risk; those with a personal history of cancer and fear that colon cancer screening would result in positive findings had higher absolute risk (all ps < .05). We determined that older individuals, those with risk factors, and those with good subjective health may not realize their colon cancer risk. Those distressed about colon cancer and who report cancer prevention information overload may require different messages.

Knowledge and perceptions of colorectal cancer screening among urban African Americans

OBJECTIVE

To explore colorectal cancer (CRC) screening knowledge, attitudes, barriers, and preferences among urban African Americans as a prelude to the development of culturally appropriate interventions to improve screening for this group.

DESIGN

Qualitative focus group study with assessment of CRC screening preferences.

SETTING

Community health center serving low-income African Americans.

PARTICIPANTS

Fifty-five self-identified African Americans over 40 years of age.

MEASUREMENTS AND MAIN RESULTS

Transcripts were analyzed using an iterative coding process with consensus and triangulation on final thematic findings. Six major themes were identified: (1) Hope--a positive attitude toward screening, (2) Mistrust--distrust that the system or providers put patients first, (3) Fear--fear of cancer, the system, and of CRC screening procedures, (4) Fatalism--the belief that screening and treatment may be futile and surgery causes spread of cancer, (5) Accuracy--a preference for the most thorough and accurate test for CRC, and (6) Knowledge--lack of CRC knowledge and a desire for more information. The Fear and Knowledge themes were most frequently noted in transcript theme counts. The Hope and Accuracy themes were crucial moderators of the influence of all barriers. The largest number of participants preferred either colonoscopy (33%) or home fecal occult blood testing (26%).

CONCLUSIONS

Low-income African Americans are optimistic and hopeful about early CRC detection and believe that thorough and accurate CRC screening is valuable. Lack of CRC knowledge and fear are major barriers to screening for this population along with mistrust, and fatalism.

Predictors of fecal occult blood test (FOBT) completion among low-income adults

BACKGROUND

Fecal occult blood testing (FOBT) can reduce colorectal cancer (CRC) mortality. Unfortunately, CRC screening is underutilized. Sociocultural mediators of FOBT adherence have not been extensively studied in lower income, minority populations. This study prospectively studied FOBT return in a low-income, multiethnic population.

METHODS

Participants (N = 298), aged > or =40 years, were surveyed and given FOBT kits with instructions. Those not returning kits within 30 days received a reminder telephone call. Bivariate and multivariate analyses assessed predictors of FOBT card return at 90 days.

RESULTS

Participants (median age = 48) were predominately African American (69%), without private insurance (88%), and of low income. The largest group of participants preferred FOBT alone (46%), followed by whatever my doctor recommends (19%), endoscopy + annual FOBT (16%), endoscopy alone (14%), and no screening (5%). In multivariate analyses, FOBT return was predicted by age (OR = 1.05) and lack of reported FOBT barriers (OR = 3.81). Among those > or =50 and not up-to-date with screening, FOBT return was predicted by cancer fatalism (OR = 0.83). FOBT barriers were associated with age (OR = 0.96), less than high school education (OR = 2.05), and less physician trust (OR = 2.12). Endoscopy barriers were associated with age (OR = 0.93), less physician trust (OR = 1.95), and female gender (OR = 3.45).

CONCLUSIONS

Younger individuals and those with less education, less trust in health care providers, and more fatalistic beliefs are at risk for CRC screening non-adherence. Strategies addressing common misconceptions should improve CRC screening rates in low-income, multiethnic populations.

Colorectal cancer screening: physician recommendation is influential advice to Marylanders

BACKGROUND

In comparison to the United States, Maryland is facing a significantly higher burden of colorectal cancer incidence and mortality. The primary objective of this study was to determine the predictors of colorectal cancer screening use in Maryland.

METHODS

We performed secondary analyses on Maryland Cancer Survey 2002 data from 2994 respondents to investigate important predictors for individual colorectal cancer screening tests. CRC screening outcomes were defined as (1) FOBT within the past year, (2) sigmoidoscopy within the past 5 years, or (3) colonoscopy within the past 10 years.

RESULTS

We found that clinician recommendation for a screening test is the best predictor in both age categories (50-64 years and 65+ years); it is a very strong indicator and consistently improves the odds of use by a factor of at least 8 for any screening test.

CONCLUSIONS

There remains a great need for improved colorectal cancer screening in Maryland. According to our results, it is clear that the most influential way to improve overall colorectal cancer screening for each test and both age groups is to increase clinician recommendation for these tests.

Factors associated with colon cancer screening: the role of patient factors and physician counseling

BACKGROUND

The prevalence of colon cancer screening is nationally low. The relative contribution of patient factors and physician counseling patterns to the low prevalence of screening is unclear.

