Adherence to Screening Examinations for Colorectal-Cancer After Diagnosis in a 1st-Degree Relative

doi:10.1006/pmed.1995.1030

Preventive Medicine

Volume 24, Issue 2, March 1995, Pages 166-170

https://doi.org/10.1006/pmed.1995.1030 Get rights and content

Abstract

Reports of colorectal cancer screening behavior were collected from 83 twin sisters of colorectal cancer cases and compared to the patterns found by national surveys. Prior to the diagnosis of colorectal cancer in a twin, the unaffected cotwins were being screened at rates close to those of the general population. In the years after diagnosis the annual frequency of each exam increased by approximately 15 to 20 percentage points. By the time of response nearly 89% of these cotwins had at least one fecal occult blood test, 90% had at least one digital rectal exam, and 69% had a sigmoidoscopy in comparison to 44, 63, and 27% of the general population, respectively. However, despite the evident familial risk, within the year prior to the report, 42.3% of colorectal cancer twins had had a fecal occult blood test, 44.3% had had a digital rectal exam, and 16% had had a sigmoidoscopy exam (the comparable figures from the general population sample are 14.5, 19.3, and 4%, respectively). The colorectal cotwins have a higher rate of sigmoidoscopy screening than either the National Health Interview Survey or the breast cotwins. Both colorectal and breast cancer cotwins have a higher rate of fecal occult blood test and digital rectal exam than the NHIS sample. This suggests that those at increased risk of cancer in general, are more likely to obtain routine screening including fecal occult blood test and digital rectal exam as part of the physical exam; however, the specialized sigmoidoscopy screening is more likely to be provided to those at most risk.

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Cited by (44)

