Colorectal cancer screening: discussions with first degree relatives

Knowledge, Attitude and Intentions Related to Colorectal Cancer Screening Using Faecal Occult Blood Tests in a Rural Australian Population

A telephone survey with 604 men and women without history of colorectal cancer (CRC)(age 50-74 years) explored knowledge of, attitudes toward, and intention to screen for CRC using faecal occult blood tests (FOBT) in a rural Australian population. Overall, 53% intended to participate in and 86% would follow a doctor's recommendation for FOBT screening. In contrast, only 18% had ever had a FOBT, and fewer than 60% of those with high-risk family history had undergone appropriate screening for CRC. Prior use of FOBT ( OR=3.2) , high perceived susceptibility to CRC ( OR=2.4), belief in the importance of screening despite the absence of symptoms ( OR=2.1) were positively and older age ( OR = 0.5) was negatively related to screening intention in multivariate logistic regression analysis. A doctor's recommendation improved screening intention among those who never tested for CRC before but believe in the importance of early treatment. This study highlights the lack of compliance with standard CRC screening recommendations in Australia and provides evidence for the importance of continued educational efforts, with the particular emphasis on older adults and the medical community. Asia Pac JPublic Health 2003; 1 5(1): 50-56.

Perceived versus predicted risks of colorectal cancer and self-reported colonoscopies by members of mismatch repair gene mutation-carrying families who have declined genetic testing

People carrying germline mutations in mismatch repair genes are at high risk of colorectal cancer (CRC), yet about half of people from mutation-carrying families decline genetic counselling and/or testing to identify mutation status. We studied the association of quantitative measures of risk perception, risk prediction and self-reported screening colonoscopy in this elusive yet high-risk group. The sample of 26 participants (mean age 43.1 years, 14 women) in the Australasian Colorectal Cancer Family Registry were relatives of mutation carriers; had not been diagnosed with any cancer at the time of recruitment and had declined an invitation to attend genetic counselling and/or testing. A structured elicitation protocol captured perceived CRC risk over the next 10 years. Self-reported colonoscopy screening was elicited during a 45-minute semi-structured interview. Predicted 10-year CRC risk based on age, gender, known mutation status and family history was calculated using "MMRpro." Mean perceived 10-year risk of CRC was 31 % [95 % CI 21, 40], compared with mean predicted risk of 4 % [2, 7] (p < 0.001); this was independent of age and sex (p = 0.9). Among those reporting any medical advice and any screening colonoscopy (n = 18), those with higher risk perception had less frequent colonoscopy (Pearson's r = 0.49 [0.02, 0.79]). People who decline genetic testing for CRC susceptibility mutations perceive themselves to be at substantially higher risk than they really are. Those with high perceived risk do not undertake screening colonoscopy more often than those who perceive themselves to be at average risk.

Psychological Barriers and Facilitators of Colorectal Cancer Screening: A French Qualitative Study

The aim of this qualitative study was to explore the psychological barriers to and facilitators of undergoing the Hemoccult-II(®) colorectal cancer screening test in France. Sixty-nine French people aged 50 to 74 years were divided into seven qualitative focus groups. Three issues were discussed with participants: knowledge and beliefs about colorectal cancer screening; facilitators of colorectal cancer screening by Hemoccult-II(®) ; barriers to colorectal cancer screening by Hemoccult-II(®). All the discussions were led by two psychologists and were recorded, transcribed verbatim and analyzed using qualitative data analysis software. Correspondence factor analyses identified three dimensions for each topic. The main psychological facilitators of colorectal cancer screening were: information about colorectal cancer screening, perceived simplicity of using Hemoccult-II(®) , and perception of risk. Uncertainty about the reliability of Hemoccult-II(®), health anxiety, and embarrassment emerged as the main barriers to colorectal cancer screening. Cross-sectional analyses identified the differences between the views expressed by women and men. Women appeared more embarrassed about Hemoccult-II(®) and men seemed to be more worried about colorectal cancer. This preliminary study suggests that psychological factors play an important role in colorectal cancer screening by Hemoccult-II(®). This finding may help health organizations to conceive better awareness campaigns to promote colorectal cancer screening in order to reduce the related mortality rate by taking into account psychological determinants.