METHODS

We used multivariable analysis to examine the prevalence of colon cancer screening nationally and the reasons for this low prevalence using data from the 2000 National Health Interview Survey, a nationally generalizable survey of US households.

RESULTS

Among 11,427 respondents to the Cancer Control Supplement, 16% reported annual fecal occult blood testing (FOBT) and 29% reported having undergone a sigmoidoscopy in the last 5 years or a colonoscopy in the last 10 years. After adjusting for age, sex, body mass index (BMI), healthcare access, and region of the country, Hispanics were less likely to undergo FOBT [OR 0.7 (95% CI 0.6-0.9)] and sigmoidoscopy or colonoscopy [OR 0.8 (95% CI 0.7-0.9)] compared to Whites. Respondents with lower education levels were also less likely to undergo screening. These factors were not associated with being less adherent to physician recommendations for screening. Nevertheless, non-Whites and those less educated were less likely to receive counseling from their health provider about colon cancer screening. Among respondents who did not undergo FOBT, 64% were unaware they needed the test; only 2% cited pain and discomfort as a deterrent, but 94% were not counseled by their physician about the test. Among those who did not undergo sigmoidoscopy or colonoscopy, 72% were unaware that they needed the test and only 1% was deterred by pain and discomfort; 92% were not counseled by their physician.

CONCLUSION

The low prevalence of screening for colorectal cancer appears to be due to lack of awareness and inadequate provider counseling rather than poor patient acceptance for screening. Systematic counseling about colorectal cancer screening will likely improve screening rates and reduce disparities by race/ethnicity and education.

Test-retest reliability of colorectal testing questions on the Massachusetts Behavioral Risk Factor Surveillance System (BRFSS)

BACKGROUND

Information on use of colorectal cancer tests, particularly for the purpose of population surveillance, is often obtained through self-report. The Behavioral Risk Factor Surveillance System (BRFSS) is a major source for population-based estimates and is used by health professionals, public health organizations, and researchers to identify and quantify self-reported utilization of screening procedures.

METHODS

We provide estimates of the reliability of responses among persons age > or = 50 to questions on the 1999 BRFSS questionnaire addressing two colorectal cancer testing procedures, fecal occult blood test (FOBT), and sigmoidoscopy or colonoscopy (endoscopy), based on responses of 868 persons who responded to a callback survey.

RESULTS

We found moderate reliability for questions addressing ever having an FOBT exam, (Kappa [K] = 0.55, 95% confidence interval [95% CI]: 0.49-0.61) and good reliability for questions addressing ever having an endoscopy exam (K = 0.69, 95% CI: 0.65-0.74). Questions addressing the timing of the most recent exam were only slightly less reliable (K = 0.49, 95% CI: 0.43-0.55 and K = 0.62, 95% CI: 0.57-0.67, respectively). We observed comparable reliability across levels of most demographic and risk factor characteristics for both ever having and recency of exam.

CONCLUSION

Our results suggest that colorectal cancer testing questions on the BRFSS display a reasonable level of test-retest reliability.

Social Ties and Colorectal Cancer Screening among Blacks and Whites in North Carolina

Few studies have examined the relationship between social networks and colorectal cancer screening in diverse populations. Prior research suggests that the type of social support as well as the amount or frequency of support available from one's social network may be associated with health outcomes. Therefore, the current study examined relationships between both structural (i.e., quantitative aspects of the social network, such as number of ties and frequency of contact with ties) and functional (i.e., functions provided by social network ties, such as offering emotional or instrumental support) aspects of social ties and utilization of colorectal cancer screening tests. Analyses included 697 randomly selected Blacks and Whites ages 51 to 80 years enrolled as controls in the North Carolina Colon Cancer Study. Social tie and screening information was obtained from face-to-face interviews. Forty-seven percent of participants (40% Blacks and 51% Whites) reported use of one of the options for colorectal cancer screening according to the guidelines at that time. Compared with those with the fewest social connections, those who were most socially connected were more likely to report recent use of colorectal cancer screening [odds ratio (OR), 3.2; 95% confidence interval (95% CI), 1.7-6.2]. This association was stronger among Blacks (OR, 3.8; 95% CI, 1.3-10.7) than Whites (OR, 2.9; 95% CI, 1.2-6.9; P for interaction = 0.006). There were also positive associations between being a church group (OR, 1.9; 95% CI, 1.4-2.7) and other group member (OR, 1.6; 95% CI, 1.1-2.2) and screening. Neither emotional (e.g., offering reassurance that one is cared for) nor instrumental (e.g., giving material assistance) support was associated with screening behavior. These data suggest that structural rather than functional aspects of social ties may be important in influencing colorectal cancer screening behavior.