Surveillance behavior of women with a reported family history of colorectal cancer

Do people really know what makes a family history of cancer?

BACKGROUND

Family history is often referred to as a family tree in casual everyday conservations, but it carries a different connotation in medicine. This study is the first to investigate people's understanding of 'family medical history' and the concept of 'family' in the context of inherited cancer.

METHODS

Three hundred and nine staff at the Faculty of Medicine and Health, University of Leeds completed an online web survey.

RESULTS

Not all respondents understood or knew what makes a family history of cancer. Only 54% knew exactly the type of information required to make a family history. Apart from blood relatives, adopted and step-siblings, step parents, in-laws, spouses, friends and colleagues were also named as 'family' for family history taking. Personal experience of living with cancer and academic qualification were not significant in influencing knowledge of family history.

CONCLUSIONS

There is misunderstanding and poor knowledge of family history of cancer and the type of information required to make a family history even in a sample of people teaching and researching medicine and health issues. Public understanding of the value of family medical history in cancer prevention and management is important if informed clinical decisions and appropriate health care are to be delivered.

Screening participation for people at increased risk of colorectal cancer due to family history: a systematic review and meta-analysis

We conducted a systematic review and a meta-analysis of observational studies to identify and summarise the level of colorectal cancer (CRC) screening participation for people at increased risk due to family history of the disease. Medline, Cinhal, Embase and PsychInfo databases were comprehensively searched between January 1995 and May 2012 to identify relevant articles. To be included, studies had to report on screening for people who had at least one first-degree relative with CRC and no previous personal diagnosis of the disease. Pooled screening participation levels were calculated for each screening modality. Seventeen studies, accounting for a total of 13,269 subjects with a family history of CRC met the inclusion criteria. Seven studies, including a total of 6,901 subjects had a pooled faecal occult blood testing screening participation (at least once) of 25 % (95 % CI 12-38). Five studies including a total of 5,091 subjects had a pooled sigmoidoscopy-based screening participation (at least once) of 16 % (95 % CI 7-27). Seven studies including a total of 9,965 subjects had pooled participation colonoscopy-based screening (at least once) of 40 % (95 % CI 26-54). There was a significant level of screening heterogeneity between studies. This review identified a substantial underuse of CRC screening for people at increased risk of developing the disease. It highlights the potential opportunity that exists for increasing screening participation among this segment of the population and the need to adjust the current CRC screening policies towards that objective.

Racial and ethnic variations in the effects of family history of colorectal cancer on screening compliance

BACKGROUND & AIMS

Individuals with a family history of colorectal cancer (CRC) have a higher risk of developing CRC than the general population, and studies have shown that they are more likely to undergo CRC screening. We assessed the overall and race- and ethnicity-specific effects of a family history of CRC on screening.

METHODS

We analyzed data from the 2009 California Health Interview Survey to estimate overall and race- and ethnicity-specific odds ratios (ORs) for the association between family history of CRC and CRC screening.

RESULTS

The unweighted and weighted sample sizes were 23,837 and 8,851,003, respectively. Individuals with a family history of CRC were more likely to participate in any form of screening (OR, 2.3; 95% confidence limit [CL], 1.7, 3.1) and in colonoscopy screening (OR, 2.7; 95% CL, 2.2, 3.4) than those without a family history, but this association varied among racial and ethnic groups. The magnitude of the association between family history and colonoscopy screening was highest among Asians (OR, 6.1; 95% CL, 3.1, 11.9), lowest among Hispanics (OR, 1.4; 95% CL, 0.67, 2.8), and comparable between non-Hispanic whites (OR, 3.1; 95% CL, 2.6, 3.8) and non-Hispanic blacks (OR 2.6; 95% CL, 1.2, 5.7) (P for interaction < .001).

CONCLUSIONS

The effects of family history of CRC on participation in screening vary among racial and ethnic groups, and have the lowest effects on Hispanics, compared with other groups. Consequently, interventions to promote CRC screening among Hispanics with a family history should be considered.

