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

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Abstract

Background.

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

Methods.

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

Results.

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

Conclusion.

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

Section snippets

Background

Colon cancer is the third leading cause of cancer and the second leading cause of cancer deaths in the US. In 2001, there were over 135,000 new cases and over 56,000 deaths from this disease [1]. Fortunately, recent studies suggest that early detection through different screening modalities, such as fecal occult blood testing (FOBT) and procedures including flexible sigmoidoscopy and colonoscopy, is effective in reducing mortality [2], [3]. Furthermore, screening appears to be cost effective [2]

The 2000 National Health Interview Survey

The NHIS is a continuing, in-person household survey about the health and healthcare use of the civilian, noninstitutionalized US population conducted by the National Center for Health Statistics [14]. In 2000, 100,618 persons (including children) from 43,437 households were surveyed, reflecting a response rate of 89%. One randomly selected adult from each household (n = 32,374) was also administered a supplemental Cancer Control Module, which included questions about cancer screening.

Screening for colon cancer

Of 11,427 respondents age 50–75 years in our sample, only 16% reported having completed annual FOBT and 29% reported having undergone either a flexible sigmoidoscopy in the preceding 5 years or a colonoscopy in the preceding 10 years; 36% were screened by FOBT, sigmoidoscopy, or colonoscopy. The mean age of respondents was 64 years. Those screened and unscreened were similar in age. Table 1 describes the unadjusted relationship between various factors and colon cancer screening. Non-Whites were

Comment

Our study confirms that screening for colorectal cancer continues to be low in the US. We observed an even lower prevalence of screening among Hispanics and those with lower education compared to their respective counterparts after adjustment, even though we found that members of these groups were no less adherent to physician recommendations to undergo screening in our study. Over 90% of patients who did not undergo screening were not counseled to do so by their physicians in the preceding

Acknowledgments

We thank the National Center for Health Statistics for providing the initial data. The analyses, interpretations, and conclusions in the manuscript, however, are those of the authors and do not reflect those of the National Center for Health Statistics.

The study was funded by a grant (R03 HS11683) from the Agency for Healthcare Research and Quality. Dr. Wee is also the recipient of a career development award from the National Institute of Diabetes, Digestive, and Kidney Diseases (K23 DK02962).

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