Patterns and predictors of colorectal cancer test use in the adult U.S. population

Seeff, Laura C.; M, Nadel; Klabunde, Carrie N.; Thompson, Beti; Shapiro, Jean A.; Vernon, Sally W.; Coates, Ralph J.

doi:10.1002/cncr.20276

Cited by 478 publications

(471 citation statements)

References 24 publications

Supporting

Mentioning

413

Contrasting

Unclassified

Order By: Relevance

“…Consistent with previously published literature regarding CRC screening, we have shown that test use varies by gender, age, income, smoking status [16,18-22]. Interestingly, respondents with higher income levels were more likely to have an endoscopy test.…”

Section: Discussionsupporting

confidence: 89%

See 1 more Smart Citation

Increasing uptake of colorectal cancer screening in Korea: a population-based study

et al. 2010

View full text Add to dashboard Cite

BackgroundColorectal cancer (CRC) screening rates are low in most Asian countries and remain largely unknown. This study examined trends in CRC screening rates after the introduction of the Korean National Cancer Screening Programme (NCSP) and determined the factors associated with uptake of CRC screening by test modality over time.MethodsAn annual population-based survey conducted through nationally representative random sampling from 2005-2008. In total, 3,699 participants from the 2005-2008 surveys were selected as study subjects. Face-to-face interviews were performed to assess the utilization rate of CRC screening by each screening modality.ResultsOverall, CRC screening within the recommended time interval increased significantly from 22.9% in 2005 to 36.6% in 2008 (p < 0.001). The proportion of subjects receiving a fecal occult blood test (FOBT) test within the previous year increased significantly from 7.2% in 2005 to 21.3% in 2008 (p < 0.001). Increases in FOBT testing were highest among those who had a lower income status (relative difference = 511.9%) and women (relative difference = 266.1%). Endoscopy use also increased from 18.0% in 2005 to 20.5% in 2008, albeit not significant. Overall, those who were male, non-smokers, 60-69 years old, and had a higher income status were more likely to have undergone up-to-date endoscopy and CRC screening.ConclusionsThis study revealed a substantial increase in up-to-date CRC screening in the general population from 2005 to 2008. However, more than half of adults in Korea are still not up-to-date with their CRC tests. It will be important to continue to investigate factors associated with up-to-date CRC screening by each modality.

show abstract

Section: Discussionsupporting

confidence: 89%

“…Globally, only half the eligible population undergoes CRC screening [18-22]. In particular, screening for CRC is not commonly practiced in most Asian countries, and CRC screening behaviors in Asian populations remains largely unknown.…”

Section: Introductionmentioning

confidence: 99%

Increasing uptake of colorectal cancer screening in Korea: a population-based study

et al. 2010

View full text Add to dashboard Cite

show abstract

“…Prior consultation with a gastroenterologist did not affect colonoscopy adherence rates in this study [7], in conflict with prior reports indicating that physician visitation in the preceding year and procedure recommendation by a physician positively influenced rates of adherence to CRC screening [6,10]. This discrepancy may reflect a higher-risk population with increased rates of comorbid conditions in their study subjects [7].…”

contrasting

confidence: 97%

“…The adherence rates in this study (overall 89.3 %) are considerably higher than in other published reports [3,6,10]. Reminder phone calls and postcards are effective in increasing rates of CRC screening [11].…”

contrasting

confidence: 66%

Adherence to Screening Colonoscopy: Can We Get Our Recommendations to Stick?

Rogers

Keswani

2015

Dig Dis Sci

View full text Add to dashboard Cite

Although colorectal cancer (CRC) remains the second leading cause of cancer-related mortality in the USA, its incidence and mortality have decreased in men and women since 1997, a reduction attributed, in part, to the increased use of CRC screening modalities [1]. Colonoscopy, regarded by most expert advisory groups as the mainstay of CRC screening, is the only modality that both detects and removes neoplastic polyps from the entire colon. Despite its efficacy, only 20-38 % of the population is adherent to CRC screening guidelines [2,3]. Colonoscopy at present is estimated to decrease CRC-related mortality by 53 %, with further decrements expected if a greater proportion of individuals received age-appropriate screening [4]. Given limited healthcare resources, information that enables practitioners to focus interventions on populations most likely to be non-adherent to screening colonoscopy is valuable.Multiple patient factors influence adherence to CRC screening [5,6]. Demographic factors associated with lower rates of screening include female gender, younger age, low income or educational attainment, recent immigrant status, lack of health insurance, and persons of African-American or Hispanic descent [5]. Health factors associated with non-adherence include multiple medical comorbidities and decreased primary care utilization [6]. Nevertheless, little is known about how adherence differs among patients who are undergoing surveillance colonoscopy indicated for a history of colorectal polyps or are undergoing screening colonoscopy.In this issue of Digestive Diseases and Sciences, Greenspan et al. [7] report the results of a prospective study comparing rates of adherence to screening and surveillance colonoscopy in a population of 617 patients seeking care at an urban, tertiary medical center. Of multiple demographic factors studied in patients scheduled to undergo colonoscopy, patients scheduled for screening colonoscopy were significantly less likely to undergo their procedures than those scheduled for surveillance of adenomatous polyps (RR 5.42,). This intuitive finding represents a new, easily identifiable factor toward which patient adherence efforts can be directed.While univariate analysis indicated that female gender and the presence of medical comorbidities (represented by clopidogrel use and a history of congestive heart failure) were associated with an increased risk of non-adherence, these were not significant according to multivariable logistic regression analysis, consistent with prior studies [8]. The single factor associated with non-adherence and repeated procedure cancellations according to multivariable analysis, was indication for colonoscopy [7]. Although patients with a prior history of adenomatous polyps are at high risk of the development of adenomas or carcinoma (20-50 %) at subsequent surveillance colonoscopy, the risk of adenoma or carcinoma in asymptomatic patients undergoing screening colonoscopy can also be as high as 50 % [9]. Thus, it is appropriate to direct efforts toward ensuri...