Colon cancer screening in women

Colorectal cancer is the third leading cause of cancer-related deaths in women. Colorectal cancer is a preventable disease with accepted screening modalities that have been proven to save lives. As women are more likely than men to develop right-sided colon cancers, colonoscopy is the preferred screening test in women. Currently, women are less likely to undergo colorectal cancer screening than men. Frank discussions addressing the fear or embarrassment of endoscopic screening are important in helping women overcome these barriers. Enhanced education of both practitioners and patients targeted to improve colorectal cancer screening adherence will improve early diagnosis and patient survival.

Colorectal cancer screening in first-degree relatives of colorectal cancer: participation, knowledge, and barriers against screening

BACKGROUND

Family history is one of the most important risk factors for developing colorectal cancer (CRC), and medical organizations recommend CRC screening in this population. However, the use of CRC screening is still low in our country.

OBJECTIVE

To investigate the use of CRC screening, knowledge about CRC and screening tests, and factors related to screening in a family-risk population.

METHODS

A total of 334 family-risk participants answered a questionnaire to assess the use of CRC screening tests, knowledge about CRC, risk perception, and barriers against screening.

RESULTS

In total, 22% of participants had undergone at least one of the recommended tests for CRC screening. Furthermore, indication for screening was found in only 8% of participants. Use of CRC screening tests was significantly lower than mammography for breast cancer detection in women (20 vs. 82%, P<0.001) and use of serum prostate-specific antigen for prostate cancer detection in men (27 vs. 46%, P<0.001). Most participants (59%) knew that being elderly was a risk factor and only about half (47%) had knowledge about any of the recommended examinations. Only in about half of the cases (47%) was subjective risk perception higher than in the general population. In the logistic regression analysis, having more than one affected relative (odds ratio= 2.63, 95% confidence interval: 1.05-6.68; P=0.03) and a high subjective perception of risk (odds ratio= 2.87, 95% confidence interval: 1.10-7.46; P=0.03) were independent predictors for CRC screening.

CONCLUSION

Less than 25% of the family-risk population has undergone a CRC screening test. Family history and subjective risk perception of CRC are the strongest predictors of CRC screening.

Screening participation in individuals with a family history of colorectal cancer: a review

Literature regarding screening behaviour in individuals with a family history of colorectal cancer was reviewed, in order to determine the prevalence of screening in this population and identify factors associated with screening participation. Four electronic databases were searched from 1994. Thirty papers met the inclusion criteria, including 3 community surveys, 13 studies on first-degree relatives of colorectal cancer patients, and 14 studies on genetic services for colorectal cancer risk assessment. Individuals with a family history of colorectal cancer, who have not received risk assessment, frequently have never had any form of screening for colorectal cancer. Uptake of endoscopic screening when offered to individuals identified as being at increased risk was generally high (often >60% participation). Having a medical recommendation to screen, a stronger family history and perceiving fewer barriers to screening were identified as predictors of screening behaviour. Existing data suggest that use of screening tests in individuals with a family history of colorectal cancer is variable, and our understanding of factors associated with screening behaviour is limited. A number of methodological problems in research to date were identified, and further research is needed in order to inform interventions to support sustained screening participation in this population.

Knowledge, health beliefs and health-related behaviours of first-degree relatives of women suffering from osteoporosis in Taiwan: a questionnaire survey

BACKGROUND

No previous study has examined knowledge, health beliefs and health-related behaviours in first-degree relatives (FDRs) of osteoporosis sufferers, especially focusing on Asian women.

AIM

This study explored osteoporosis knowledge, beliefs and behaviours of women with a family history of osteoporosis, and drew a comparison with women with no such history.

DESIGN

This study recruited women at a large public health centre in northern Taiwan. A questionnaire was applied on FDRs and non-FDRs women with a focus on osteoporosis knowledge, health beliefs and behaviours. Descriptive analysis was initially conducted. Differences between FDRs and non-FDRs were rated via Student's t-tests for continuous variables and the chi-squared test for categorical variables.

