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Chronic Constipation as a Risk Factor for Colorectal Cancer: Results From a Nationwide, Case-Control Study. Clin Gastroenterol Hepatol 2022; 20:1867-1876.e2. [PMID: 34687968 PMCID: PMC9018894 DOI: 10.1016/j.cgh.2021.10.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/12/2021] [Accepted: 10/14/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Prolonged colon transit times may increase the contact time between potential carcinogens in the stool and the colonic mucosa. Nonetheless, previous studies have yielded conflicting results connecting chronic constipation with the risk of colorectal cancer (CRC). We examined the association between chronic constipation and later CRC. METHODS In this nationwide case-control study, we identified 41,299 CRC cases by colorectal biopsy in Sweden between July 2007 and December 2016 and matched them to 203,181 age- and sex-matched controls from the general population. We compared odds of earlier chronic constipation (defined as ≥2 laxative prescriptions in the Prescribed Drug Register with ≥6 months between the first and last prescription) between CRC cases and controls using logistic regression. In separate analyses, we compared odds of earlier constipation between CRC cases and sibling comparators, but also examined earlier risk of having an inpatient/outpatient specialty diagnosis of chronic constipation before CRC. RESULTS Overall, 3943 patients with CRC met our criteria for chronic constipation before CRC. The crude proportion of chronic constipation in CRC patients was 9.5% compared with 8.8% in controls. After multivariable adjustment, there was a modest association between chronic constipation and later CRC (odds ratio [OR], 1.10; 95% CI, 1.06-1.14) that vanished using sibling comparators to control for residual confounding (OR, 1.04; 95% CI, 0.97-1.13). In a sensitivity analysis of 126,650 CRC patients diagnosed from 1989 to 2016, we found no association with earlier chronic constipation diagnosed in inpatient/outpatient specialty clinics (OR, 0.88; 95% CI, 0.75-1.04). CONCLUSIONS In a nationwide case-control study, chronic constipation was not associated with later CRC.
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Conran CA, Shi Z, Resurreccion WK, Na R, Helfand BT, Genova E, Zheng SL, Brendler CB, Xu J. Assessing the clinical utility of genetic risk scores for targeted cancer screening. J Transl Med 2021; 19:41. [PMID: 33482857 PMCID: PMC7821544 DOI: 10.1186/s12967-020-02699-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/31/2020] [Indexed: 02/08/2023] Open
Abstract
Background Genome-wide association studies have identified thousands of disease-associated single nucleotide polymorphisms (SNPs). A subset of these SNPs may be additively combined to generate genetic risk scores (GRSs) that confer risk for a specific disease. Although the clinical validity of GRSs to predict risk of specific diseases has been well established, there is still a great need to determine their clinical utility by applying GRSs in primary care for cancer risk assessment and targeted intervention. Methods This clinical study involved 281 primary care patients without a personal history of breast, prostate or colorectal cancer who were 40–70 years old. DNA was obtained from a pre-existing biobank at NorthShore University HealthSystem. GRSs for colorectal cancer and breast or prostate cancer were calculated and shared with participants through their primary care provider. Additional data was gathered using questionnaires as well as electronic medical record information. A t-test or Chi-square test was applied for comparison of demographic and key clinical variables among different groups. Results The median age of the 281 participants was 58 years and the majority were female (66.6%). One hundred one (36.9%) participants received 2 low risk scores, 99 (35.2%) received 1 low risk and 1 average risk score, 37 (13.2%) received 1 low risk and 1 high risk score, 23 (8.2%) received 2 average risk scores, 21 (7.5%) received 1 average risk and 1 high risk score, and no one received 2 high risk scores. Before receiving GRSs, younger patients and women reported significantly more worry about risk of developing cancer. After receiving GRSs, those who received at least one high GRS reported significantly more worry about developing cancer. There were no significant differences found between gender, age, or GRS with regards to participants’ reported optimism about their future health neither before nor after receiving GRS results. Conclusions Genetic risk scores that quantify an individual’s risk of developing breast, prostate and colorectal cancers as compared with a race-defined population average risk have potential clinical utility as a tool for risk stratification and to guide cancer screening in a primary care setting.
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Affiliation(s)
- Carly A Conran
- University of Illinois College of Medicine, Chicago, IL, USA.
| | - Zhuqing Shi
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL, USA
| | | | - Rong Na
- Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, China
| | - Brian T Helfand
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL, USA
| | - Elena Genova
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL, USA
| | - Siqun Lilly Zheng
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL, USA
| | - Charles B Brendler
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL, USA
| | - Jianfeng Xu
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL, USA
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Eom KY, Jarlenski M, Schoen RE, Robertson L, Sabik LM. Sex differences in the impact of Affordable Care Act Medicaid expansion on colorectal cancer screening. Prev Med 2020; 138:106171. [PMID: 32592796 DOI: 10.1016/j.ypmed.2020.106171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 05/14/2020] [Accepted: 06/14/2020] [Indexed: 12/23/2022]
Abstract
Access to care varies by sex such that interactions with insurance status result in mixed patterns of preventive services utilization. We examined sex-specific effects of ACA Medicaid expansions on receipt of CRC screening. We used Behavioral Risk Factor Surveillance System data (2008-2016) for adults aged 50-64 years with household income ≤138% of federal poverty level to examine self-reported lifetime use of guideline-recommended CRC screening services overall and by screening modality. We employed difference-in-difference models comparing changes in CRC screening in 20 Medicaid expansion states before and after the ACA to changes in 18 states that did not expand Medicaid during our study period. We divided the expansion period into implementation (2014) and post-expansion (2016) periods to account for possible lagged effects. We observed time-varying effects of Medicaid expansion that revealed relative increases in CRC screening occurring during the post-expansion period. Heterogeneous effects by sex and by screening modality were also observed: there was a significant relative increase of 16.2 percentage points (95% CI [2.2, 30.2]; p-value = 0.023) in lifetime colonoscopy use among women in expansion states relative to non-expansion states in the post-expansion period. There were no significant effects of Medicaid expansion among men. Health insurance expansion had a lagged but significant effect on CRC screening among low-income non-elderly women in Medicaid expansion states, but no effect for men. The observed increase in CRC screening among women suggests that barriers to CRC screening may differ by sex, and tailored interventions to increase CRC screening improve outcomes.
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Affiliation(s)
- Kirsten Y Eom
- University of Pittsburgh, Department of Health Policy and Management, Pittsburgh, PA, United States of America.
| | - Marian Jarlenski
- University of Pittsburgh, Department of Health Policy and Management, Pittsburgh, PA, United States of America
| | - Robert E Schoen
- University of Pittsburgh, Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, Pittsburgh, PA, United States of America
| | - Linda Robertson
- UPMC Hillman Cancer Center, Pittsburgh, PA, United States of America
| | - Lindsay M Sabik
- University of Pittsburgh, Department of Health Policy and Management, Pittsburgh, PA, United States of America
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4
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Sieverding M, Arbogast AL, Zintel S, von Wagner C. Gender differences in self-reported family history of cancer: A review and secondary data analysis. Cancer Med 2020; 9:7772-7780. [PMID: 32835456 PMCID: PMC7571831 DOI: 10.1002/cam4.3405] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/20/2020] [Accepted: 08/06/2020] [Indexed: 12/20/2022] Open
Abstract
Background Assessment of family history of cancer (FHC) mostly relies on self‐report. Our goal was to find out whether there is a systematic gender difference in self‐reported FHC. Methods We identified nine population‐based studies which provided statistics of FHC in men and women (N1 = 404 541). Furthermore, we analyzed data (N2 = 167 154) from several iterations of the US‐based Health Information National Trends Survey (HINTS) and the National Health Interview Survey (NHIS). We calculated the proportion of positive FHC, odds ratios (OR M/F), 95% confidence intervals, and aggregated statistics. We additionally analyzed in‐depth questions about FHC from HINTS 5 Cycle 2. Results In the reviewed studies the odds of men reporting a FHC were lower compared with the odds of women with an average OR of 0.84 [0.71; 1.00] across all studies and an OR of 0.75 [0.70; 0.80] for the six studies from the US and Europe. The gender gap was replicated in our own analyses of HINTS and NHIS with an average OR of 0.75 [0.71; 0.79]. In HINTS 5 Cycle 2 men described themselves as less familiar with their FHC and less confident answering questions regarding FHC. They were also less likely to discuss FHC with family members. Conclusions Men— at least in the US and Europe—were consistently less likely to report FHC compared with women. Future research should investigate how the assessment of FHC can be improved to reduce these differences. Health care professionals should also consider the potential for biased reporting by gender when assessing FHC.
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Affiliation(s)
- Monika Sieverding
- Department of Psychology, Ruprecht Karls University Heidelberg, Heidelberg, Germany
| | - Anna Lisa Arbogast
- Department of Psychology, Ruprecht Karls University Heidelberg, Heidelberg, Germany
| | - Stephanie Zintel
- Department of Psychology, Ruprecht Karls University Heidelberg, Heidelberg, Germany
| | - Christian von Wagner
- Research Department of Behavioural Science and Health, University College London, London, UK
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5
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Murphy CC, Halm EA, Skinner CS, Balasubramanian BA, Singal AG. Challenges and Approaches to Measuring Repeat Fecal Immunochemical Test for Colorectal Cancer Screening. Cancer Epidemiol Biomarkers Prev 2020; 29:1557-1563. [PMID: 32457184 DOI: 10.1158/1055-9965.epi-20-0230] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/14/2020] [Accepted: 05/11/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Colorectal cancer screening with fecal immunochemical testing (FIT) can reduce colorectal cancer-related mortality. Effectiveness of FIT may be compromised when patients do not adhere to a regular schedule. However, having no standard measure of repeat FIT presents challenges for assessing effectiveness across populations and settings. We compared three measures of repeat FIT in a large, integrated health care system in Dallas, Texas. METHODS We identified 18,257 patients age-eligible (50-60 years) for FIT in January 1-December 31, 2010 and followed over four rounds of screening. Measures included: (i) repeat FIT in prior screeners, or completion of FIT within 9-15 months of the previous; (ii) yes-no patterns, whereby patients were assigned yes or no in 9-15 month windows; and 3) proportion of time covered (PTC), or the amount of time patients were up-to-date with screening relative to time eligible. RESULTS Repeat FIT varied by measure. Using a prior screeners measure, 15.8% of patients with a normal FIT in round 1 completed repeat FIT in round 2. Repeat FIT was notably higher (52.3%) using PTC. The most common yes-no pattern was YNNN or "one-and-done," and only 9.4% of patients completed two consecutive FITs across all rounds (YYNN). CONCLUSIONS Different measures of repeat FIT yielded a range of estimates, making comparison across studies difficult. Researchers should weigh the advantages and disadvantages of each measure and select the most appropriate to their research question. IMPACT Our study highlights the need for future research of repeat FIT measures that best approximate screening effectiveness.