Screening practices of unaffected people at familial risk of colorectal cancer

Our objective was to determine screening practices of unaffected people in the general population at moderately increased and potentially high risk of colorectal cancer (CRC) because of their family history of the disease. A total of 1,627 participants in the Australasian Colorectal Cancer Family Registry study were classified into two CRC risk categories, according to the strength of their family history of the disease. We calculated the proportion of participants that adhered to national CRC screening guidelines by age group and for each familial risk category. We carried out a multinomial logistic regression analysis to evaluate the associations between screening and sociodemographic factors. Of the 1,236 participants at moderately increased risk of CRC, 70 (6%) reported having undergone guideline-defined "appropriate" screening, 251 (20%) reported some, but less than appropriate screening, and 915 (74%) reported never having had any CRC screening test. Of the 392 participants at potentially high risk of CRC, three (1%) reported appropriate screening, 140 (36%) reported some, but less than appropriate screening, and 249 (64%) reported never having had any CRC screening test. On average, those of middle age, higher education, and who had resided in Australia longer were more likely to have had screening for CRC. The uptake of recommended screening by unaffected people at the highest familial risk of developing CRC is extremely low. Guidelines for CRC screening are not being implemented in the population. More research is needed to identify the reasons so as to enable development of strategies to improve participation in screening.

Determinants of participation in colonoscopic screening by siblings of colorectal cancer patients in France

Background

Targeted colonosocopic screening is recommended for first-degree relatives of colorectal cancer patients diagnosed before the age of 60 and offers the possibility of reducing morbidity and mortality, but participation remains too low. The objective of this study was to determine in a French population the factors that affect siblings' participation in screening, notably those relating to the individuals, their medical care, their family and their social network.

Methods

A cross sectional survey was conducted in siblings of index patients having undergone surgery for colorectal cancer between 1999 and 2002 in two French counties. Siblings were contacted during 2007 and 2008 through the index patient. The factors affecting participation in colonoscopic screening were studied by logistic regression taking into account family cluster effect.

Results

172 siblings of 74 index cases were included. The declared rate of undergoing at least one colonoscopy among siblings was 66%; 95%CI 59-73%. Five variables were independently associated with colonoscopic screening: perceiving fewer barriers to screening (OR = 3.2; 95%CI 1.2-8.5), having received the recommendation to undergo screening from a physician (OR = 4.9; 1.7-13.7), perceiving centres practising colonoscopy as more accessible (OR = 3.2, 1.3-7.8), having discussed screening with all siblings (OR = 3.9; 1.6-9.6) and being a member of an association (OR = 2.6; 1.0-6.6).

Conclusions

The factors independently associated with participation in CRC screening by an individual at increased risk belonged to each of four dimensions relating to his individual psychosocial characteristics, to his relationship with a physician, within the family and social environment. The relevance of these results to clinical practice may help to improve compliance to recommendations in a global preventive strategy including all stages of the information pathway from the physician to the index patient and his relatives.

An examination of the psychosocial factors influencing colorectal cancer patients' communication of colorectal cancer patient risk with their siblings

This study examined psychosocial factors influencing colorectal cancer (CRC) patients' communication with their first-degree relatives regarding their CRC risk. Among a sample of CRC patients who were members of a colon registry in New York (n = 127), 60% reported discussing CRC risk with their siblings. These discussions were related to the CRC patients' age of diagnosis, such that those diagnosed before age 45 years were more likely to communicate with their siblings about CRC risk. Despite advances made in CRC prevention, compliance with screening recommendations among individuals who may be at familial risk for the disease is low. Perhaps this underrepresentation reflects how CRC patients communicate with their first-degree relatives about their potential risk for the disease. This study examined the psychosocial factors influencing whether CRC patients communicate with their siblings about CRC risk. The sample included CRC patients with siblings who enrolled in a colon disease registry at a NYC metropolitan hospital. Participants completed questionnaires regarding their current psychosocial functioning, perceived risk of sibling's development of CRC, and communication of CRC risk with their siblings. Patients were predominantly Caucasian, with a mean age of 60.4 years. Of the 127 patients, 60% engaged in discussions with their siblings regarding their CRC risk. Patients diagnosed with CRC before the age of 45 years were more likely to discuss the risk of CRC with their siblings (P < 0.01). These data suggest that CRC patients may serve as an effective vehicle to promote CRC screening and support the need for health care providers to not only educate patients of the familial risk of CRC, but to also encourage these patients to communicate this information with their siblings.

