Journal of Community Health

, Volume 38, Issue 2, pp 285–292

Self-Reported Barriers to Colorectal Cancer Screening in a Racially Diverse, Low-Income Study Population

  • Benjamin W. Quick
  • Christina M. Hester
  • Kristin L. Young
  • K. Allen Greiner
Original Paper

Abstract

Colorectal cancer (CRC) screening is underutilized, especially in low income, high minority populations. We examined the effect test-specific barriers have on colonoscopy and fecal immunochemical test (FIT) completion, what rationales are given for non-completion, and what “switch” patterns exist when participants are allowed to switch from one test to another. Low income adults who were not up-to-date with CRC screening guidelines were recruited from safety-net clinics and offered colonoscopy or FIT (n = 418). Follow up telephone surveys assessed test-specific barriers. Test completion was determined from patient medical records. For subjects who desired colonoscopy at baseline, finding a time to come in and transportation applied more to non-completers than completers (p = 0.001 and p < 0.001, respectively). For participants who initially wanted FIT, keeping track of cards, never putting stool on cards, and not remembering to mail cards back applied more to non-completers than completers (p = 0.003, p = 0.006, and p < 0.001, respectively). The most common rationale given for not completing screening was a desire for the other screening modality: 7 % of patients who initially preferred screening by FIT completed colonoscopy, while 8 % of patients who initially preferred screening by colonoscopy completed FIT. We conclude that test-specific barriers apply more to subjects who did not complete CRC screening. As a common rationale for test non-completion is a desire to receive a different screening modality, our findings suggest screening rates could be increased by giving patients the opportunity to switch tests after an initial choice is made.