RESULTS

Overall, most of the participants were aware of some osteoporosis-related information but the proportions of correct responses to the questions that tested knowledge between FDRs and non-FDRs were only 44.0% and 42%, respectively. Meanwhile, participants in the FDRs group not only reported higher concern in developing the disease, but also perceived higher barriers compared with the non-FDRs group. As the study demonstrates, for health-related behaviours, the FDRs group did not undertake actual preventive behaviours, and only bone mineral density screening behaviour differed significantly from the non-FDRs group.

CONCLUSIONS

This study highlights the inadequate information on osteoporosis and constraining beliefs of FDRs women. Additionally, as preventative behaviours for osteoporosis were not noted in FDRs group, community health nurses and researchers should make efforts to assist and encourage women to take practical preventative behaviours.

RELEVANCE TO CLINICAL PRACTICE

This investigation reviews the knowledge, beliefs and behaviours of the FDRs group for Taiwanese women with osteoporosis. The results of this work can be used to provide effective implementation guidelines for preventing osteoporosis especially for women with a family history of the disease.

Predictors of colorectal cancer screening behaviors among average-risk older adults in the United States

OBJECTIVE

To critically evaluate recent studies that examined determinants of CRC screening behaviors among average-risk older adults (>or=50 years) in the United States.

METHODS

A PUBMED (1996-2006) search was conducted to identify recent articles that focused on predictors of CRC initiation and adherence to screening guidelines among average-risk older adults in the United States.

RESULTS

Frequently reported predictors of CRC screening behaviors include older age, male gender, marriage, higher education, higher income, White race, non-Hispanic ethnicity, smoking history, presence of chronic diseases, family history of CRC, usual source of care, physician recommendation, utilization of other preventive health services, and health insurance coverage. Psychosocial predictors of CRC screening adherence are mostly constructs from the Health Belief Model, the most prominent of which are perceived barriers to CRC screening.

CONCLUSIONS

Evidence suggests that CRC screening is a complex behavior with multiple influences including personal characteristics, health insurance coverage, and physician-patient communication. Health promotion activities should target both patients and physicians, while focusing on increasing awareness of and accessibility to CRC screening tests among average-risk older adults in the United States.

Genetic counseling outcomes: perceived risk and distress after counseling for hereditary colorectal cancer

Genetic counseling may turn risk information into cancer prevention behavior by modifying health beliefs and cancer-related distress. We assessed the effect of genetic counseling on these factors in 101 adult first-degree-relatives of colorectal cancer patients from families with known or suspected hereditary nonpolyposis colorectal cancer. Before counseling and once afterward, subjects completed self-report measures of perceived lifetime risk and cancer-distress. Most persons overestimated their cancer risk, and higher perceived risk was associated with believing that colorectal cancer cannot be prevented. Individual perceived risk changed after counseling, although mean perceived risk was unchanged. After adjusting for baseline risk, older persons and those with higher estimated objective cancer risk had larger postcounseling decreases. Distress after counseling was positively correlated with baseline distress and anxiety symptoms, and inversely correlated with tolerance for ambiguity. The findings suggest counseling interventions that should increase the likelihood of screening and offer hypotheses for future research.

Barriers to colorectal cancer screening: an educational diagnosis

BACKGROUND

Colorectal cancer (CRC) is a largely preventable disease through early detection and treatment, yet screening rates remain low and mortality rates remain high, particularly among low-income, minority populations. This study was conducted to identify barriers to CRC screening.

METHODS

Repeated telephone contacts were conducted with 226 individuals from 52 to 80 years of age, who had not recently received CRC screening. The contacts were intended to educate and encourage participants to obtain CRC screening. Within this context, CRC screening barriers were identified and categorized using an educational diagnosis as specified in the Precede-Proceed Framework.

RESULTS

Findings showed that the most frequently observed barrier was lack of familiarity with CRC screening guidelines and tests. Availability and accessibility to screening tests was a barrier that was difficult to overcome for many participants. The majority of participants faced two or more barriers.

CONCLUSIONS

This study suggests a need for public health education about CRC screening guidelines and tests and greater accessibility to CRC screening.