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Affiliation(s)
- Caitlin C Murphy
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas.
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
| | - Ethan A Halm
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
| | - Celette Sugg Skinner
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
- Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
| | - Bijal A Balasubramanian
- Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
- Department of Epidemiology, Human Genetics, and Environmental Science, UTHealth School of Public Health in Dallas, Dallas, Texas
| | - Amit G Singal
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
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Vrinten C, Stoffel S, Dodd RH, Waller J, Lyratzopoulos Y, von Wagner C. Cancer worry frequency vs. intensity and self-reported colorectal cancer screening uptake: A population-based study. J Med Screen 2019; 26:169-178. [PMID: 31042098 PMCID: PMC6854611 DOI: 10.1177/0969141319842331] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 03/15/2019] [Indexed: 12/31/2022]
Abstract
Objectives Many studies of cancer worry use items measuring frequency or intensity. Little is known about how each of these relate to cancer screening uptake. This study compared the association between worry frequency vs. intensity and colorectal cancer screening intention/uptake. Methods Across four surveys (2014–2016), we collected data from 2878 screening-eligible men and women (aged 60–70) in England. Measures included single-items assessing cancer worry frequency and intensity, and a derived combination of both. We also assessed self-reported past faecal occult blood testing uptake (ever vs. never), intention to participate when next invited (yes vs. no), and demographics. Using logistic regression, we compared a model containing sociodemographic characteristics (Model 1), with four models adding cancer worry frequency (Model 2), intensity (Model 3), both (Model 4), or the combined measure (Model 5). Results A model with cancer worry intensity and demographics (Model 3) explained significantly more variance in uptake and intention (R 2 = 0.068 and 0.062, respectively) than demographics alone (Model 1: R 2 = 0.058 and 0.042; p < 0.001), or a model with demographics and cancer worry frequency (Model 2: R 2 = 0.059 and 0.052; p < 0.001). The model was also equally as effective as models including both the frequency and intensity items (Model 4: R 2 = 0.070 n.s. and 0.062 n.s.), or using the derived combination of both (Model 5: R 2 = 0.063 n.s. and 0.053 n.s.). Conclusion A single item measure of cancer worry intensity appeared to be most parsimonious for explaining variance in colorectal cancer screening intention and uptake.
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Affiliation(s)
- Charlotte Vrinten
- Department of Behavioural Science and Health, University College London, London, UK
| | - Sandro Stoffel
- Department of Behavioural Science and Health, University College London, London, UK
| | - Rachael H Dodd
- Department of Behavioural Science and Health, University College London, London, UK
| | - Jo Waller
- Department of Behavioural Science and Health, University College London, London, UK
| | - Yoryos Lyratzopoulos
- Department of Behavioural Science and Health, University College London, London, UK
| | - Christian von Wagner
- Department of Behavioural Science and Health, University College London, London, UK
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7
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Murphy CC, Sen A, Watson B, Gupta S, Mayo H, Singal AG. A Systematic Review of Repeat Fecal Occult Blood Tests for Colorectal Cancer Screening. Cancer Epidemiol Biomarkers Prev 2019; 29:278-287. [PMID: 31740521 DOI: 10.1158/1055-9965.epi-19-0775] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/29/2019] [Accepted: 11/12/2019] [Indexed: 12/14/2022] Open
Abstract
Screening with fecal occult blood tests (FOBT) reduces colorectal cancer mortality. Failure to complete repeat tests may compromise screening effectiveness. We conducted a systematic review of repeat FOBT across diverse health care settings. We searched MEDLINE, Embase, and the Cochrane Library for studies published from 1997 to 2017 and reported repeat FOBT over ≥2 screening rounds. Studies (n = 27 reported in 35 articles) measured repeat FOBT as (i) proportion of Round 1 participants completing repeat FOBT in Round 2; (ii) proportion completing two, consecutive FOBT; or (iii) proportion completing ≥3 rounds. Among those who completed FOBT in Round 1, 24.6% to 89.6% completed repeat FOBT in Round 2 [median: 82.0%; interquartile range (IQR): 73.7%-84.6%]. The proportion completing FOBT in two rounds ranged from 16.4% to 80.0% (median: 46.6%; IQR: 40.5%-50.0%), and in studies examining ≥3 rounds, repeat FOBT ranged from 0.8% to 64.1% (median: 39.2%; IQR: 19.7%-49.4%). Repeat FOBT appeared higher in mailed outreach (69.1%-89.6%) compared with opportunistic screening (24.6%-48.6%). Few studies examined correlates of repeat FOBT. In summary, we observed a wide prevalence of repeat FOBT, and prevalence generally declined in successive screening rounds. Interventions that increase and maintain participation in FOBT are needed to optimize effectiveness of this screening strategy.
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Affiliation(s)
- Caitlin C Murphy
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, Texas.
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas
| | - Ahana Sen
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Bianca Watson
- Department of Psychiatry and Behavioral Sciences, Tulane School of Medicine, New Orleans, Louisiana
| | - Samir Gupta
- Veterans Affairs San Diego Healthcare System, UC San Diego, San Diego, California
| | - Helen Mayo
- Health Sciences Digital Library and Learning Center, UT Southwestern Medical Center, Dallas Texas
| | - Amit G Singal
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
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8
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Olver I. Bowel cancer screening for women at midlife. Climacteric 2018; 21:243-248. [PMID: 29609509 DOI: 10.1080/13697137.2018.1455823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
In Australia one in 15 women will be diagnosed with colorectal cancer in their lifetime because of the high incidences of lifestyle risk factors. The risk could be reduced by taking aspirin. Evidence-based Clinical Practice Guidelines for the prevention, early detection and management of colorectal cancer produced by Cancer Council Australia and approved by the National Health and Medical Research Council recommended that 'population screening in Australia, directed at those at average risk of colorectal cancer and without relevant symptoms, is immunochemical fecal occult blood testing every 2 years, starting at age 50 years and continuing to age 74 years.' Women at high risk because of family history will need more intense screening. At the current 40% participation rate, it is estimated that biennial screening with fecal immunohistochemical tests (FIT) reduces colorectal cancer incidence by 23% and mortality by 36%. The major adverse effects of screening are the psychological impact of a positive FIT that does not prove to be cancer, or adenomas on colonoscopy (47.7%), and the rare side-effects of colonoscopy of hemorrhage, bleeding or even death. A range of factors that could increase a woman's participation rate includes advice to screen from her general practitioner and more information about the nature of the screening tests.
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Affiliation(s)
- I Olver
- a Sansom Institute for Health Research , University of South Australia , Adelaide , Australia
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9
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Finney Rutten LJ, Jacobson RM, Wilson PM, Jacobson DJ, Fan C, Kisiel JB, Sweetser S, Tulledge-Scheitel SM, St Sauver JL. Early Adoption of a Multitarget Stool DNA Test for Colorectal Cancer Screening. Mayo Clin Proc 2017; 92:726-733. [PMID: 28473037 PMCID: PMC5505626 DOI: 10.1016/j.mayocp.2017.01.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 12/14/2016] [Accepted: 01/09/2017] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To characterize early adoption of a novel multitarget stool DNA (MT-sDNA) screening test for colorectal cancer (CRC) screening and to test the hypothesis that adoption differs by demographic characteristics and prior CRC screening behavior and proceeds predictably over time. PATIENTS AND METHODS We used the Rochester Epidemiology Project research infrastructure to assess the use of the MT-sDNA screening test in adults aged 50 to 75 years living in Olmsted County, Minnesota, in 2014 and identified 27,147 individuals eligible or due for screening colonoscopy from November 1, 2014, through November 30, 2015. We used electronic Current Procedure Terminology and Health Care Common Procedure codes to evaluate early adoption of the MT-sDNA screening test in this population and to test whether early adoption varies by age, sex, race, and prior CRC screening behavior. RESULTS Overall, 2193 (8.1%) and 974 (3.6%) individuals were screened by colonoscopy and MT-sDNA, respectively. Age, sex, race, and prior CRC screening behavior were significantly and independently associated with MT-sDNA screening use compared with colonoscopy use after adjustment for all other variables (P<.05 for all). The rates of adoption of MT-sDNA screening increased over time and were highest in those aged 50 to 54 years, women, whites, and those who had a history of screening. The use of the MT-sDNA screening test varied predictably by insurance coverage. The rates of colonoscopy decreased over time, whereas overall CRC screening rates remained steady. CONCLUSION The results of the present study are generally consistent with predictions derived from prior research and the diffusion of innovation framework, pointing to increasing use of the new screening test over time and early adoption by younger patients, women, whites, and those with prior CRC screening.
