BackgroundColorectal 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.MethodsN = 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.ResultsInterview 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’).ConclusionsMarked 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...

Colorectal cancer (CRC) is the second leading cause of cancerrelated death worldwide [1]. CRC is amenable to early detection with earlier diagnosis improving prognosis [2-4]. Like many regions around the world, Canadian provincial screening programs use fecal occult blood tests (FOBTs)-guaiac or immunochemical, depending on the province-as the initial CRC screening test [5]. When FOBTs are positive (FOBT+), colonoscopy is required for a definitive CRC diagnosis [6]. Delays in obtaining follow-up colonoscopy increase the risk of CRC, including advanced-stage disease [7, 8], while non-adherence considerably increases the risk of CRC death [9]. Timely receipt of follow-up colonoscopy is therefore critical to reducing the burden of CRC at the population level. Colon Cancer Check (CCC) is Ontario's organized CRC screening program and Canada's largest CRC screening program, serving just over 4 million eligible individuals [6]. CCC recommends biennial guaiac FOBT (Hema-Screen, Immunostics Inc., NJ, USA) for persons ages 50-74 at average CRC risk [10]. Primary care providers (PCPs) facilitate screening by dispensing FOBT kits, receiving test results and arranging follow-up colonoscopy for persons with FOBT + results. While a follow-up colonoscopy rate of 85-90%

Background: Prior randomized, controlled trials (RCTs) indicate that patient navigation can boost colorectal cancer screening rates in primary care. The sparse literature on pragmatic trials of interventions designed to increase colorectal cancer screening adherence motivated this trial on the impact of a patient navigation intervention that included support for performance of the participants' preferred screening test (colonoscopy or stool blood testing).Materials and Methods: Primary care patients (n ¼ 5,240), 50 to 74 years of age, with no prior diagnosis of bowel cancer and no record of a recent colorectal cancer screening test, were identified at the Group Health Centre in northern Ontario. These patients were randomly assigned to an intervention group (n ¼ 2,629) or a usual care control group (n ¼ 2,611). Intervention group participants were contacted by a trained nurse navigator by telephone to discuss colorectal cancer screening. Interested patients met with