Do colorectal cancer patients understand that their family is at risk?

AIM

The aim of this study was to assess whether patients with colorectal cancer (CRC) are aware of the risk to family members and to test an educational intervention.

METHODS

CRC patients were surveyed regarding their cancer, family history, understanding of familial risk of CRC, and knowledge of existing screening guidelines for their relatives. An educational intervention was mailed to them and 6 months later they were resurveyed.

RESULTS

Of 253 CRC patients who agreed to participate, only 120 (47.4%) knew that their first-degree relatives were at increased risk for CRC. African-American (AA) race, educational background, income, and previous family history of CRC were significant predictive factors on univariate analysis, but only AA race remained significant on multivariate analysis. Two hundred two patients received the educational intervention and were resurveyed. The understanding of family risk did not improve with this intervention.

CONCLUSION

Most CRC patients do not know about their family members' risk. Better educational tools are needed.

General practitioner and specialist views on colonoscopic screening of first-degree relatives of colorectal cancer patients

INTRODUCTION

Barriers to targeted colonoscopic screening of first-degree relatives of colorectal cancer patients have been the subject of considerable literature, always as seen from the patient's viewpoint. In the specific context of screening individuals with a family history, physicians may also play a predominant role in motivating their colorectal cancer patients to pass on screening information to their relatives. The aim of this study was to examine the views of general practitioners and specialists regarding barriers and facilitators affecting participation of relatives in colonoscopic screening.

METHODS

A qualitative study was conducted to collect and analyse information from two focus groups of 4 general practitioners and 9 gastroenterologists respectively, and from semi-structured individual interviews with 10 general practitioners, 2 surgeons and 3 oncologists. An extended focus group of 36 gastroenterologists was organized to validate the results.

RESULTS

The main barriers to colonoscopic screening of FDRs were associated with lack of direct communication between physicians and FDRs. Physicians needed support in the task of informing index patients and persuading them to transfer information on screening to their FDRs. The general practitioners spoke of their expectations in terms of training in and motivation for promoting screening and the gastroenterologists expressed the wish for patient education material specific to colonoscopy and for systematic post-colonoscopy consultations to inform patients about their results, follow-up and screening their relatives.

CONCLUSION

The findings, notably the need for specific education materials and for training to improve the motivation of physicians, will help to develop effective interventions intended to increase participation in screening.

Willingness to undergo colorectal cancer screening in first-degree relatives of hospitalized patients with colorectal cancer

AIMS

To evaluate whether willingness to undergo colonoscopy screening is influenced by being a first-degree relative of hospitalized patients with or without colorectal cancer after briefing and surgeon recommendation.

METHODS

We performed a cross-sectional study of 327 first-degree relatives of hospitalized patients aged higher than 40 years, divided into Group A (151 relatives of colorectal cancer patients) and Group B (176 relatives of non-cancer patients) at the University Hospital of the Canary Islands, Spain. All were personally briefed by a surgeon, aided by a colorectal cancer pamphlet, and encouraged to accept screening colonoscopy with sedation.

RESULTS

Willingness to undergo colonoscopy screening was greater in Group A (66.9%) than in Group B (29.0%); (odds ratio: 11.1; 95% confidence interval = 4.27 to 29.14; P < 0.001). Pre-briefing awareness of screening colonoscopy was also significantly higher in Group A (76.8% vs. 33.5%; P < 0.001), the main source of information being a close relative with colorectal cancer.

CONCLUSIONS

Being a close relative of a colorectal cancer patient is positively related with willingness to undergo colonoscopy screening in this study. This cross-sectional study outlines a strategy for increasing the level of willingness to undergo colorectal cancer screening in a group of people at risk.

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.

Quality of life of family caregivers of cancer survivors: across the trajectory of the illness

BACKGROUND

Cancer affects not only the quality of life (QOL) of individuals with the disease but also that of their family members and close friends. The impact on various aspects of the family caregivers' QOL is significant throughout the trajectory of the illness. The authors reviewed literature on the QOL of family caregivers at the acute and middle- to long-term survivorship phases as well as the bereavement phase.

METHODS

By using several databases, the authors searched the literature published in English from 1996 through July 2007. Keywords searched included cancer, carcinoma, family, family member, caregivers, and quality of life. Several criteria were used to guide the literature review: Articles had to be published in refereed journals and had to use rigorous methods, sample, and validated measures.