Keywords

Colorectal cancer screening Barriers FIT Colonoscopy Test preference 

References

  1. 1.
    Altekruse SF, Kosary CL, Krapcho M, et al. (2010). SEER cancer statistics review, 1975–2007. Bethesda, MD: National Cancer Institute. http://seer.cancer.gov/csr/1975_2007/, based on November 2009 SEER data submission, posted to the SEER web site.
  2. 2.
    Sonnenberg, A., Delcò, F., & Inadomi, J. M. (2000). Cost-effectiveness of colonoscopy in screening for colorectal cancer. Annals of Internal Medicine, 133(8), 573–584.PubMedGoogle Scholar
  3. 3.
    Pignone, M., Saha, S., Hoerger, T., & Mandelblatt, J. (2002). Cost-effectiveness analyses of colorectal cancer screening. Annals of Internal Medicine, 137(2), 96–104.PubMedGoogle Scholar
  4. 4.
    Calonge, N., Petitti, D. B., DeWitt, T. G., et al. (2008). Screening for colorectal cancer: U.S. preventive services task force recommendation statement. Annals of Internal Medicine, 149(9), 627–637.Google Scholar
  5. 5.
    Levin, B., Lieberman, D. A., McFarland, B., et al. (2008). Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: A joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. Gastroenterology, 134(5), 1570–1595.PubMedCrossRefGoogle Scholar
  6. 6.
    U.S. Department of Health and Human Services. (2012). Office of disease prevention and health promotion. Healthy people 2020. Washington, DC. Available at http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=5. Accessed May 24, 2012.
  7. 7.
    Ries LAG, Eisner MP, Kosary CL, et al. SEER cancer statistics review, 1975–2002. Bethesda, MD: National Cancer Institute. http://seer.cancer.gov/csr/1975_2002/, based on November 2004 SEER data submission, posted to the SEER web site 2005.
  8. 8.
    Berkowitz, Z., Hawkins, N. A., Peipins, L. A., White, M. C., & Nadel, M. R. (2008). Beliefs, risk perceptions, and gaps in knowledge as barriers to colorectal cancer screening in older adults. Journal of the American Geriatrics Society, 56(2), 307–314.PubMedCrossRefGoogle Scholar
  9. 9.
    James, T. M., Greiner, K. A., Ellerbeck, E. F., Feng, C., & Ahluwalia, J. S. (2006). Disparities in colorectal cancer screening: A guideline-based analysis of adherence. Ethnicity and Disease, 16(1), 228–233.PubMedGoogle Scholar
  10. 10.
    Christman, L. K., Abdulla, R., Jacobsen, P. B., et al. (2004). Colorectal cancer screening among a sample of community health center attendees. Journal of Health Care for the Poor and Underserved, 15(2), 281–293.PubMedCrossRefGoogle Scholar
  11. 11.
    Farraye, F. A., Wong, M., Hurwitz, S., et al. (2004). Barriers to endoscopic colorectal cancer screening: Are women different from men? American Journal of Gastroenterology, 99(2), 341–349.PubMedCrossRefGoogle Scholar
  12. 12.
    Janz, N. K., Wren, P. A., Schottenfeld, D., & Guire, K. E. (2003). Colorectal cancer screening attitudes and behavior: A population-based study. Preventive Medicine, 37(6), 627–634.PubMedCrossRefGoogle Scholar
  13. 13.
    Meissner, H. I., Breen, N., Klabunde, C. N., & Vernon, S. W. (2006). Patterns of colorectal cancer screening uptake among men and women in the United States. Cancer Epidemiology, Biomarkers and Prevention, 15(2), 389.PubMedCrossRefGoogle Scholar
  14. 14.
    Gupta, S., Tong, L., Allison, J. E., et al. (2009). Screening for colorectal cancer in a safety-net health care system: Access to care is critical and has implications for screening policy. Cancer Epidemiology Biomarkers Prevention, 18(9), 2373–2379.CrossRefGoogle Scholar
  15. 15.
    Cokkinides, V. E., Chao, A., Smith, R. A., Vernon, S. W., & Thun, M. J. (2003). Correlates of underutilization of colorectal cancer screening among US adults, age 50 years and older. Preventive Medicine, 36(1), 85–91.PubMedCrossRefGoogle Scholar
  16. 16.
    Ioannou, G. N., Chapko, M. K., & Dominitz, J. A. (2003). Predictors of colorectal cancer screening participation in the United States. The American Journal of Gastroenterology, 98(9), 2082–2091.PubMedCrossRefGoogle Scholar
  17. 17.
    Sun, W. Y., Basch, C. E., Wolf, R. L., & Li, X. J. (2004). Factors associated with colorectal cancer screening among Chinese-Americans. Preventive Medicine, 39(2), 323–329.PubMedCrossRefGoogle Scholar
  18. 18.
    Guessous, I., Dash, C., Lapin, P., Doroshenk, M., Smith, R. A., & Klabunde, C. N. (2010). Colorectal cancer screening barriers and facilitators in older persons. Preventive Medicine, 50(1–2), 3–10.PubMedCrossRefGoogle Scholar
  19. 19.
    Thompson, B., Coronado, G., Neuhouser, M., & Chen, L. (2005). Colorectal carcinoma screening among Hispanics and non Hispanic whites in a rural setting. Cancer, 103(12), 2491–2498.PubMedCrossRefGoogle Scholar
  20. 20.
    Seeff, L. C., Nadel, M. R., Klabunde, C. N., et al. (2004). Patterns and predictors of colorectal cancer test use in the adult US population. Cancer, 100(10), 2093–2103.PubMedCrossRefGoogle Scholar
  21. 21.
    Greiner, K. A., Engelman, K. K., Hall, M. A., & Ellerbeck, E. F. (2004). Barriers to colorectal cancer screening in rural primary care. Preventive Medicine, 38(3), 269–275.PubMedCrossRefGoogle Scholar
  22. 22.
    van Jaarsveld, C. H., Miles, A., Edwards, R., & Wardle, J. (2006). Marriage and cancer prevention: Does marital status and inviting both spouses together influence colorectal cancer screening participation? Journal of Medical Screening, 13(4), 172–176.PubMedGoogle Scholar
  23. 23.
    Klabunde, C. N., Schenck, A. P., & Davis, W. W. (2006). Barriers to colorectal cancer screening among medicare consumers. American Journal of Preventive Medicine, 30(4), 313–319.PubMedCrossRefGoogle Scholar
  24. 24.
    Greiner, K. A., Born, W., Nollen, N., & Ahluwalia, J. S. (2005). Knowledge and perceptions of colorectal cancer screening among urban African Americans. Journal of General Internal Medicine, 20(11), 977–983.PubMedCrossRefGoogle Scholar
  25. 25.