Rapid review of factors associated with flexible sigmoidoscopy screening use
2019, Preventive Medicine
Citation Excerpt :
All consistently non-significant factors are reported in the appendix (see Appendix 2). The most frequently examined sociodemographic factors were: gender (n = 28) (Power et al., 2008; Sutton et al., 2000; Whitaker et al., 2011; Walsh et al., 2004; Ko et al., 2005; Janz et al., 2003; Walsh et al., 2002; Lawsin et al., 2007; Taylor et al., 2003; Yip et al., 2006; Blom et al., 2008; Hol et al., 2009; McGregor et al., 2016; Robb et al., 2010; Van Jaarsveld et al., 2006; Kang and Bloom, 1993; McCaffery et al., 2002; Bevan et al., 2015; Brotherstone et al., 2007; Juon et al., 2003; Segnan et al., 2007; Investigators, 2002; Bostick et al., 1993; Lewis and Jensen, 1995; van Dam et al., 2013; Kremers et al., 2000; Senore et al., 2010; McCarthy and Moskowitz, 1993), age (n = 26) (Power et al., 2008; Sutton et al., 2000; Wardle et al., 2005; Whitaker et al., 2011; Walsh et al., 2004; Ko et al., 2005; Janz et al., 2003; Walsh et al., 2002; Lawsin et al., 2007; Taylor et al., 2003; Yip et al., 2006; Hol et al., 2009; Van Jaarsveld et al., 2006; Kang and Bloom, 1993; McCaffery et al., 2002; Juon et al., 2003; Segnan et al., 2007; Bostick et al., 1993; Lewis and Jensen, 1995; van Dam et al., 2013; Kremers et al., 2000; Senore et al., 2010; McCarthy and Moskowitz, 1993; Richardson et al., 1995; Brenes and Paskett, 2000; Ruffin et al., 2000), education (n = 15) (Sutton et al., 2000; Walsh et al., 2004; Lawsin et al., 2007; Taylor et al., 2003; Blom et al., 2008; Van Jaarsveld et al., 2006; Juon et al., 2003; Lewis and Jensen, 1995; van Dam et al., 2013; Kremers et al., 2000; Senore et al., 2010; McCarthy and Moskowitz, 1993; Richardson et al., 1995; Brenes and Paskett, 2000; Bostick et al., 1994), marital status (n = 12) (Tang et al., 2001; Power et al., 2008; Wardle et al., 2005; Lawsin et al., 2007; Taylor et al., 2003; Blom et al., 2008; Van Jaarsveld et al., 2006; Juon et al., 2003; Lewis and Jensen, 1995; van Dam et al., 2013; Brenes and Paskett, 2000; Bostick et al., 1994), socioeconomic status (n = 10) (Power et al., 2008; Wardle et al., 2005; Whitaker et al., 2011; Hol et al., 2009; McGregor et al., 2016; Robb et al., 2010; McCaffery et al., 2002; Bevan et al., 2015; Brotherstone et al., 2007; van Dam et al., 2013), ethnicity (n = 9) (Sutton et al., 2000; Walsh et al., 2004; Ko et al., 2005; Janz et al., 2003; Walsh et al., 2002; Lewis and Jensen, 1995; McCarthy and Moskowitz, 1993; Brenes and Paskett, 2000; Robb et al., 2008), income (n = 6) (Tang et al., 2001; Walsh et al., 2004; Lawsin et al., 2007; Blom et al., 2008; Kang and Bloom, 1993; Bostick et al., 1994) and employment status (n = 5) (Power et al., 2008; Wardle et al., 2005; van Dam et al., 2013; Senore et al., 2010; McCarthy and Moskowitz, 1993). Those most frequently positively associated with FS screening use included: male gender (n = 12/28; 42.9%) (Sutton et al., 2000; Whitaker et al., 2011; Ko et al., 2005; Janz et al., 2003; Walsh et al., 2002; Hol et al., 2009; McGregor et al., 2016; Van Jaarsveld et al., 2006; McCaffery et al., 2002; Segnan et al., 2007; Bostick et al., 1993; McCarthy and Moskowitz, 1993), higher socioeconomic status (n = 9/10; 90%) (Power et al., 2008; Wardle et al., 2005; Whitaker et al., 2011; Hol et al., 2009; McGregor et al., 2016; Robb et al., 2010; McCaffery et al., 2002; Bevan et al., 2015; Brotherstone et al., 2007), older age (n = 5/26; 19.2%) (Walsh et al., 2004; Janz et al., 2003; Walsh et al., 2002; Hol et al., 2009; Ruffin et al., 2000), higher education (n = 4/15; 26.6%) (Lawsin et al., 2007; Van Jaarsveld et al., 2006; Kang and Bloom, 1993; Bostick et al., 1994), being married (n = 4/12; 33.3%) (Wardle et al., 2005; Blom et al., 2008; Van Jaarsveld et al., 2006; Juon et al., 2003) and White, Black, or Hispanic ethnicity (n = 5/9; 55.6%) (Walsh et al., 2004; Ko et al., 2005; Janz et al., 2003; Walsh et al., 2002; Robb et al., 2008).
Flexible sigmoidoscopy (FS) screening has been shown to reduce colorectal cancer (CRC) incidence and mortality among screened adults. The aim of this review was to identify patient-related factors associated with the screening test's use.
We searched PubMed for studies that examined the association between FS screening use and one or more factors. To determine the eligibility of studies, we first reviewed titles, then abstracts, and finally the full paper. We started with a narrow search, which we expanded successively (by adding ‘OR’ terms) until the number of new publications eligible after abstract review was <1% of the total number of publications. We then abstracted factors from eligible papers and reported the number of times each was found to be positively or negatively associated with FS screening use.
We identified 42 papers, most of which reported studies conducted in the United States of America (n = 21, 50%) and the United Kingdom (n = 13, 31%). Across studies, a wide range of factors were examined (n = 123), almost half of which were found to be associated with FS screening use at least once (n = 60). Sociodemographic and health and lifestyle factors that were frequently positively associated with FS screening use included: male gender, higher socioeconomic status and a family history of CRC. Frequently positively associated psychosocial factors included low perceived barriers and high perceived benefits.