RESULTS

The findings suggested that the QOL of family caregivers of individuals with cancer varies along the illness trajectory. This highlights were importance of assessing the ongoing adjustment of the caregivers over time. However, there were few theory-driven studies, and significant gaps remain in the current understanding of the effects of family caregiving beyond the time of diagnosis and treatment.

CONCLUSIONS

Accumulating evidence has supported the concept that cancer affects not only the patients/survivors but also their family members. However, theoretically and methodologically rigorous research on various aspects of the family's QOL, including not only the psychological but also the physical, spiritual, and behavioral adjustment to cancer in the family, remains sparse. Family-based interventions across the trajectory of the illness also are needed.

Randomized trial of a self-administered decision aid for colorectal cancer screening

Objective

Previous studies have not assessed whether evidence-based information about the outcomes of colorectal cancer screening increases informed choice among people from a range of socioeconomic backgrounds nor have they assessed whether this can be administered away from a health-care provider.

Methods

Randomized controlled trial in six primary care locations. Three hundred and fourteen people aged 50–74 years received a self-administered decision aid (DA) booklet about outcomes of biennial faecal occult blood testing (FOBT) screening or government consumer guidelines (G).

Results

Significantly more DA recipients (20.9%) were ‘informed’ compared with G recipients (5.8%) ( P = 0.0001, OR 4.32; 95% CI 2.49 to 7.52); the DA did not affect values clarity (61.9% clear after DA versus 59.1% after G) nor screening decisions overall (87.3% would screen after DA versus 90.5% after G). Test uptake at one month was uniformly low (5.2% DA versus 6.6% G); mostly due to being ‘too busy’. DA recipients were more likely to make decisions ‘integrating’ knowledge with values (10.4% DA versus 1.5% G). Decisions not to screen were equally uncommon in both groups but more likely to be uninformed in G ( P = 0.03). More DA recipients from all education levels were ‘informed’ ( P = 0.02), particularly in lower education (50.0% DA versus 17.8% G) and university-educated groups (79.4% DA versus 32.1% G).

Conclusion

Detailed absolute risk and benefit information about FOBT screening can be effectively used at home by people to increase informed choice. The DA was effective in people with lower education levels.

Trial Registration

Unique Protocol ID 211705 ClinicalTrials.gov ID NCT 00148226.

Can targeted intervention in CRC patients' relatives influence screening behaviour? A pilot study

OBJECTIVE

This study aimed to assess the utility of a standardised risk information tool with respect to the uptake of screening activities administered to an accessible population of first-degree relatives of patients with sporadic colorectal cancer.

METHOD

Patients admitted for colorectal cancer resection were invited to enroll their family unit in the study. Families were randomised either to receive standard care or the intervention tool. The intervention group received a structured one page pamphlet outlining the risk associated with a family history of colorectal cancer, and the availability of and potential benefits from screening. Three months after the initial contact with the index patient, family members were invited to participate in a telephone interview. Primary end-points were both intention to screen and uptake of screening activities.

RESULTS

Forty-seven families had 156 eligible first degree relatives. Ninety-one consented to participate and were enrolled: 59 received standard care, 32 received the intervention. Age and sex were similar between groups. There was no significant difference in previous screening activities. The intervention tool had no influence on perceived self-risk of developing colorectal cancer or uptake of screening activities within the study period.

CONCLUSION

This study suggests that the provision of targeted risk information to first-degree relatives is not likely to positively influence screening behaviour. Health care providers need to find alternative methods of disseminating information to this high-risk group.

Increased cancer risk for individuals with a family history of prostate cancer, colorectal cancer, and melanoma and their associated screening recommendations and practices

Prostate cancer, colorectal cancer, and melanoma are three malignancies that appear to have strong genetic components that can confer additional risk to family members. Screening tools, albeit controversial, are widely available to potentially aide in early diagnosis. Family members are now more attuned to the risks and benefits of cancer screening, thus, it is imperative that physicians understand the screening tools and how to interpret the information they provide. We reviewed the current literature regarding the cancer risks for individuals with a family history of prostate cancer, colon cancer, and melanoma, the current screening recommendations for family members, and actual screening practices of individuals with a family history of these malignancies. This review should serve as a guide for physicians and cancer control planners when advising their patients and the public regarding screening decisions.