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Affiliation(s)
- Lila J Finney Rutten
- Population Health Science Program, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
| | - Robert M Jacobson
- Population Health Science Program, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Division of Community Pediatric and Adolescent Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Patrick M Wilson
- Population Health Science Program, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Debra J Jacobson
- Population Health Science Program, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Chun Fan
- Population Health Science Program, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - John B Kisiel
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Seth Sweetser
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN
| | | | - Jennifer L St Sauver
- Population Health Science Program, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
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10
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Hamman MK, Kapinos KA. Affordable Care Act Provision Lowered Out-Of-Pocket Cost And Increased Colonoscopy Rates Among Men In Medicare. Health Aff (Millwood) 2017; 34:2069-76. [PMID: 26643627 DOI: 10.1377/hlthaff.2015.0571] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Colorectal cancer screening is one of the few cancer screenings with an "A" rating from the US Preventive Services Task Force, meaning that the procedure confers a substantial health benefit. However, 40 percent of people who should receive colorectal cancer screenings do not receive them. Colonoscopies are the most thorough method of screening because they allow physicians to view the entire length of the colon and remove polyps as needed. Billing methods that distinguish between screening and therapeutic procedures have kept expected colonoscopy costs high. However, the Affordable Care Act partially closed the so-called colonoscopy loophole and reduced expected out-of-pocket expenses for all Medicare beneficiaries. Using data from the Behavioral Risk Factor Surveillance System, we found that annual colonoscopy rates among men ages 66-75 increased significantly (by 4.0 percentage points) after the Affordable Care Act policy change, and we found some evidence of even larger increases among socioeconomically disadvantaged men. We found no significant increases among women, a result that may be explained by health behavior and other factors and that requires further study. Our research indicates that cost may be an important barrier to colorectal cancer screening, at least among men, and that making further policy changes to close remaining loopholes may improve screening rates.
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Affiliation(s)
- Mary K Hamman
- Mary K. Hamman is an assistant professor of economics at the University of Wisconsin-La Crosse
| | - Kandice A Kapinos
- Kandice A. Kapinos is an economist at the RAND Corporation in Arlington, Virginia
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11
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Hamman MK, Kapinos KA. Colorectal Cancer Screening and State Health Insurance Mandates. HEALTH ECONOMICS 2016; 25:178-191. [PMID: 25521438 DOI: 10.1002/hec.3132] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2011] [Revised: 10/17/2014] [Accepted: 11/05/2014] [Indexed: 06/04/2023]
Abstract
Colorectal cancer (CRC) is the third most deadly cancer in the USA. CRC screening is the most effective way to prevent CRC death, but compliance with recommended screenings is very low. In this study, we investigate whether CRC screening behavior changed under state mandated private insurance coverage of CRC screening in a sample of insured adults from the 1997 to 2008 Behavioral Risk Factor Surveillance Survey (BRFSS). We present difference-in-difference-in-differences (DDD) estimates that compare insured individuals age 51 to 64 to Medicare age-eligible individuals (ages 66 to 75) in mandate and non-mandate states over time. Our DDD estimates suggest endoscopic screening among men increased by 2 to 3 percentage points under mandated coverage among 51 to 64 year olds relative to their Medicare age-eligible counterparts. We find no clear evidence of changes in screening behavior among women. DD estimates suggest no evidence of a mandate effect on either type of CRC screening for men or women.
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Affiliation(s)
- Mary K Hamman
- Department of Economics, University of Wisconsin, La Crosse, La Crosse, WI, USA
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12
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Pruitt SL, Leonard T, Murdoch J, Hughes A, McQueen A, Gupta S. Neighborhood effects in a behavioral randomized controlled trial. Health Place 2014; 30:293-300. [PMID: 25456014 DOI: 10.1016/j.healthplace.2014.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 09/29/2014] [Accepted: 10/02/2014] [Indexed: 10/24/2022]
Abstract
Randomized controlled trials (RCTs) of interventions intended to modify health behaviors may be influenced by neighborhood effects which can impede unbiased estimation of intervention effects. Examining a RCT designed to increase colorectal cancer (CRC) screening (N=5628), we found statistically significant neighborhood effects: average CRC test use among neighboring study participants was significantly and positively associated with individual patient's CRC test use. This potentially important spatially-varying covariate has not previously been considered in a RCT. Our results suggest that future RCTs of health behavior interventions should assess potential social interactions between participants, which may cause intervention arm contamination and may bias effect size estimation.
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Affiliation(s)
- Sandi L Pruitt
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA; Harold C. Simmons Comprehensive Cancer Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9169, USA.
| | - Tammy Leonard
- Economics Department, University of Dallas, 1845 E. Northgate Dr., Irving, TX 75026, United States
| | - James Murdoch
- School of Economic, Political, and Policy Sciences, University of Texas-Dallas, 800W. Campbell Rd, GR31, Richardson, TX 75080, USA
| | - Amy Hughes
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA; School of Economic, Political, and Policy Sciences, University of Texas-Dallas, 800W. Campbell Rd, GR31, Richardson, TX 75080, USA
| | - Amy McQueen
- Division of Health Behavior Research, Department of Medicine, Washington University School of Medicine, 660 South Euclid Avenue Campus, Box 8005, St. Louis, MO 63110, USA
| | - Samir Gupta
- Division of Gastroenterology, Department of Internal Medicine, Moores Cancer Center, University of California, San Diego, CA, USA; Department of Veterans Affairs, San Diego Healthcare System, 3350 La Jolla Village Dr MC 111D, San Diego, CA 92161, USA
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Diabetes and colorectal cancer screening among men and women in the USA: National Health Interview Survey: 2008, 2010. Cancer Causes Control 2014; 25:553-60. [PMID: 24562970 DOI: 10.1007/s10552-014-0360-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 02/12/2014] [Indexed: 01/01/2023]
Abstract
PURPOSE Adults with diabetes are at increased risk of being diagnosed with and dying from colorectal cancer, but it is unclear whether colorectal cancer screening (CRCS) use is lower in this population. Using the 2008 and 2010 National Health Interview Survey data, we examined whether guideline-concordant CRCS is lower among men and women with self-reported diabetes. METHODS We calculated the weighted percentage of guideline-concordant CRCS and unadjusted and adjusted prevalence ratios (PR) comparing adults aged 51-75 years with diabetes (n = 6,514) to those without (n = 8,371). We also examined effect modification by age (51-64 and 65-75), race/ethnicity, and number of medical office visits (0-3, ≥ 4). RESULTS The unadjusted prevalence of CRCS among men with diabetes was significantly higher than men without (63.3 vs. 58.0 %; PR = 1.09 95 % CI 1.03-1.16). In adjusted models, this relationship was evident among older [adjusted PR (aPR) = 1.13 95 % CI 1.06-1.21] but not younger men (aPR = 0.99 95 % CI 0.91-1.08; p for interaction term ≤ 0.01). There was no significant association between diabetes and CRCS among women overall (56.6 vs. 57.9 %; PR = 0.98 95 % CI 0.92-1.04) or by age group. Race/ethnicity and the number of medical visits did not significantly modify the association between diabetes and CRCS for men or women. CONCLUSIONS Men and women with self-reported diabetes were not less likely to be up to date with CRCS than those without diabetes. Older men with diabetes were more likely to be up to date with CRCS than those without diabetes.
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Boehm JE, Rohan EA, Preissle J, DeGroff A, Glover-Kudon R. Recruiting patients into the CDC's Colorectal Cancer Screening Demonstration Program: strategies and challenges across 5 sites. Cancer 2014; 119 Suppl 15:2914-25. [PMID: 23868486 DOI: 10.1002/cncr.28161] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 10/05/2012] [Accepted: 11/05/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND In 2005, the Centers for Disease Control and Prevention (CDC) funded 5 sites as part of the Colorectal Cancer Screening Demonstration Program (CRCSDP) to provide colorectal cancer screening to low-income, uninsured, and underinsured individuals. Funded sites experienced unexpected challenges in recruiting patients for services. METHODS The authors conducted a longitudinal, qualitative case study of all 5 sites to document program implementation, including recruitment. Data were collected during 3 periods over the 4-year program and included interviews, document review, and observations. After coding and analyzing the data, themes were identified and triangulated across the research team. Patterns were confirmed through member checking, further validating the analytic interpretation. RESULTS During early implementation, patient enrollment was low at 4 of the 5 CRCSDP sites. Evaluators found 3 primary challenges to patient recruitment: overreliance on in-reach to National Breast and Cervical Cancer Early Detection Program patients, difficulty keeping colorectal cancer screening and the program a priority among staff at partnering primary care clinics responsible for patient recruitment, and a lack of public knowledge about the need for colorectal cancer screening among patients. To address these challenges, site staff expanded partnerships with additional primary care networks for greater reach, enhanced technical support to primary care providers to ensure more consistent patient enrollment, and developed tailored outreach and education. CONCLUSIONS Removing financial barriers to colorectal cancer screening was necessary but not sufficient to reach the priority population. To optimize colorectal cancer screening, public health practitioners must work closely with the health care sector to implement evidence-based, comprehensive strategies across individual, environmental, and systems levels of society.
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Affiliation(s)
- Jennifer E Boehm
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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15
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Duncan A, Zajac I, Flight I, Stewart BJR, Wilson C, Turnbull D. Comparison of mailed invitation strategies to improve fecal occult blood test participation in men: protocol for a randomized controlled trial. Trials 2013; 14:239. [PMID: 23902589 PMCID: PMC3751457 DOI: 10.1186/1745-6215-14-239] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 07/05/2013] [Indexed: 02/03/2023] Open
Abstract
Background Men have a significantly increased risk of being diagnosed with, and dying from, colorectal cancer (CRC) than women. Men also participate in fecal occult blood test (FOBT) screening at a lower rate than women. This study will determine whether strategies that target men’s attitudes toward screening, and matched to stage of readiness to screen, increase men’s FOBT participation compared to a standard approach. Methods/Design Eligible trial participants will be a national sample of 9,200 men aged 50 to 74 years, living in urban Australia and randomly selected from the Australian electoral roll. Trial participants will be mailed an advance notification letter, followed 2 weeks later by an invitation letter and a free fecal immunochemical test (FIT) kit. The intervention is a factorial design, randomized controlled trial (RCT) with four trial arms, including a control. The content of the advance notification and invitation letters will differ by trial arm as follows: 1) standard advance notification and standard invitation (control arm); 2) targeted advance notification and standard invitation; 3) standard advance notification and targeted invitation; and 4) targeted advance notification and targeted invitation. The standard letters will replicate as closely as possible the letters included in the Australian National Bowel Cancer Screening Program (NBCSP). Modified advance notification and invitation letters will incorporate additional messages to target men in the precontemplation (advance notification) and contemplation stages (invitation). The primary outcome is return of the completed FIT within 12 weeks of invitation. Analysts will be blinded to trial assignment and participants will be blinded to the use of varying invitational materials. Subsamples from each trial arm will complete baseline and endpoint surveys to measure the psychological impact of the intervention, and qualitative interviews will be conducted to evaluate attitudes toward the intervention. Discussion The outcomes of this study will have implications for the way FOBT screening is offered to men. Findings will help to identify how invitations for men to screen should be framed and delivered in order to maximize participation. Trial registration Australian New Zealand Clinical Trials Registry: ACTRN12612001122842
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Affiliation(s)
- Amy Duncan
- School of Psychology, The University of Adelaide, Adelaide 5005, South Australia, Australia.