show abstract

“…However, in the years under investigation, the overall impact of CRC screening is likely to have been limited, and gender differences in screening utilisation quite small compared to the major gender difference in CRC incidence and mortality. In particular, participation in Table 1 Age-adjusted mortality of colorectal cancer among men and women, and ages at which 10-year cumulative mortality among women reaches levels observed among men at ages 50, 55, and 60 endoscopic screening examinations was slightly lower rather than higher among women compared with men in the US (Seeff et al, 2004;Lieberman et al, 2005;Meissner et al, 2006), and could thus not explain the lower CRC mortality among women. Our analysis only considers the 'net differences' in CRC incidence and mortality between women and men, which might be owing to a variety of reasons.…”

Section: Discussionmentioning

confidence: 99%

Gender differences in colorectal cancer: implications for age at initiation of screening

et al. 2007

View full text Add to dashboard Cite

There is some variation regarding age at initiation of screening for colorectal cancer (CRC) between countries, but the same age of initiation is generally recommended for women and men within countries, despite important gender differences in the epidemiology of CRC. We have explored whether, and to what extent, these differences would be relevant regarding age at initiation of CRC screening. Using population-based cancer registry data from the US and national mortality statistics from different countries, we looked at cumulative 10-year incidence and mortality of CRC reached among men at ages 50, 55, and 60, and found that women mainly reached equivalent levels when 4 to 8 years older. The gender differences were remarkably constant across populations and over time. These patterns suggest that gender differentiation of age at initiation may be worthwhile to utilise CRC-screening resources more efficiently. With more than one million new cases and more than 500 000 deaths per year, colorectal cancer (CRC) is the third commonest cancer and the fourth commonest cancer cause of death worldwide (Parkin et al, 2005). Owing to its typically slow development, there is a large potential for reducing the burden of the disease by early detection and removal of precancerous lesions or early cancer stages. Various screening examinations, including faecal occult blood testing (FOBT), sigmoidoscopy, and colonoscopy have meanwhile been recommended by expert committees and implemented in screening offers in a number of countries (e.g. Winawer et al, 2003;Schmiegel et al, 2004;Malila et al, 2005;Smith et al, 2006). Regarding the age at initiation of screening, which is a crucial parameter for the effectiveness and cost-effectiveness of screening programmes (Vijan et al, 2001), there is some variation between countries (typically ranging from 50 to 60 years for the population at average risk). However, within countries, the same age of initiation is generally recommended for women and men, despite important gender differences in the epidemiology of CRC. In particular, age-specific CRC incidence and mortality are lower in women than in men, which implies that women reach comparable levels of CRC incidence and mortality at higher ages than men. This paper aims to address the question whether and to what extent these epidemiological differences might be relevant for defining age at initiation of CRC screening among women and men. METHODS Outcome measureWhen attempting to translate the gender differences in the epidemiology of CRC into gender-specific ages at initiation of screening, it is first necessary to define an appropriate outcome measure. In a screening programme that primarily aims at the early detection of CRC, as applies to FOBT-based screening, (cumulative) age-and sex-specific CRC incidence appears to be a natural choice. In a screening programme that aims to detect both CRC and its precursors (adenomas), as applies to endoscopy-based screening, the epidemiology of adenomas might also be considered. However, if the time...

show abstract

Patterns and predictors of colorectal cancer test use in the adult U.S. population

Cited by 478 publications

References 24 publications

Increasing uptake of colorectal cancer screening in Korea: a population-based study

Increasing uptake of colorectal cancer screening in Korea: a population-based study

Adherence to Screening Colonoscopy: Can We Get Our Recommendations to Stick?

Gender differences in colorectal cancer: implications for age at initiation of screening

Contact Info

Product

Resources

About