Lay understanding of familial risk of common chronic diseases: a systematic review and synthesis of qualitative research

PURPOSE

Although the family history is increasingly used for genetic risk assessment of common chronic diseases in primary care, evidence suggests that lay understanding about inheritance may conflict with medical models. This study systematically reviewed and synthesized the qualitative literature exploring understanding about familial risk held by persons with a family history of cancer, coronary artery disease, and diabetes mellitus.

METHODS

Twenty-two qualitative articles were found after a comprehensive literature search and were critically appraised; 11 were included. A meta-ethnographic approach was used to translate the studies across each other, synthesize the translation, and express the synthesis.

RESULTS

A dynamic process emerged by which a personal sense of vulnerability included some features that mirror the medical factors used to assess risk, such as the number of affected relatives. Other features are more personal, such as experience of a relative's disease, sudden or premature death, perceived patterns of illness relating to gender or age at death, and comparisons between a person and an affected relative. The developing vulnerability is interpreted using personal mental models, including models of disease causation, inheritance, and fatalism. A person's sense of vulnerability affects how that person copes with, and attempts to control, any perceived familial risk.

CONCLUSIONS

Persons with a family history of a common chronic disease develop a personal sense of vulnerability that is informed by the salience of their family history and interpreted within their personal models of disease causation and inheritance. Features that give meaning to familial risk may be perceived differently by patients and professionals. This review identifies key areas for health professionals to explore with patients that may improve the effectiveness of communication about disease risk and management.

Relatives of colorectal cancer patients: factors associated with screening behavior

BACKGROUND

The purpose of this study was to identify whether decisions regarding colorectal cancer (CRC) screening by relatives of CRC patients are influenced by social interactions with family members, friends, and physicians or by public awareness campaigns.

METHODS

Screened (n=236) and nonscreened (n=132) relatives of CRC patients were interviewed in 2001. A socioecologic model was used as the framework for the interview variables, which included interactions with relatives, medical professionals, and social groups, as well as perceived benefits and barriers to screening and perceived susceptibility.

RESULTS

Physician encouragement, fewer barriers to screening, strong CRC family history, encouragement from relatives, advice from a surgeon, and discussion of CRC screening with social groups were all associated with ever having been screened. Having been encouraged by a physician was the strongest correlate of screening behavior. Perceived susceptibility to CRC, advice from family members, and exposure to public awareness information were not associated with screening.

CONCLUSIONS

The socioecologic framework is a good explanatory model of CRC screening in increased-risk relatives, as variables from each level were associated with screening. These findings can guide interventions aimed at increasing screening uptake, particularly those involving physicians.

Colorectal cancer screening and familial risk: a survey of internal medicine residents' knowledge and practice patterns

OBJECTIVE

Risk stratification is essential to the appropriate use of colorectal cancer screening recommendations. The principal objective of this study was to assess the knowledge and screening behavior of internal medicine (IM) residents regarding familial colorectal cancer.

METHODS

We conducted a survey of IM residents in their second and third year of postgraduate training from two university-based programs (n = 127). The survey instrument assessed physician knowledge of screening recommendations and current practices for individuals with a family history of colorectal cancer, adenomatous polyps, familial adenomatous polyposis, and hereditary nonpolyposis colorectal cancer. The instrument also elicited data regarding familial risk assessment, documentation, and notification of at-risk family members.

RESULTS

Eighty-one IM eligible residents (81%) completed the survey. Most respondents identified a family history of colorectal cancer as an important factor in assessing colorectal cancer risk and appropriately implemented relevant screening recommendations. However, for patients with a family history of adenomatous polyps diagnosed before age 60 yr, knowledge and adherence to recommendations advocating screening at age 40 was relatively poor. More importantly, for patients with familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer, respondents lacked the necessary risk assessment skills and knowledge to appropriately implement current recommendations. There were no consistent differences in knowledge or screening behavior when stratified on the basis of program site or postgraduate year status.

CONCLUSION

Many IM residents are deficient in their knowledge, risk assessment skills, and screening practices for patients at familial risk of colorectal cancer. Effective educational strategies that promote awareness regarding familial risk, risk assessment skills, and appropriate use of relevant screening guidelines are needed.

Screening for bowel cancer among NSW adults with varying levels of risk: a community survey

OBJECTIVE

To estimate the extent and modality of screening for colorectal cancer in NSW among community-dwelling adults aged over 40 with varying degrees of familial risk.