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16
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Martinez KA, Pollack CE, Phelan DF, Markakis D, Bone L, Shapiro G, Wenzel J, Howerton M, Johnson L, Garza MA, Ford JG. Gender differences in correlates of colorectal cancer screening among Black Medicare beneficiaries in Baltimore. Cancer Epidemiol Biomarkers Prev 2013; 22:1037-42. [PMID: 23629519 PMCID: PMC3681887 DOI: 10.1158/1055-9965.epi-12-1215] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Previous research has shown colorectal cancer (CRC) screening disparities by gender. Little research has focused primarily on gender differences among older Black individuals, and reasons for existing gender differences remain poorly understood. METHODS We used baseline data from the Cancer Prevention and Treatment Demonstration Screening Trial. Participants were recruited from November 2006 to March 2010. In-person interviews were used to assess self-reported CRC screening behavior. Up-to-date CRC screening was defined as self-reported colonoscopy or sigmoidoscopy in the past 10 years or fecal occult blood testing in the past year. We used multivariable logistic regression to examine the association between gender and self-reported screening, adjusting for covariates. The final model was stratified by gender to examine factors differentially associated with screening outcomes for males and females. RESULTS The final sample consisted of 1,552 female and 586 male Black Medicare beneficiaries in Baltimore, Maryland. Males were significantly less likely than females to report being up-to-date with screening (77.5% vs. 81.6%, P = 0.030), and this difference was significant in the fully adjusted model (OR: 0.72; 95% confidence interval, 0.52-0.99). The association between having a usual source of care and receipt of cancer screening was stronger among males compared with females. CONCLUSIONS Although observed differences in CRC screening were small, several factors suggest that gender-specific approaches may be used to promote screening adherence among Black Medicare beneficiaries. IMPACT Given disproportionate CRC mortality between White and Black Medicare beneficiaries, gender-specific interventions aimed at increasing CRC screening may be warranted among older Black patients.
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Affiliation(s)
- Kathryn A Martinez
- North Campus Research Complex, 2800 Plymouth Road, Building 16, 4th Floor, Ann Arbor, MI 48109, USA.
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17
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Gender differences in attitudes impeding colorectal cancer screening. BMC Public Health 2013; 13:500. [PMID: 23706029 PMCID: PMC3672022 DOI: 10.1186/1471-2458-13-500] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 04/08/2013] [Indexed: 01/13/2023] Open
Abstract
Background Colorectal cancer screening (CRCS) is the only type of cancer screening where both genders reduce risks by similar proportions with identical procedures. It is an important context for examining gender differences in disease-prevention, as CRCS significantly reduces mortality via early detection and prevention. In efforts to increase screening adherence, there is increasing acknowledgment that obstructive attitudes prevent CRCS uptake. Precise identification of the gender differences in obstructive attitudes is necessary to improve uptake promotion. This study randomly sampled unscreened, screening - eligible individuals in Ontario, employing semi-structured interviews to elicit key differences in attitudinal obstructions towards colorectal cancer screening with the aim of deriving informative differences useful in planning promotions of screening uptake. Methods N = 81 participants (49 females, 32 males), 50 years and above, with no prior CRCS, were contacted via random-digit telephone dialing, and consented via phone-mail contact. Altogether, N = 4,459 calls were made to yield N = 85 participants (1.9% response rate) of which N = 4 participants did not complete interviews. All subjects were eligible for free-of-charge CRCS in Ontario, and each was classified, via standard interview by CRCS screening decision-stage. Telephone-based, semi-structured interviews (SSIs) were employed to investigate gender differences in CRCS attitudes, using questions focused on 5 attitudinal domains: 1) Screening experience at the time of interview; 2) Barriers to adherence; 3) Predictors of Adherence; 4) Pain-anxiety experiences related to CRCS; 5) Gender-specific experiences re: CRCS, addressing all three modalities accessible through Ontario’s program: a) fecal occult blood testing; b) flexible sigmoidoscopy; c) colonoscopy. Results Interview transcript analyses indicated divergent themes related to CRCS for each gender: 1) bodily intrusion, 2) perforation anxiety, and 3) embarrassment for females and; 1) avoidant procrastination with underlying fatalism, 2) unnecessary health care and 3) uncomfortable vulnerability for males. Respondents adopted similar attitudes towards fecal occult blood testing, flexible sigmoidoscopy and colonoscopy, and were comparable in decision stage across tests. Gender differences were neither closely tied to screening stage nor modality. Women had more consistent physician relationships, were more screening-knowledgeable and better able to articulate views on screening. Men reported less consistent physician relationships, were less knowledgeable and kept decision-making processes vague and emotionally distanced (i.e. at ‘arm’s length’). Conclusions Marked differences were observed in obstructive CRCS attitudes per gender. Females articulated reservations about CRCS-associated distress and males suppressed negative views while ambiguously procrastinating about the task of completing screening. Future interventions could seek to reduce CRCS-related stress (females) and address the need to overcome procrastination (males).
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18
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Choi KC, So WKW, Chan DNS, Shiu ATY, Ho SSM, Chan HYL, Lam WWT, Cheng KKF, Goggins WB, Chan CWH. Gender differences in the use of colorectal cancer tests among older Chinese adults. Eur J Oncol Nurs 2013; 17:603-9. [PMID: 23462304 DOI: 10.1016/j.ejon.2013.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 12/20/2012] [Accepted: 01/05/2013] [Indexed: 01/15/2023]
Abstract
PURPOSE The study aimed to explore the gender difference in using colorectal cancer (CRC) tests among Chinese aged 50 years or over. METHODS A cross-sectional study was conducted in 2004 Chinese older adults through anonymous telephone survey which covered socio-demographic variables, health status, use of complementary therapy, health-related perceptions and use of CRC tests. RESULTS The uptake rate of flexible sigmoidoscopy (FS)/colonoscopy was 14% for males and 10% for females, with males significantly more likely to have had the test after adjusting for their differences in socio-demographics, health status, use of complementary therapies, health-related perceptions and recommendation received from health professionals (adjusted OR = 1.5, 95% CI: 1.1-2.0, p = 0.005). The uptake of fecal occult blood test was nearly the same (19%) for both genders. Further interaction analyses indicates that the effect of a family history of cancer on the uptake of a FS/colonoscopy is significantly weaker in males than in females (the interaction odds ratio = 0.4, 95% CI: 0.2-0.8, p = 0.011), whereas a male perceived that visiting a doctor is good for health will be more likely to have an uptake of a FS/colonoscopy than a female with such perception (the interaction odds ratio = 2.1, 95% CI: 1.1-3.8, p = 0.018). CONCLUSIONS The uptake of CRC tests was low in this average-risk population. More effort is needed to educate the public about the importance and benefits of CRC tests. In view of the gender differences in some determinants of FS/colonoscopy uptake, particular attention should be given to develop gender-specific strategies to improve the rate.
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Affiliation(s)
- Kai Chow Choi
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
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Yim M, Butterly LF, Goodrich ME, Weiss JE, Onega TL. Perception of colonoscopy benefits: a gap in patient knowledge? J Community Health 2012; 37:719-24. [PMID: 22109385 DOI: 10.1007/s10900-011-9506-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Our study aimed to determine, for patients who had undergone recent colonoscopy, associations between specific colonoscopy patient characteristics, exam characteristics and patients' perception of colonoscopy reducing their risk of dying from colorectal cancer. A cross-sectional analysis was conducted using data (2004-2008) from the New Hampshire Colonoscopy Registry, consisting of a Self-report Questionnaire, Colonoscopy Report form, and a Follow-up Questionnaire, which measured agreement responses to the statement, "Having a colonoscopy decreased my chances of dying from colon cancer". Chi-square tests and logistic regression were used to assess differences in patient responses by patient and colonoscopy characteristics. A majority of patients (N=5,672, 81%) agreed that having a colonoscopy decreased their chances of dying from colon cancer. Patients with a personal history of polyps were more likely to agree that colonoscopy reduced their chances of dying compared to patients without prior polypectomy [OR (95% CI) =1.34 (1.06, 1.69)] and patients with a family history of colorectal cancer were 33% more likely to agree to the statement than those without a family history [OR (95% CI) =1.33 (1.12, 1.58)]. Personal history of polyps and family history of colorectal cancer are significant predictors of patients' positive perception of colonoscopy, suggesting that personal experience, rather than the potential preventive effect of colonoscopy itself, may influence the perceived benefit of colonoscopy. Intervention efforts should be made to effectively disseminate knowledge of the preventive benefit of colonoscopy.
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Affiliation(s)
- Michael Yim
- Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, Lebanon, NH, USA
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20
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Groth S, Krause H, Behrendt R, Hill H, Börner M, Bastürk M, Plathner N, Schütte F, Gauger U, Riemann JF, Altenhofen L, Rösch T. Capsule colonoscopy increases uptake of colorectal cancer screening. BMC Gastroenterol 2012; 12:80. [PMID: 22734948 PMCID: PMC3407015 DOI: 10.1186/1471-230x-12-80] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 06/26/2012] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Screening colonoscopy effectiveness is hampered by limited adherence by the general population. The present prospective study was performed to evaluate whether adding capsule colonoscopy to the endoscopic screening options increases uptake. METHODS Invitation letters were sent to 2150 persons above the age of 55 insured with a German medical insurance company in the area of Rinteln, Lower Saxony with a baseline spontaneous annual screening colonoscopy uptake of 1 %. Both capsule or conventional colonoscopy were offered. Interested persons were given information about the two screening options by four local gastroenterologists and examinations were then performed according to screenees' final choice. RESULTS 154 persons sought further information, and 34 and 90 underwent conventional and capsule colonoscopy, respectively. Colonoscopy uptake was thus increased by the invitation process by 60 % (1.6 % vs. 1 %; p = 0.075), while the option of capsule endoscopy led to a fourfold increase of screening uptake (4.2 % vs. 1 %, p < 0.001). Despite similar age distribution in both sex groups, uptake in men was significantly higher (5.6 % vs. 2.8 %, p = 002). However, overall adenoma yield was not different in both groups. CONCLUSIONS The present study suggests that offering the option of capsule colonoscopy increases uptake of endoscopic colorectal cancer screening. However, capsule endoscopy sensitivity for adenoma detection needs to be improved.