Findings suggest that future research should focus on developing a theoretical framework of cancer screening behaviour to allow a greater level of consistency and specificity in measuring key constructs.
Differences in response to a dietary intervention between the general population and first-degree relatives of colorectal cancer patients
2014, Journal of Nutrition Education and Behavior
Citation Excerpt :
Furthermore, in a longitudinal study of FDRs of women with breast cancer, relatives increased fruit and vegetable consumption 6 months after their family members' diagnoses.8 Similarly, twins of colon cancer patients were more likely than the general population to be screened after their co-twin's diagnoses.11 Less is known about whether FDRs of CRC patients are more likely to adhere to preventive dietary behaviors than the general population.
To determine whether response to a dietary intervention is greater among people with family history of colorectal cancer (CRC) compared with a general population.
Cohort study examining participants from 2 related studies.
Rural Virginia.
Seventy people with first-degree relatives with CRC and 113 participants from the intervention arm of a trial in the general population.
Both studies implemented a low-intensity intervention delivered via telephone and mail, including low-literacy self-help booklets and personalized dietary feedback.
Fat, fiber, and fruit and vegetable behavior.
Propensity score matching controlled for confounders. Mixed-model ANOVAs compared samples; mediation by perceived cancer risk was assessed.
Participants in both groups significantly improved fat, fiber, and fruit and vegetable behavior at 1-month follow-up; there was significantly greater improvement in the general population sample. Cancer risk perception did not mediate the relationship between study sample and dietary change.
Contrary to expectations, first-degree relatives of CRC patients did not respond better to a dietary intervention than the general population, nor was risk perception related to dietary change. Given the role of diet in CRC risk, additional research should investigate targeted strategies to improve dietary intakes of people at higher cancer risk.
Screening participation predictors for people at familial risk of colorectal cancer: A systematic review
2013, American Journal of Preventive Medicine
Citation Excerpt :
Of these, six studies26,28–31,33 used existing population-based studies or cancer registries to recruit participants. Two studies32,35 were hospital-based, and one study34 recruited participants through an advertising campaign. One study27 used a case–control design to assess the impact of a screening program targeting first-degree relatives of CRC cases; it also reported factors associated with screening uptake among screeners.
People with a family history of colorectal cancer (CRC) are at increased risk of developing the disease. Information on the screening practices of this segment of the population is scarce.
A systematic review was conducted of observational studies to identify factors associated with CRC screening participation for people at increased risk due to family history of the disease.MEDLINE, Cinahl Information Sevices, Embase, and PsycINFO databases were searched comprehensively 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, have described the study design, and reported on at least two predictors of adherence to CRC screening using a multivariate analysis.
The search identified a total of 4986 articles, of which ten met the review's inclusion criteria. There were important inconsistencies among studies in the factors that were associated with screening. Receiving recommendations from clinicians was the most consistent predictor identified across studies. The review also revealed a consistent pattern of association with predictors related to familial aspects of CRC, such as strength of family history, and relationship to the affected relative. Among the psychological constructs, “social influence” emerged as the most consistent predictor of screening participation.
This review provides evidence that clinicians, as well as use of family history and social networks, offer the most promising avenues to promoting and improving screening participation by individuals at increased risk of colorectal cancer.
A randomized trial of two print interventions to increase colon cancer screening among first-degree relatives
2008, Patient Education and Counseling
First-degree relatives (FDRs) of people diagnosed with colorectal cancer (CRC) have a two- to threefold increased risk of developing the same disease. Tailored print interventions based on behavior change theories have demonstrated considerable promise in facilitating health-promoting behaviors. This study compared the impact of two mailed print interventions on CRC screening outcomes among FDRs.