DESIGN

Cross-sectional telephone survey with participants randomly selected from the electronic NSW telephone directory.

MAIN RESULTS

5.7% of people at average risk aged 40-49 report having had at least one faecal occult blood test (FOBT) in the previous five years, compared with 18.4% of those at average risk aged 50 and over. Of those at above-average risk (by age and familial risk), 7.9% reported that they had had an FOBT in the previous five years. Around 5% of respondents aged 40-49 and 10% of those aged 50+ reported having had a colonoscopy/sigmoidoscopy for screening within the previous five years, compared with 30% of those at above-average risk. People with medical insurance were more likely to have undergone a screening test (either FOBT or sigmoidoscopy/colonoscopy), than those without insurance (PR = 1.30; 95% CI 1.02-1.67). Compared with those employed full time, those who were retired (PR = 1.45 95% CI 1.01-2.09) and those who reported home duties (PR = 1.54 95% CI 1.01-2.36) were slightly, but significantly more likely to report having had a test. As perception of personal risk for colorectal cancer increased, so did the likelihood of having had a screening test within the previous five years (PR = 1.19; 95% CI 1.05-1.35).

CONCLUSION

We have reported important baseline data with which to compare the progress of both pilot screening programs and more widespread implementation of colorectal screening in Australia. In particular, we have highlighted the need for greater participation in screening for those at increased familial risk.

Family history and colorectal cancer screening: a survey of physician knowledge and practice patterns

OBJECTIVES

Risk stratification is essential to effective implementation of colorectal cancer (CRC) screening strategies. The objectives of this study were to assess and compare the current knowledge and practice patterns of gastroenterologists and primary care physicians regarding familial risk of CRC.

METHODS

We conducted a survey of regional gastroenterologists and a sample of university- and community-based primary care physicians. The survey instrument assessed physician knowledge of screening recommendations and current practices for individuals with family histories of CRC, adenomatous polyps (APs), familial adenomatous polyposis (FAP), and hereditary nonpolyposis cancer (HNPCC). The instrument also elicited data about familial risk assessment, documentation, and notification of at-risk family members.

RESULTS

Thirty-five gastroenterologists (65%) and 58 primary care physicians (92%) completed the survey. Most gastroenterologists and primary care physicians (85% vs 72%) chose age 40 as the appropriate age to begin screening for a family history of CRC, but relatively few (37% vs 36%) recommended screening at age 40 for a family history of APs. Gastroenterologists were significantly more likely to recommend screening for FAP at puberty (80% vs 27%, p < 0.001) and for HNPCC at age 25 (73% vs 50%, p = 0.04). Colonoscopy was the preferred screening strategy by both groups for family histories of CRC (97%), HNPCC (97%), and APs (77%); primary care physicians also preferred colonoscopy for family histories of CRC (72%) and HNPCC (76%) but flexible sigmoidoscopy plus fecal occult blood testing for a family history of APs (38%). Gastroenterologists were more likely to recommend genetic testing for persons at risk of FAP (91% vs 71%, p = 0.03) and HNPCC (72% vs 57%, p = 0.18), routinely inquire about a family history of CRC or APs (93% vs 63%, p < 0.001), and recommend notification of at-risk first-degree relatives with family histories of CRC (94% vs 55%, p < 0.001) or AP (53% v.s 6%, p < 0.001).

CONCLUSION

Although gastroenterologists are more likely than primary care physicians to elicit a family history of colorectal neoplasia and implement appropriate screening strategies, overall compliance with recommended guidelines and notification of at-risk relatives are suboptimal. Novel approaches for improving awareness of the available screening guidelines are needed.

Faecal occult blood test: current practice in a rural Queensland community

The findings of a recent telephone survey of 604 residents (50-74 years of age) in a rural community in Queensland are presented. The survey focused on the participants' knowledge concerning the faecal occult blood test (FOBT) and their previous testing history. Responses were analysed in terms of gender, age and education differences. More than half of all participants were aware of the FOBT, and 109 (18%) had undergone FOBT in the past. Fewer understood the importance of "health checks without symptoms" than the "advantage of early treatment". The most common reasons to use FOBT were: "prevention" and "I want to know if I have cancer". A person's gender, age and education were shown to be associated with their knowledge and beliefs. These results suggest an increase in the use of the FOBT with time (in relation to previous surveys), but a poor understanding of its place in promoting health.

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.