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Affiliation(s)
- Stefan Groth
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Regional Hospital, Hamburg, Germany
- Private Gastroenterology Offices Rinteln, BKK 24 Medical Insurance, Obernkirchen, LebensBlicke Foundation for the Prevention of Colon Cancer, Ludwigshafen, Central Research Institute of Ambulatory Health Care, Berlin, Germany
| | - Horst Krause
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Regional Hospital, Hamburg, Germany
- Private Gastroenterology Offices Rinteln, BKK 24 Medical Insurance, Obernkirchen, LebensBlicke Foundation for the Prevention of Colon Cancer, Ludwigshafen, Central Research Institute of Ambulatory Health Care, Berlin, Germany
| | - Rainer Behrendt
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Regional Hospital, Hamburg, Germany
- Private Gastroenterology Offices Rinteln, BKK 24 Medical Insurance, Obernkirchen, LebensBlicke Foundation for the Prevention of Colon Cancer, Ludwigshafen, Central Research Institute of Ambulatory Health Care, Berlin, Germany
| | - Helge Hill
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Regional Hospital, Hamburg, Germany
- Private Gastroenterology Offices Rinteln, BKK 24 Medical Insurance, Obernkirchen, LebensBlicke Foundation for the Prevention of Colon Cancer, Ludwigshafen, Central Research Institute of Ambulatory Health Care, Berlin, Germany
| | - Michael Börner
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Regional Hospital, Hamburg, Germany
- Private Gastroenterology Offices Rinteln, BKK 24 Medical Insurance, Obernkirchen, LebensBlicke Foundation for the Prevention of Colon Cancer, Ludwigshafen, Central Research Institute of Ambulatory Health Care, Berlin, Germany
| | - Murat Bastürk
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Regional Hospital, Hamburg, Germany
- Private Gastroenterology Offices Rinteln, BKK 24 Medical Insurance, Obernkirchen, LebensBlicke Foundation for the Prevention of Colon Cancer, Ludwigshafen, Central Research Institute of Ambulatory Health Care, Berlin, Germany
| | - Nora Plathner
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Regional Hospital, Hamburg, Germany
- Private Gastroenterology Offices Rinteln, BKK 24 Medical Insurance, Obernkirchen, LebensBlicke Foundation for the Prevention of Colon Cancer, Ludwigshafen, Central Research Institute of Ambulatory Health Care, Berlin, Germany
| | - Friedrich Schütte
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Regional Hospital, Hamburg, Germany
- Private Gastroenterology Offices Rinteln, BKK 24 Medical Insurance, Obernkirchen, LebensBlicke Foundation for the Prevention of Colon Cancer, Ludwigshafen, Central Research Institute of Ambulatory Health Care, Berlin, Germany
| | - Ulrich Gauger
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Regional Hospital, Hamburg, Germany
- Private Gastroenterology Offices Rinteln, BKK 24 Medical Insurance, Obernkirchen, LebensBlicke Foundation for the Prevention of Colon Cancer, Ludwigshafen, Central Research Institute of Ambulatory Health Care, Berlin, Germany
| | - Jürgen Ferdinand Riemann
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Regional Hospital, Hamburg, Germany
- Private Gastroenterology Offices Rinteln, BKK 24 Medical Insurance, Obernkirchen, LebensBlicke Foundation for the Prevention of Colon Cancer, Ludwigshafen, Central Research Institute of Ambulatory Health Care, Berlin, Germany
| | - Lutz Altenhofen
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Regional Hospital, Hamburg, Germany
- Private Gastroenterology Offices Rinteln, BKK 24 Medical Insurance, Obernkirchen, LebensBlicke Foundation for the Prevention of Colon Cancer, Ludwigshafen, Central Research Institute of Ambulatory Health Care, Berlin, Germany
| | - Thomas Rösch
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Regional Hospital, Hamburg, Germany
- Private Gastroenterology Offices Rinteln, BKK 24 Medical Insurance, Obernkirchen, LebensBlicke Foundation for the Prevention of Colon Cancer, Ludwigshafen, Central Research Institute of Ambulatory Health Care, Berlin, Germany
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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Maruthur NM, Bolen S, Gudzune K, Brancati FL, Clark JM. Body mass index and colon cancer screening: a systematic review and meta-analysis. Cancer Epidemiol Biomarkers Prev 2012; 21:737-46. [PMID: 22492832 DOI: 10.1158/1055-9965.epi-11-0826] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Obesity is associated with increased colon cancer mortality and lower rates of mammography and Pap testing. METHODS We conducted a systematic review to determine whether obesity is associated with lower rates of colon cancer screening. We searched the PubMed, CINAHL, and Cochrane Library databases. Two investigators reviewed citations, abstracts, and articles independently. Two investigators abstracted study information sequentially and evaluated quality independently using standardized forms. We included all studies in our qualitative syntheses. We used random effects meta-analyses to combine those studies providing screening results by the following body mass index (BMI) categories: Normal, 18.5-24.9 kg/m(2) (reference); overweight, 25-29.9 kg/m(2); class I obesity, 30-34.9 kg/m(2); class II obesity, 35-39.9 kg/m(2); and class III obesity, ≥ 40 kg/m(2). RESULTS Of 5,543 citations, we included 23 articles. Almost all studies were cross-sectional and ascertained BMI and screening through self-report. BMI was not associated with colon cancer screening overall. The subgroup of obese white women reported lower rates of colon cancer screening compared with those with a normal BMI with combined ORs (95% CI) of 0.87 (0.82-0.93), 0.80 (0.65-0.99), and 0.73 (0.58-0.94) for class I, II, and III obesity, respectively. Results were similar among white men with class II obesity. CONCLUSIONS Overall, BMI was not associated with colon cancer screening. Obese white men and women may be less likely to undergo colon cancer screening compared with those with a normal BMI. IMPACT Further investigation of this disparity may reduce the risk of obesity-related colon cancer death.
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Affiliation(s)
- Nisa M Maruthur
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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Abotchie PN, Vernon SW, Du XL. Gender differences in colorectal cancer incidence in the United States, 1975-2006. J Womens Health (Larchmt) 2012; 21:393-400. [PMID: 22149014 PMCID: PMC3321677 DOI: 10.1089/jwh.2011.2992] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Gender differences have been documented among patients diagnosed with colorectal cancer (CRC). It is still not clear, however, how these differences have changed over the past 30 years and if these differences vary by geographic areas. We examined trends in CRC incidence between 1975 and 2006. METHODS The study population consisted of 373,956 patients ≥40 years diagnosed with malignant CRC between 1975 and 2006 who resided in one of the nine Surveillance, Epidemiology and End Results (SEER) regions of the United States. Age-adjusted incidence rates over time were reported by gender, race, CRC subsite, stage, and SEER region. RESULTS Overall, CRC was diagnosed in roughly equal numbers of men (187,973) and women (185,983). Men had significantly higher age-adjusted CRC incidence rates across all categories of age, race, tumor subsite, stage, and SEER region. Gender differences in CRC age-adjusted incidence rates widened slightly from 1975 to 1988, reached a peak in 1985-1988, and have narrowed over time since 1990. The largest gap and decline in CRC incidence rates between men and women were observed among those ≥80 years (p<0.001), followed by those 70-79 and then 60-69 years. Gender differences in CRC incidence rates for the 40-49 and 50-59 age categories were small and increased only slightly over time (p=0.003). CONCLUSIONS Higher CRC age-adjusted incidence among men than among women has persisted over the past 30 years. Although gender differences narrowed in the population ≥60 years, especially from 1990 to 2006, gender gaps, albeit small ones, in those younger than 60 increased over time. Future studies may need to examine the factors associated with these differences and explore ways to narrow the gender gap.
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Affiliation(s)
- Peter N Abotchie
- Division of Health Promotion and Behavioral Science, University of Texas School of Public Health, Houston, TX 77030, USA
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23
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Should There Be Gender Differences in the Guidelines for Colorectal Cancer Screening? CURRENT COLORECTAL CANCER REPORTS 2012. [DOI: 10.1007/s11888-011-0113-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Medina GG, McQueen A, Greisinger AJ, Bartholomew LK, Vernon SW. What would make getting colorectal cancer screening easier? Perspectives from screeners and nonscreeners. Gastroenterol Res Pract 2012; 2012:895807. [PMID: 22272194 PMCID: PMC3261462 DOI: 10.1155/2012/895807] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 10/20/2011] [Accepted: 11/03/2011] [Indexed: 01/04/2023] Open
Abstract
Background. Despite the availability of multiple effective tests for colorectal cancer (CRC), screening rates are low. Greater understanding of barriers between screeners and nonscreeners may improve public health initiatives to increase CRC screening (CRCS). Methods. We conducted a content analysis of 625 responses to the question: "Was there anything that would have made getting tested easier?" Respondents were patients at a multispecialty practice who participated in a behavioral intervention trial to increase CRCS. Using clinic records, we classified patients as early-screeners (<6 months), late-screeners(6-12 months), and nonscreeners (>12 months). Results. Both screeners and nonscreeners reported the same categories of barriers. However, early-screeners predominantly cited dislike of test attributes such as bowel preparation, whereas nonscreeners cited concerns regarding finances and work and family responsibilities. Conclusion. Multilevel strategies that address scheduling barriers and external screening barriers may improve CRCS. Future studies may test hypotheses about mediators explaining how screeners overcome barriers.
