Associations in breast and colon cancer screening behavior in women1

doi:10.1016/j.acra.2004.12.024

Academic Radiology

Volume 12, Issue 4, April 2005, Pages 451-458

https://doi.org/10.1016/j.acra.2004.12.024 Get rights and content

Rationale and objectives

Gender-based psychosocial factors appear to influence colorectal cancer (CRC) screening adherence. Given its near-universal acceptance by the public, screening mammography represents a potential “teachable moment” for educating patients about the risk of CRC. Accordingly, to better understand screening behaviors among women, data from the Behavioral Risk Factors Surveillance Survey (BRFSS) were analyzed to identify potential relationships that would allow interventions to enhance CRC screening.

Materials and methods

Women 50 years and older who participated in the BRFSS 2001 survey were included in the analysis. Colorectal, breast, and cervical cancer screening adherence with American Cancer Society guidelines was determined. We identified the association between breast and cervical cancer screening adherence and general health and demographic characteristics with CRC screening adherence.

Results

After adjustment for sociodemographic factors in a multivariate analysis, women 60–69 years old (adjusted odds ratio [OR], 1.50; P < .01) and 70–79 years old (adjusted OR, 1.39; P < .01), having achieved at least some high school (adjusted OR, 1.62; P < .01) or college (adjusted OR, 2.11; P < .01) education, having health coverage (adjusted OR, 1.67; P < .01) or a personal physician (adjusted OR, 1.60; P < .01), and adherence to screening mammography (adjusted OR, 2.42; P < .01) and Pap smear (adjusted OR, 1.70; P < .01) were independently associated with an increased likelihood CRC screening adherence. Women in self-reported good general health were less likely to have adhered to CRC screening guidelines (adjusted OR, 0.79; P < .01). Current smokers were also less likely to have adhered to CRC screening guidelines than were women who never smoked or formerly smoked (adjusted OR, 0.76; P < .01). Participants who adhered to both mammography and Pap smear guidelines were significantly more likely to adhere to CRC screening (51.5% CRC screening adherence) compared with women who adhered to neither screening test (8.2% CRC screening adherence), with an adjusted OR of 5.67 (P < .001). Participants who adhered to both mammography and Pap smear guidelines were significantly more likely to adhere to CRC screening than were women who adhered to either screening test (38.0% CRC screening adherence) with an adjusted OR of 1.94 (P < .001).

Conclusion

Women with up-to-date mammography and cervical cancer screening were more likely to be up-to-date with CRC screening. Regardless of the increased association between non−CRC-related cancer screening and CRC screening, rates of CRC screening utilization remained low in these otherwise compliant populations.

Section snippets

Survey design and data collection

The BRFSS is an annual telephone survey of a nationally representative sample of noninstitutionalized adults designed to measure preventive health practices and risk behaviors in adults (15). The BRFSS contains a module on women’s health, including items on breast and cervical cancer health behaviors, and a module on colon cancer screening behavior. Although the survey does not capture the results of the screening tests, the women’s health component does record the self-reported reason for last

Respondents versus nonrespondents to colorectal cancer screening items

A total of 53,752 women aged 50 and older participated in the 2001 BRFSS; 52,478 (97.6%) responded to CRC screening items (Table 1). In the states in which the women’s health module was administered, 13,048 women (97.8%) responded to the mammography items and 12,987 women (97.3%) responded to the cervical cancer screening items. The respondents, whose average age was 65 years, were predominantly white or Hispanic with a median annual income of $25,000–$49,999. Almost all participants attended

Discussion

The ACS predicted that CRC would be the cause of an approximate 56,000 deaths in the year 2005 (1). Despite ample evidence demonstrating the effectiveness of screening in reducing colon cancer mortality, several population-based studies illustrate the suboptimal rate of CRC screening adherence (20, 21, 22, 23). According to the National Center for Health Statistics, 34% of eligible women had completed an FOBT within the preceding 2 years compared with 36% of men. Similarly, 33% of women had

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Special report Radiology Alliance for Health Services ResearchScientific reportsAssociations in breast and colon cancer screening behavior in women1

Rationale and objectives

Materials and methods

Results

Conclusion

Section snippets

Survey design and data collection

Respondents versus nonrespondents to colorectal cancer screening items

Discussion

Lancet

Lancet

Am J Med

Am J Prev Med

Am J Gastroenterol

Am J Gastroenterol

Screening for colorectal cancer in adults at average riska summary of the evidence for the U.S. Preventive Services Task Force

Ann Intern Med

Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study

N Engl J Med

A case-control study of screening sigmoidoscopy and mortality from colorectal cancer

N Engl J Med

Screening sigmoidoscopy and colorectal cancer mortality

J Natl Cancer Inst

Protection by endoscopy against death from colorectal cancer. A case- control study among veterans

Arch Intern Med

Cost-effectiveness analyses of colorectal cancer screeninga systematic review for the U.S. Preventive Services Task Force

Ann Intern Med

Healthy people 2010

Special report Radiology Alliance for Health Services Research
Scientific reports
Associations in breast and colon cancer screening behavior in women¹