Does colorectal cancer risk perception predict screening behavior? A systematic review and meta-analysis

Abstract

Objective Although health behavior theories postulate that risk perception should motivate colorectal cancer (CRC) screening, this relationship is unclear. This meta-analysis aims to examine the relationship between CRC risk perception and screening behavior, while considering potential moderators and study quality. Method A search of six databases yielded 58 studies (63 effect sizes) that quantitatively assessed the relationship between CRC risk perception and screening behavior. Results Most included effect sizes (75%) reported a positive association between CRC risk perception and screening behavior. A random effects meta-analysis yielded an overall effect size of z=0.13 (95% CI 0.10–0.16), which was heterogeneous (I2=99%, τ2=0.01). Effect sizes from high-quality studies were significantly lower than those from lower quality studies (z=0.02 vs. 0.16). Conclusions We found a small, positive relationship between CRC risk perception and reported screening behavior, with important identified heterogeneity across moderators. Future studies should focus on high quality study design.

Reactions to online colorectal cancer risk estimates among a nationally representative sample of adults who have never been screened

“…To address these processes, several strategies that can enhance acceptance of CRC risk estimates were offered and deserve future testing. Our findings also replicate the positive link between risk appraisals and screening intentions (Atkinson et al, 2015), while highlighting key pathways through which a single CRC risk estimate influences screening intentions (Figure 1). Ultimately a strong test of the efficacy of tailored risk estimates to influence screening will require enhancing acceptance of risk estimates while taking into account the various modalities through which it can be delivered (e.g., clinic, web).…”

“…To this end, one general practice gave patients who were off-schedule the ability to view their tailored CRC risk estimate online (Sequist et al, 2011); patients who reviewed their risk estimate were more likely to get screened than patients who did not view their risk (30% vs. 15%). These findings align with a recent meta-analysis showing a positive link between heightened perceived CRC risk and screening (Atkinson et al, 2015; see also Edwards et al, 2013). These results reinforce the utility of giving patients CRC risk online and suggest that conveying tailored CRC risk via the internet more broadly may encourage screening.…”

Conflating Colorectal Cancer Screening and Diagnostic Testing—Letter

“…From a behavioral perspective, these findings dovetail with our recent meta-analysis of the relationship between CRC risk perception and screening behavior (2), where we found a small, significant overall effect size of z = 0.13 (95% CI 0.10-0.16). We observed that only 22% of the 58 studies in our analysis excluded tests for symptoms; this was the only study characteristic that moderated the relationship between CRC risk perception and screening, with a significantly lower relationship observed in studies that excluded tests for symptoms ( z = 0.03 vs. 0.17, respectively).…”

“…We observed that only 22% of the 58 studies in our analysis excluded tests for symptoms; this was the only study characteristic that moderated the relationship between CRC risk perception and screening, with a significantly lower relationship observed in studies that excluded tests for symptoms ( z = 0.03 vs. 0.17, respectively). Our findings led us to propose that, “risk perceptions may be less important in the asymptomatic screening context” (p.846) (2). …”

An opportunity to address modifiable breast cancer risks: Mammography screening and physical activity readiness to change

“…False positive mammograms are particularly common in the US; 61% of women who are screened annually (42% biannually) for 10 years will receive at least one false positive result (Hubbard et al, 2011). Cues to action, such as a false positive cancer screen, and enhanced risk perceptions are components of the Health Belief model known to stimulate health protective behaviors (Atkinson et al, 2015, Cohen et al, 2011, Senore et al, 2012). However, as behavior change typically occurs in stages over a period of time (Marcus and Forsyth, 2003), we were interested in assessing readiness to change physical activity, as described by the Trantheoretical (TTM)/Stages of Change model.…”