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Affiliation(s)
- Gilda G. Medina
- School of Public Health, The University of Texas-Houston, 1200 Herman Pressler, Houston, TX 77030, USA
| | - Amy McQueen
- Washington University School of Medicine, 4444 Forest Park Avenue, St. Louis, MO 63110, USA
| | | | - L. Kay Bartholomew
- School of Public Health, The University of Texas-Houston, 1200 Herman Pressler, Houston, TX 77030, USA
| | - Sally W. Vernon
- School of Public Health, The University of Texas-Houston, 1200 Herman Pressler, Houston, TX 77030, USA
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Deshpande AD, McQueen A, Coups EJ. Different effects of multiple health status indicators on breast and colorectal cancer screening in a nationally representative US sample. Cancer Epidemiol 2011; 36:270-5. [PMID: 22079763 DOI: 10.1016/j.canep.2011.10.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Revised: 10/03/2011] [Accepted: 10/07/2011] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To examine the independent associations between multiple health status indicators and breast and colorectal cancer screening (CRCS) in a national US sample. STUDY DESIGN AND SETTING Analysis of cross-sectional data from the 2005 National Health Interview Survey (NHIS) involved 5115 men and 7100 women aged 50 years and older. MEASURES Health status indicators included: self-reported perceived health status, number of chronic conditions, and functional limitation due to a chronic condition. Individuals were considered adherent to CRCS guidelines if they reported having a home-based fecal occult blood test in the past year or endoscopy in the past 10 years. Women were adherent to breast cancer screening guidelines if they reported having a mammogram in the previous 2 years. Statistical analyses were conducted using SUDAAN software to account for the complex sampling of the NHIS survey. Logistic regression was used to examine associations between each of the health status indicators and screening adherence for CRCS and mammography and to calculate estimated screening rates. RESULTS The three health status indicators were independently and differentially associated with screening adherence. Poor perceived health was associated with lower mammography among women, whereas a greater number of chronic conditions were consistently associated with greater screening. In adjusted analyses, functional limitation was only significantly associated with greater CRCS among women. CONCLUSIONS Our analyses included three common indicators of health status and provide new evidence of their complex associations with cancer screening. Future studies must examine the mechanisms by which these indicators influence screening recommendations and adherence among older adults over time.
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Affiliation(s)
- Anjali D Deshpande
- Division of Health Behavior Research, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63108, USA.
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Kiviniemi MT, Bennett A, Zaiter M, Marshall JR. Individual-level factors in colorectal cancer screening: a review of the literature on the relation of individual-level health behavior constructs and screening behavior. Psychooncology 2011; 20:1023-33. [PMID: 21954045 PMCID: PMC3038178 DOI: 10.1002/pon.1865] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Revised: 09/10/2010] [Accepted: 09/16/2010] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Compliance with colorectal cancer screening recommendations requires considerable conscious effort on the part of the individual patient, making an individual's decisions about engagement in screening an important contributor to compliance or noncompliance. The objective of this paper was to examine the effectiveness of individual-level behavior theories and their associated constructs in accounting for engagement in colorectal cancer screening behavior. METHODS We reviewed the literature examining constructs from formal models of individual-level health behavior as factors associated with compliance with screening for colorectal cancer. All published studies examining one or more constructs from the health belief model, theory of planned behavior, transtheoretical model, or social cognitive theory and their relation to screening behavior or behavioral intentions were included in the analysis. RESULTS By and large, results of studies supported the theory-based predictions for the influence of constructs on cancer screening behavior. However, the evidence base for many of these relations, especially for models other than the health belief model, is quite limited. CONCLUSIONS Suggestions are made for future research on individual-level determinants of colorectal cancer screening.
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Affiliation(s)
- Marc T Kiviniemi
- Department of Health Behavior, University at Buffalo, New York 14124, USA.
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Krishnan S, Wolf JL. Colorectal cancer screening and prevention in women. ACTA ACUST UNITED AC 2011; 7:213-26. [PMID: 21410347 DOI: 10.2217/whe.11.7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Colorectal cancer (CRC) is the third most common cause of cancer in women. Screening for CRC increases early detection of cancer and premalignant polyps and decreases morbidity from this disease. However, adherence to the screening guidelines continues to remain inadequate both at the physician and patient levels. Several factors are of special importance to women. Presence of prior gynecological malignancies may increase the risk of CRC in women. Furthermore, new studies have shown other factors such as obesity and smoking to increase the risk of CRC in women. This article highlights issues unique to women with regards to CRC and outlines special considerations for determining screening intervals in women, identifies factors that make screening more difficult in women, and reviews studies that identify preventative strategies which, together with screening, may reduce the burden of CRC.
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Affiliation(s)
- Sandeep Krishnan
- Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
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Burkhalter JE, Hay JL, Coups E, Warren B, Li Y, Ostroff JS. Perceived risk for cancer in an urban sexual minority. J Behav Med 2011; 34:157-69. [PMID: 20872174 PMCID: PMC3684154 DOI: 10.1007/s10865-010-9296-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2009] [Accepted: 09/07/2010] [Indexed: 10/19/2022]
Abstract
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.
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Affiliation(s)
- Jack E. Burkhalter
- Department of Psychiatry and Behavioral Sciences, Memorial, Sloan-Kettering Cancer Center, 641 Lexington Avenue, 7th Floor, New York, NY 10022-4503, USA
| | - Jennifer L. Hay
- Department of Psychiatry and Behavioral Sciences, Memorial, Sloan-Kettering Cancer Center, 641 Lexington Avenue, 7th Floor, New York, NY 10022-4503, USA
| | - Elliot Coups
- The Cancer Institute of New Jersey, UMDNJ-Robert Wood, Johnson Medical School, 195 Little Albany Street, 5th Floor, Room 5567, New Brunswick, NJ 08901, USA
| | - Barbara Warren
- Hunter College Institute for LGBT Social Science & Public Policy, 695 Park Avenue, Rm 1305, New York, NY 10065, USA
| | - Yuelin Li
- Department of Psychiatry and Behavioral Sciences, Memorial, Sloan-Kettering Cancer Center, 641 Lexington Avenue, 7th Floor, New York, NY 10022-4503, USA
| | - Jamie S. Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial, Sloan-Kettering Cancer Center, 641 Lexington Avenue, 7th Floor, New York, NY 10022-4503, USA
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Abstract
OBJECTIVES Immunological and guaiac-based fecal occult blood tests (iFOBTs and gFOBTs) are widely used for early detection of colorectal cancer (CRC). We aimed to assess potential sex differences in performance of iFOBTs and gFOBT in the screening setting. METHODS The sensitivity, specificity, and positive and negative predictive values for detection of advanced colorectal neoplasms (CRC or advanced adenoma) were assessed by sex for a range of cutpoints of a quantitative iFOBT (RIDASCREEN Hemoglobin), six qualitative iFOBTs, and a gFOBT (HemOccult) among 1,157 male and 1,167 female participants of the German screening colonoscopy program (mean age: 63.0 and 62.0 years, respectively). RESULTS The prevalence of advanced colorectal neoplasms was much higher among men (13.5%) than among women (7.5%). At any cutpoint of the quantitative iFOBT, and for all qualitative iFOBTs and the gFOBT, the sensitivity and positive predictive value were substantially higher, and specificity and negative predictive value were substantially lower among men than among women. At the cutpoint of 2 μg/g stool given by the manufacturer of the quantitative iFOBT, sensitivity, specificity, and the positive and negative predictive values were 47.6, 85.0, 33.0, and 91.3% among men, and 30.7, 89.5, 19.3, and 94.1% among women (P value for sex differences 0.001, 0.002, 0.004, and 0.019, respectively). Sex differences in predictive values were mostly explained by sex differences in the prevalence of advanced colorectal neoplasms. CONCLUSIONS There are major sex differences in the performance of fecal occult blood testing, which might require careful attention in the interpretation of test results, and in the design, modeling, and evaluation of CRC screening strategies.
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Affiliation(s)
- Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.
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Fenton JJ, Elmore JG, Buist DSM, Reid RJ, Tancredi DJ, Baldwin LM. Longitudinal adherence with fecal occult blood test screening in community practice. Ann Fam Med 2010; 8:397-401. [PMID: 20843880 PMCID: PMC2939414 DOI: 10.1370/afm.1133] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Although screening with fecal occult blood testing (FOBT) reduces colorectal cancer (CRC) mortality, its effectiveness may diminish if patients do not adhere with repeated screenings. Among patients who had previously engaged in FOBT screening, we assessed subsequent adherence with FOBT screening. METHODS We assessed longitudinal adherence with biennial FOBT screening (every other year) within a cohort of patients enrolled in an integrated Washington State health plan. Among 11,110 patients who participated in FOBT screening during a 2-year baseline period (2000-2001), we ascertained CRC screening use during a subsequent 2-year observation period (2002-2003). We used multinomial logistic regression to identify patient characteristics associated with higher incidence of repeat CRC screening (with or without FOBT) relative to patients who received no CRC screening. RESULTS Despite prior participation in FOBT screening, less than one-half of patients (44.4%; 95% CI, 42.9%-45.8%) completed FOBT screening during the 2-year observation period. Although 8.8% of patients (95% CI, 8.0%-9.7%) received other CRC tests without FOBT during the observation period, nearly one-half, 46.8% (95% CI, 45.3%-48.4%), received no CRC screening. After adjustment for other patient characteristics, receipt of a preventive health examination was strongly associated with FOBT adherence relative to no CRC screening (adjusted relative rate ratio = 11.16; 95% CI, 9.61-12.96). CONCLUSIONS Longitudinal adherence with FOBT screening was low in this insured population, potentially compromising its effectiveness in population CRC mortality reduction. Interventions to promote adherence may be necessary to achieve high effectiveness in population-based FOBT screening programs.
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Affiliation(s)
- Joshua J Fenton
- Department of Family and Community Medicine, University of California, Davis, Sacramento, California 95817, USA.