This randomized trial compared effects of two mailed print interventions – one tailored and one nontailored – on participation in CRC screening among FDRs of CRC survivors. Data collected via phone interviews from 140 FDRs at baseline, 1 week post-intervention, and 3 months post-intervention.
At 3 months, both the tailored and nontailored interventions yielded modest but statistically insignificant increases in adherence to any CRC screening test (14% vs. 21%, respectively; p = 0.30). While there were no main effects for tailored versus nontailored interventions, there were significant interactions that showed that the tailored print intervention had significantly greater effects on forward stage movement for CRC screening depending on stage of adoption at baseline, race, and objective CRC risk. Receipt of the tailored intervention was 2.5 times more likely to move baseline precontemplators and contemplators forward in stage of adoption for colonoscopy (95% CI: 1.10–5.68) and was three times more likely to move Caucasians forward in stage of adoption for FOBT (95% CI: 1.00–9.07). In addition, the tailored intervention was 7.7 times more likely to move people at average risk forward in stage of adoption for colonoscopy (95% CI: 1.25–47.75).
The tailored print intervention was more effective at moving Caucasians, those in precontemplation and contemplation at baseline, and those at average risk forward in their stage of adoption for CRC screening.
Both tailored and nontailored print interventions showed moderate effects for increasing CRC screening participation. Tailored print interventions may be more effective for certain subgroups.
Familial risk and colorectal cancer screening health beliefs and attitudes in an insured population
2007, Preventive Medicine
To examine the relationship between health beliefs and attitudes toward colorectal cancer screening, strength of family history risk, and being appropriately screened for colorectal cancer.
In February 2004, 7000 randomly selected members of a multi-specialty group practice located in Boston, MA were mailed a brief survey that was used to ascertain colorectal cancer family history. A follow-up survey that contained questions representing selected constructs of the Health Belief Model, Theory of Planned Behavior, and healthcare experiences was then mailed to all 355 individuals who reported a family history in the initial survey and 710 randomly selected participants with no colorectal cancer family history.
Participants who were appropriately screened had higher mean scores for perceived cancer risk, subjective norms, and perceived benefits and lower scores for perceived barriers. Multivariate findings indicate that having high perceptions of risk for colorectal cancer was a significant correlate of being screened appropriately among individuals with a strong family history.
For those at greatest colorectal cancer risk due to family history, ensuring that these individuals understand their personal risk might lead to increased colorectal cancer screening participation. Future intervention research is warranted to examine if raising perceptions of risk can increase screening behaviors in individuals with colorectal cancer risk due to family history.
Is the type of test used for mass colorectal cancer screening a determinant of compliance?. A cluster-randomized controlled trial comparing fecal occult blood testing with flexible sigmoidoscopy
2006, Cancer Detection and Prevention
Background: The efficacy of colorectal cancer screening has been proved, and three different screening tests are recommended by international guidelines: the faecal occult blood test, flexible sigmoidoscopy and colonoscopy. While the effectiveness of a screening program depends on the compliance obtained, the role of the type of test on compliance has not yet been sufficiently studied. Aims: To measure the effect of the type of screening test used, i.e. faecal occult blood test or flexible sigmoidoscopy, on the compliance to colorectal cancer screening programs. Subjects and methods: A cluster-randomized two-arm trial was conducted. We randomly assigned 20 GP's practices that had an average of 150 patients between 50 and 74 years old. Results: 1449 individuals were referred to faecal occult blood test and 1538 to flexible sigmoidoscopy. The faecal occult blood test obtained higher compliance: 17.2% (95%CI 12.5–25.7) versus 7.0% (95%CI 5.7–9.0). The socio-economic status was an effect modifier of the test type: the effect of the type of test was smaller in low socioeconomic classes. Conclusions: The type of screening test used for colorectal cancer is a determinant of participation. In a low compliance area, better compliance will result from offering the faecal occult blood test than from the flexible sigmoidoscopy.

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Regular ArticleAdherence to Screening Examinations for Colorectal-Cancer After Diagnosis in a 1st-Degree Relative

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Regular Article
Adherence to Screening Examinations for Colorectal-Cancer After Diagnosis in a 1st-Degree Relative