Barriers to preventive intervention

A spectrum of colorectal cancer screening studies identified barriers to screening adherence, although definitive and comprehensive conclusions cannot be drawn. Barriers can be intrinsic (demographic, medical, psychological, and knowledge/attitudes/beliefs) or extrinsic (access to health care, health care provider knowledge and motivation, and lifestyle issues). Certain consistent patterns are emerging. Lower adherence is generally seen in persons who have less knowledge and lower perceived risk of colorectal cancer, as well as when health care providers do not recommend screening. Remedies that reduce intrinsic and extrinsic barriers to screening adherence are needed.

Psychological benefits of prostate cancer screening: the role of reassurance

OBJECTIVES

The role of reassurance in decision-making about screening for health problems is largely unknown. We examined the reassurance value of prostate cancer screening in primary care patients.

SETTING AND PARTICIPANTS

One hundred and sixty eight men, aged 45-70 years, who had no history of prostate cancer, from three family medicine practices in southeast Texas.

METHODS

A hypothetical scenario was developed where men were asked to assume they did not have prostate cancer, and then to rank three predefined screening states with regard to reassurance value: (A) unknown (no screening), (B) normal by screening [a prostate-specific antigen (PSA) test and a digital rectal examination (DRE)] and (C) normal by biopsy (abnormal PSA test and DRE results but a negative ultrasound-guided prostate biopsy).

RESULTS

Most of the men (96.8%) associated some reassurance value with screening, considering health state A to be the worst possible health state. Results from a multivariate analysis showed that preference for screening state C was associated with a family history of prostate cancer and perceived greater risk for prostate cancer compared with other men.

CONCLUSION

These findings suggest that prostate cancer screening may have some reassurance value for men, and that increased risk status may explain why some men prefer the added reassurance afforded by screening.

Colorectal cancer screening participation: comparisons with mammography and prostate-specific antigen screening

OBJECTIVES

The relation of personal characteristics, health and lifestyle behaviors, and cancer screening practices to current colorectal cancer (CRC) screening was assessed and compared with those factors' relation to current mammography screening in women and prostate-specific antigen (PSA) screening in men.

METHODS

A cross-sectional random-digit-dialed telephone survey of 954 Massachusetts residents aged 50 and older was conducted.

RESULTS

The overall prevalence of current CRC screening was 55.3%. Logistic regression results indicated that family history of CRC (odds ratio [OR] = 1.98; 95% confidence interval [CI] = 1.02, 3.86), receiving a regular medical checkup (OR = 3.07; 95% CI = 2.00, 4.71), current screening by mammography in women and PSA in men (OR = 4.40; 95% CI = 2.94, 6.58), and vitamin supplement use (OR = 1.87; 95% CI = 1.27, 2.77) were significant predictors of CRC screening.

CONCLUSIONS

Health and lifestyle behaviors were related to increased current CRC, mammography, and PSA screening. Personal factors independently related to CRC screening were not consistent with those related to mammography and PSA screening. This lack of consistency may reflect different stages of adoption of each type of screening by clinicians and the public.

Risk and reluctance: understanding impediments to colorectal cancer screening

PURPOSE

Screening to detect and prevent colorectal cancer (CRC) is well below optimal, contributing to needless CRC-related morbidity and mortality. Little detailed information exists explaining why screening technologies are underutilized and why screening adherence rates are low. Prior to the design of an intervention study, we assessed knowledge about CRC among adult women and men with access to health care. We also investigated patterns of perceived risk for CRC, barriers and facilitators to screening, and experience and intentions with regard to both fecal occult blood testing and flexible sigmoidoscopy.

METHODS

We analyzed data from semistructured focus group interviews with a small, nonrepresentative sample (n = 39) of community-dwelling adult men and women ages 50 to 64 and 65 plus.

RESULTS

CRC-related knowledge is low, and misperceptions are common. Provider practices reinforce low levels of perceived risk. Multiple barriers to screening exist, of which many are remediable.

CONCLUSIONS

We are at an early stage in the diffusion of information about CRC. Screening utilization may be improved through development of appropriate public health awareness campaigns and by addressing service factors. Recommendations are provided.