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Gwede CK, William CM, Thomas KB, Tarver WL, Quinn GP, Vadaparampil ST, Kim J, Lee JH, Meade CD. Exploring disparities and variability in perceptions and self-reported colorectal cancer screening among three ethnic subgroups of U. S. Blacks. Oncol Nurs Forum 2010; 37:581-91. [PMID: 20797950 PMCID: PMC2946332 DOI: 10.1188/10.onf.581-591] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
PURPOSE/OBJECTIVES To explore perceptions of colorectal cancer (CRC) and self-reported CRC screening behaviors among ethnic subgroups of U. S. blacks. DESIGN Descriptive, cross-sectional, exploratory, developmental pilot. SETTING Medically underserved areas in Hillsborough County, FL. SAMPLE 62 men and women aged 50 years or older. Ethnic subgroup distribution included 22 African American, 20 English-speaking Caribbean-born, and 20 Haitian-born respondents. METHODS Community-based participatory research methods were used to conduct face-to-face individual interviews in the community. MAIN RESEARCH VARIABLES Ethnic subgroup, health access, perceptions of CRC (e.g., awareness of screening tests, perceived risk, perceived barriers to screening), healthcare provider recommendation, and self-reported CRC screening. FINDINGS Awareness of CRC screening tests, risk perception, healthcare provider recommendation, and self-reported use of screening were low across all subgroups. However, only 55% of Haitian-born participants had heard about the fecal occult blood test compared to 84% for English-speaking Caribbean-born participants and 91% for African Americans. Similarly, only 15% of Haitian-born respondents had had a colonoscopy compared to 50% for the English-speaking Caribbean and African American subgroups. CONCLUSIONS This exploratory, developmental pilot study identified lack of awareness, low risk perception, and distinct barriers to screening. The findings support the need for a larger community-based study to elucidate and address disparities among subgroups. IMPLICATIONS FOR NURSING Nurses play a major role in reducing cancer health disparities through research, education, and quality care. Recognition of the cultural diversity of the U. S. black population can help nurses address health disparities and contribute to the health of the community.
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Affiliation(s)
- Clement K Gwede
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
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The interrelationships between and contributions of background, cognitive, and environmental factors to colorectal cancer screening adherence. Cancer Causes Control 2010; 21:1357-68. [DOI: 10.1007/s10552-010-9563-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Accepted: 04/02/2010] [Indexed: 10/19/2022]
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Nnoaham KE, Frater A, Roderick P, Moon G, Halloran S. Do geodemographic typologies explain variations in uptake in colorectal cancer screening? An assessment using routine screening data in the south of England. J Public Health (Oxf) 2010; 32:572-81. [PMID: 20410067 DOI: 10.1093/pubmed/fdq025] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Uptake of colorectal cancer (CRC) screening in UK is less than 60%. Geodemographic typologies are useful in describing patterns of individual preventive health behaviour but little is known of their value in assessing uptake of CRC screening, or how this compares to traditional measures of area deprivation. METHODS We used data on CRC screening uptake in the South Central, South-East Coast and South-West England National Health Service regions in multilevel logistic regression to describe the effects of individual composition and contextual factors (area deprivation and geodemographic segments) on non-response to screening invitation. The relative impact of geodemographic segmentation and the index of multiple deprivation (IMD) 2007 was compared. The potential population impact of a targeted increase in uptake in specific geodemographic segments was examined. RESULTS About 88 891 eligible adults were invited to be screened from 2006 to 2008. Uptake rate was 57.3% (CI: 57.0-57.7) and was lower amongst younger persons, men, residents of more deprived areas and people in specific geodemographic segments. Age and gender were significant determinants of uptake and contextual factors explained an additional 3% of the variation. Geodemographic segmentation reduced this residual contextual variation in uptake more than the IMD 2007 (72% vs. 53% reduction). The three geodemographic types that best predicted non-response were characterized by both ethnic mix and a higher than average proportion of single pensioner households renting council properties. Achieving average uptake in the 2.3% of the study population in these geodemographic segments would only increase the total population uptake rate by 0.5% (57.3-57.8%). CONCLUSION Variation in the CRC screening uptake in Southern England is principally explained by characteristics of individuals but contextual factors also have a small but significant effect. This effect is captured in greater detail by geodemographic segmentation than by IMD 2007. This information could be used to inform the design of interventions aiming to improve uptake.
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Affiliation(s)
- Kelechi E Nnoaham
- South Central Strategic Health Authority, Newbury, Berkshire RG14 2PZ, UK.
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Stock C, Haug U, Brenner H. Population-based prevalence estimates of history of colonoscopy or sigmoidoscopy: review and analysis of recent trends. Gastrointest Endosc 2010; 71:366-381.e2. [PMID: 19846082 DOI: 10.1016/j.gie.2009.06.018] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2009] [Accepted: 06/15/2009] [Indexed: 12/19/2022]
Abstract
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.
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Affiliation(s)
- Christian Stock
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
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Griffin JM, Burgess D, Vernon SW, Friedemann-Sanchez G, Powell A, van Ryn M, Halek K, Noorbaloochi S, Grill J, Bloomfield H, Partin M. Are gender differences in colorectal cancer screening rates due to differences in self-reporting? Prev Med 2009; 49:436-41. [PMID: 19765609 DOI: 10.1016/j.ypmed.2009.09.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2009] [Revised: 09/10/2009] [Accepted: 09/10/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Studies have found that women are less likely than men to undergo colorectal cancer (CRC) screening. While one source of these disparities may be gender differences in barriers and facilitators to screening, another may be differences in reporting bias. METHOD In this study of 345 male and female veterans, conducted in 2006 in Minneapolis, MN, we examined CRC screening adherence rates by gender using medical records and self-report and assessed whether any differences were due to reporting bias. RESULTS We found a significantly higher rate of colonoscopy use among men when using self-report data, but no significant differences in either overall or test-specific screening adherence when using medical record data. Analyses examining the prevalence and determinants of concordance between self-report and medical records screening revealed that compared to women, men were less accurate in reporting sigmoidoscopy and colonoscopy and over-reported screening by colonoscopy. Men were also more likely to have missing self-report data and how missing data were handled affected differences in screening behavior. Accuracy in screening behavior was not explained by demographic variables, good physical or mental health, or physician recommendation for screening. CONCLUSIONS Reported gender disparities in CRC screening adherence may be a result of reporting bias.
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Affiliation(s)
- Joan M Griffin
- Center for Chronic Disease Outcomes Research, Minneapolis VA Medical Center, Minneapolis, MN 55417, USA.
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Abstract
PURPOSE Mitochondrial DNA mutations are found in many kinds of human cancer and the 1.1 kb displacement loop region has been identified as a "hot spot" for mutation in mitochondrial DNA of tumors. This study evaluated the mutation frequencies in hypervariable regions of mitochondrial displacement loop in patients with colorectal cancer. METHODS We examined the frequency of mutations in the mitochondrial DNA displacement loop region of 40 colorectal cancer samples in comparison to 150 samples from people without any type of familial cancer history, by automated DNA sequencing. Alignment was made with the revised Cambridge Reference Sequence and any differences recorded as single base substitution, insertions, and deletions. RESULTS Our results showed that the rate of displacement loop variations was higher in colorectal cancer patients than controls. Nineteen single nucleotide polymorphisms were found; among them eighteen occurred in the displacement loop region. CONCLUSIONS Mutations in mtDNA D-loop region probably do not cause colorectal cancer but are more likely to be epiphenomena; patients with the high mtDNA variants are at a higher risk of colorectal cancer.
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Itzkowitz S, Brand R, Jandorf L, Durkee K, Millholland J, Rabeneck L, Schroy PC, Sontag S, Johnson D, Markowitz S, Paszat L, Berger BM. A simplified, noninvasive stool DNA test for colorectal cancer detection. Am J Gastroenterol 2008; 103:2862-70. [PMID: 18759824 DOI: 10.1111/j.1572-0241.2008.02088.x] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND As a noninvasive colorectal cancer (CRC) screening test, a multi-marker first generation stool DNA (sDNA V 1.0) test is superior to guaiac-based fecal occult blood tests. An improved sDNA assay (version 2), utilizing only two markers, hypermethylated vimentin gene (hV) and a two site DNA integrity assay (DY), demonstrated in a training set (phase 1a) an even higher sensitivity (88%) for CRC with a specificity of 82%. AIM To validate in an independent set of patients (phase 1b) the sensitivity and specificity of sDNA version 2 for CRC. METHODS Forty-two patients with CRC and 241 subjects with normal colonoscopy (NC) provided stool samples, to which they immediately added DNA stabilizing buffer, and mailed their specimen to the laboratory. DNA was purified using gel-based capture, and analyzed for hV and DY using methods identical to those previously published. RESULTS Using the same cutpoints as the 1a training set (N = 162; 40 CRCs, 122 normals), hV demonstrated a higher and DY a slightly lower sensitivity, for a combined sensitivity of hV + DY of 86%. Optimal cutpoints based on the combined phase 1a + 1b dataset (N = 445; 82 CRCs, 363 normals) yielded a CRC sensitivity of 83%. The vast majority of cancers were detected regardless of tumor stage, tumor location, or patient age. Assay specificity in the phase 1b dataset for hV, DY, and hV + DY was 82%, 85%, and 73%, respectively, using the phase 1a cutpoints. Optimal cutpoints based on the combined phase 1a + 1b dataset yield a specificity of 82%. CONCLUSIONS This study provides validation of a simplified, improved sDNA test that incorporates only two markers and that demonstrates high sensitivity (83%) and specificity (82%) for CRC. Test performance is highly reproducible in a large set of patients. The use of only two markers will make the test easier to perform, reduce the cost, and facilitate distribution to local laboratories.
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Affiliation(s)
- Steven Itzkowitz
- Department of Medicine and Oncological Sciences, Mount Sinai School of Medicine, New York, New York 10029, USA
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Abstract
BACKGROUND Screening reduces incidence and mortality from colorectal cancer (CRC). Despite improved access, screening is suboptimal and disparate among minority groups. Quality of patient-provider communication may impact CRC screening. OBJECTIVES We examined the relationship between patient-provider communication and socioeconomic variables on the receipt of CRC screening using data from the Medical Expenditure Panel Survey. SUBJECTS All persons age 50 years or older (N = 8488). MEASURES Dependent measures were receipt of CRC screening, fecal occult blood testing, and colonoscopy or sigmoidoscopy. Independent variables included demographic characteristics, patient language, and patient-provider communication measures from the Consumer Assessment of Health Plan survey. RESULTS Patients who felt they had sufficient time with their healthcare provider were more likely to be screened for CRC. Receiving adequate explanation of healthcare needs from provider was a significant predictor of fecal occult blood testing screening. In addition, persons with less than a high school education, the uninsured, or those with low income were associated with reduced likelihood of receiving CRC screening. Asians and Hispanics had a significantly reduced likelihood of receiving screening in comparison with whites; however, after adjusting for language, no significant differences for race or ethnicity were observed. CONCLUSIONS Adequate time with a healthcare provider and receiving sufficient explanation of the healthcare processes by providers may improve screening rates. Patient-provider communication may be improved by addressing language needs of non-English speaking patients. Overall improved communication may increase CRC screening rates in underserved populations.
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Crawley LM, Ahn DK, Winkleby MA. Perceived medical discrimination and cancer screening behaviors of racial and ethnic minority adults. Cancer Epidemiol Biomarkers Prev 2008; 17:1937-44. [PMID: 18687583 DOI: 10.1158/1055-9965.epi-08-0005] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Discrimination has been shown as a major causal factor in health disparities, yet little is known about the relationship between perceived medical discrimination (versus general discrimination outside of medical settings) and cancer screening behaviors. We examined whether perceived medical discrimination is associated with lower screening rates for colorectal and breast cancers among racial and ethnic minority adult Californians. METHODS Pooled cross-sectional data from 2003 and 2005 California Health Interview Survey were examined for cancer screening trends among African American, American Indian/Alaskan Native, Asian, and Latino adult respondents reporting perceived medical discrimination compared with those not reporting discrimination (n = 11,245). Outcome measures were dichotomous screening variables for colorectal cancer among respondents ages 50 to 75 years and breast cancer among women ages 40 to 75 years. RESULTS Women perceiving medical discrimination were less likely to be screened for colorectal [odds ratio (OR), 0.66; 95% confidence interval (95% CI), 0.64-0.69] or breast cancer (OR, 0.52; 95% CI, 0.51-0.54) compared with women not perceiving discrimination. Although men who perceived medical discrimination were no less likely to be screened for colorectal cancer than those who did not (OR, 1.02; 95% CI, 0.97-1.07), significantly lower screening rates were found among men who perceived discrimination and reported having a usual source of health care (OR, 0.30; 95% CI, 0.28-0.32). CONCLUSIONS These findings of a significant association between perceived racial or ethnic-based medical discrimination and cancer screening behaviors have serious implications for cancer health disparities. Gender differences in patterns for screening and perceived medical discrimination warrant further investigation.
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Affiliation(s)
- LaVera M Crawley
- Stanford University Center for Biomedical Ethics, Palo Alto, California, USA.
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de Bosset V, Atashili J, Miller W, Pignone M. Health insurance-related disparities in colorectal cancer screening in Virginia. Cancer Epidemiol Biomarkers Prev 2008; 17:834-7. [PMID: 18398024 DOI: 10.1158/1055-9965.epi-07-2760] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Colorectal cancer (CRC) screening rates remain low in the United States. The effect of health insurance on CRC screening is not clear. We assessed the association between having health insurance and being screened for CRC and the factors that modify this association. METHODS We used data from the 2005 Virginia Behavioral Risk Factor Surveillance System to evaluate the association of self-reported insurance coverage on self-reported CRC screening among all men and women ages > or =50 years (N = 2,887). Prevalence odds ratios (POR) were estimated using unconditional logistic regression. All covariates were assessed for potential effect measure modification and confounding. All analyses accounted for the Behavioral Risk Factor Surveillance System complex survey sampling design. RESULTS Overall, participants who reported having insurance coverage were more than twice as likely to report being screened for CRC compared with those who reported having none [crude POR, 2.16; 95% confidence interval (95% CI), 1.26-3.68]. This relationship differed between men and women (POR(males), 3.37; 95% CI, 1.63-6.96; POR(females), 1.46; 95% CI, 0.74-2.89). After adjusting for age and income, self-reported insurance coverage had a positive association with report of being screened among men (POR, 2.02; 95% CI, 0.96-4.23) but not among women (POR, 0.81; 95% CI, 0.34-1.93). CONCLUSIONS Men who reported having health insurance were more likely to report having CRC screening than those who reported not having insurance coverage. However, this effect was not observed in women. These findings, if confirmed in other study populations, indicate that improving CRC screening coverage may require not only insurance status specifications but also gender-explicit considerations.
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Affiliation(s)
- Vanessa de Bosset
- Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7435, USA.
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Coburn N, Fulton J, Pearlman DN, Law C, DiPaolo B, Cady B. Treatment Variation by Insurance Status for Breast Cancer Patients. Breast J 2008; 14:128-34. [DOI: 10.1111/j.1524-4741.2007.00542.x] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Has the surge in media attention increased public awareness about colorectal cancer and screening? J Community Health 2008; 33:1-9. [PMID: 18080203 DOI: 10.1007/s10900-007-9065-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
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.
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Ng EST, Tan CH, Teo DCL, Seah CYE, Phua KH. Knowledge and perceptions regarding colorectal cancer screening among Chinese--a community-based survey in Singapore. Prev Med 2007; 45:332-5. [PMID: 17707496 DOI: 10.1016/j.ypmed.2007.06.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2006] [Revised: 06/09/2007] [Accepted: 06/11/2007] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Despite the increase in colorectal cancer (CRC) incidence among Chinese in Asia, there are no data on predictors of CRC screening uptake in this population. This study investigated how knowledge and perceptions about CRC correlated with screening behavior in Singaporean-Chinese. METHODS A community-based cross-sectional study was carried out on Singaporean-Chinese at least 50 years old in Queenstown Estate, Singapore between 1/1/2006 and 1/2/2006. A questionnaire administered via face-to-face interviews elicited knowledge, perceptions and screening behavior of subjects. RESULTS The response rate was 72.4%, with 514 completed responses. Expense was the commonest perceived barrier to screening (56.6% agreed), unlike for other populations. Social influence is important, with 67.5% agreeing to the statement "I would go for CRC screening if my family wanted me to". After excluding confounders, Chinese who had been for fecal occult blood test (FOBT) screening had higher knowledge score (p<0.001), lower perceived severity (p<0.01), were more likely to have been influenced by their family/friends to go for screening (p=0.04) and to have attended screening tests for other diseases (p<0.001). CONCLUSION FOBT screening uptake is associated with specific areas of knowledge and perception among Singaporean-Chinese. To increase screening uptake within Chinese populations, clinicians should consider these factors in their approach to patients.
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Affiliation(s)
- E S T Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Not an equal opportunity disease – a sex and gender-based review of colorectal cancer in men and women: Part II. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/j.jmhg.2007.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Brotherstone H, Vance M, Edwards R, Miles A, Robb KA, Evans REC, Wardle J, Atkin W. Uptake of population-based flexible sigmoidoscopy screening for colorectal cancer: a nurse-led feasibility study. J Med Screen 2007; 14:76-80. [PMID: 17626706 PMCID: PMC2817449 DOI: 10.1258/096914107781261972] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To assess uptake of once-only flexible sigmoidoscopy (FS) in a community sample to determine whether FS would be viable as a method of population-based screening for colorectal cancer. METHODS All adults aged 60-64 years registered at three General Practices in North West London, UK (510 men and women) were sent a letter of invitation to attend FS screening carried out by an experienced nurse, followed by a reminder if they did not make contact to confirm or decline the invitation. The primary outcome was attendance at the endoscopy unit for a FS test. RESULTS Of the 510 people invited to attend, 280 (55%) underwent FS. Among non-attenders, 91 (18%) were ineligible for screening or did not receive the invitation, 19 (4%) accepted the offer of screening but were unable to attend during the study period, 52 (10%) declined the offer, 41 (8%) did not respond to the invitation, and 27 (5%) accepted the offer of screening but did not attend. Attendance among those eligible to be screened, who had received the invitation, was 67%. People from more socioeconomically deprived neighbourhoods were less likely to attend (odds ratio [OR] = 0.90; confidence interval [CI] = 0.84-0.96; P = 0.003). Women were more likely to attend than men (OR = 1.44; CI = 1.01-2.05; P = 0.041). CONCLUSIONS Attendance rates in this pilot for nurse-led, population-based FS screening were higher than those reported in other FS studies, and comparable with adherence to fecal occult blood testing (FOBT) in the UK FOBT pilot. Having a female nurse endoscopist may have been responsible for increasing female uptake rates but this warrants confirmation in a larger study.
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Affiliation(s)
- Hannah Brotherstone
- Cancer Research UK Health Behaviour Unit, Department of Epidemiology and Public Health, University College London, London WC1E 6BT, UK
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Peterson NB, Murff HJ, Ness RM, Dittus RS. Colorectal cancer screening among men and women in the United States. J Womens Health (Larchmt) 2007; 16:57-65. [PMID: 17324097 DOI: 10.1089/jwh.2006.0131] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A few previous studies have shown that men were more likely than women to be screened for colorectal cancer (CRC). METHODS The 2000 National Health Interview Survey (NHIS) was administered to 32,374 adults > or = 18 years of age. Participants were asked if they ever had a sigmoidoscopy or colonoscopy and if they ever had a home fecal occult blood test (FOBT). Men and women > or = 50 years were eligible for analysis. Participants were considered to be current in testing if they reported sigmoidoscopy in the last 5 years, colonoscopy in the last 10 years, or home FOBT in the last 1 year. RESULTS Overall, 62.9% of adults had ever had CRC testing, and 37.1% were current for testing. Compared to older men, a greater proportion of older women were not current for testing (62.6% for women vs. 56.7% for men > 75 years). In multivariate analysis, women were not less likely than men to be current in CRC testing (OR 0.98, 95% CI 0.88-1.08). When compared with white women, black women were less likely to be current for CRC screening (OR 0.79, 95% CI 0.65-0.95). CONCLUSIONS CRC screening is underused. Targeting interventions to improve CRC screening for all appropriate patients will be important.
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Affiliation(s)
- Neeraja B Peterson
- Center for Health Services Research, Division of General Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee 37232-8300, USA.
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