    Smith-Howell, E. R., Rawl, S. M., Champion, V. L., et al. (2011). Exploring the role of cancer fatalism as a barrier to colorectal cancer screening. Western Journal of Nursing Research, 33(1), 140.CrossRefGoogle Scholar
  26. 26.
    Fernandez, M. E., Wippold, R., Torres-Vigil, I., et al. (2008). Colorectal cancer screening among Latinos from U.S. Cities along the Texas-Mexico border. Cancer Causes and Control, 19(2), 195–206.PubMedCrossRefGoogle Scholar
  27. 27.
    Klabunde, C. N., Vernon, S. W., Nadel, M. R., Breen, N., Seeff, L. C., & Brown, M. L. (2005). Barriers to colorectal cancer screening: a comparison of reports from primary care physicians and average-risk adults. Medical Care, 43(9), 939.PubMedCrossRefGoogle Scholar
  28. 28.
    Tessaro, I., Mangone, C., Parkar, I., & Pawar, V. (2006). Knowledge, barriers, and predictors of colorectal cancer screening in an Appalachian church population. Preventing Chronic Disease, 3(4), A123.PubMedGoogle Scholar
  29. 29.
    Beeker, C., Kraft, J. M., Southwell, B. G., & Jorgensen, C. M. (2000). Colorectal cancer screening in older men and women: Qualitative research findings and implications for intervention. Journal of Community Health, 25(3), 263–278.PubMedCrossRefGoogle Scholar
  30. 30.
    Feldman, M. D., Zhang, J., & Cummings, S. R. (1999). Chinese and US internists adhere to different ethical standards. Journal of General Internal Medicine, 14(8), 469–473.PubMedCrossRefGoogle Scholar
  31. 31.
    Gilbert, A., & Kanarek, N. (2005). Colorectal cancer screening: Physician recommendation is influential advice to Marylanders. Preventive Medicine, 41(2), 367–379.PubMedCrossRefGoogle Scholar
  32. 32.
    Brawarsky, P., Brooks, D., Mucci, L., & Wood, P. (2004). Effect of physician recommendation and patient adherence on rates of colorectal cancer testing. Cancer Detection and Prevention, 28(4), 260–268.PubMedCrossRefGoogle Scholar
  33. 33.
    Lafata, J. E., Divine, G., Moon, C., & Williams, L. (2006). Patient-physician colorectal cancer screening discussions and screening use. American Journal of Preventive Medicine, 31(3), 202–209.PubMedCrossRefGoogle Scholar
  34. 34.
    Matthews, B. A., Anderson, R. C., & Nattinger, A. B. (2005). Colorectal cancer screening behavior and health insurance status (United States). Cancer Causes and Control, 16(6), 735–742.PubMedCrossRefGoogle Scholar
  35. 35.
    Pollack, L. A., Blackman, D. K., Wilson, K. M., Seeff, L. C., & Nadel, M. R. (2006). Colorectal cancer test use among Hispanic and non-Hispanic US populations. Preventing Chronic Disease, 3(2), A50.PubMedGoogle Scholar
  36. 36.
    Coughlin, S. S., & Thompson, T. D. (2004). Colorectal cancer screening practices among men and women in rural and nonrural areas of the United States, 1999. The Journal of Rural Health, 20(2), 118–124.PubMedCrossRefGoogle Scholar
  37. 37.
    Denberg, T. D., Melhado, T. V., Coombes, J. M., et al. (2005). Predictors of nonadherence to screening colonoscopy. Journal of General Internal Medicine, 20(11), 989–995.PubMedCrossRefGoogle Scholar
  38. 38.
    O’Malley, A., Beaton, E., Yabroff, K., Abramson, R., & Mandelblatt, J. (2004). Patient and provider barriers to colorectal cancer screening in the primary care safety-net. Preventive Medicine, 39(1), 56–63.PubMedCrossRefGoogle Scholar
  39. 39.
    Walsh, J. M. E., Kaplan, C. P., Nguyen, B., Gildengorin, G., McPhee, S. J., & Pérez Stable, E. J. (2004). Barriers to colorectal cancer screening in Latino and Vietnamese Americans. Journal of General Internal Medicine, 19(2), 156–166.PubMedCrossRefGoogle Scholar
  40. 40.
    Zimmerman, R. K., Tabbarah, M., Trauth, J., Nowalk, M. P., & Ricci, E. M. (2006). Predictors of lower endoscopy use among patients at three inner-city neighborhood health centers. Journal of Urban Health, 83(2), 221–230.PubMedCrossRefGoogle Scholar
  41. 41.
    Goodman, M. J., Ogdie, A., Kanamori, M. J., Canar, J., & O’Malley, A. S. (2006). Barriers and facilitators of colorectal cancer screening among mid-Atlantic Latinos: focus group findings. Ethnicity and Disease, 16(1), 255.PubMedGoogle Scholar
  42. 42.
    Haverkamp, D., Perdue, D. G., Espey, D., & Cobb, N. (2011). A survey of Indian Health Service and tribal health providers’ colorectal cancer screening knowledge, perceptions, and practices. Journal of Health Care for the Poor and Underserved, 22(1), 243–257.PubMedGoogle Scholar
  43. 43.
    Cole, S. R., Young, G. P., Byrne, D., Guy, J. R., & Morcom, J. (2003). A randomised trial of the impact of new faecal haemoglobin test technologies on population participation in screening for colorectal cancer. Journal of Medical Screening, 10(3), 117–122.Google Scholar
  44. 44.
    Sequist, T. D., Zaslavsky, A. M., Marshall, R., Fletcher, R. H., & Ayanian, J. Z. (2009). Patient and physician reminders to promote colorectal cancer screening: A randomized controlled trial. Archives of Internal Medicine, 169(4), 364.PubMedCrossRefGoogle Scholar
  45. 45.
    Denberg, T. D., Coombes, J. M., Byers, T. E., et al. (2006). Effect of a mailed brochure on appointment-keeping for screening colonoscopy. Annals of Internal Medicine, 145(12), 895.PubMedGoogle Scholar
  46. 46.
    Myers, R. E., Hyslop, T., Sifri, R., et al. (2008). Tailored navigation in colorectal cancer screening. Medical Care, 46(9,Suppl1), S123–S131.PubMedCrossRefGoogle Scholar
  47. 47.
    Basch, C. E., Wolf, R. L., Brouse, C. H., et al. (2006). Telephone outreach to increase colorectal cancer screening in an urban minority population. American Journal of Public Health, 96(12), 2246–2253.PubMedCrossRefGoogle Scholar
  48. 48.
    Percac-Lima, S., Grant, R., Green, A., et al. (2009). A culturally tailored navigator program for colorectal cancer screening in a community health center: a randomized, controlled trial. Journal of General Internal Medicine, 24(2), 211–217.PubMedCrossRefGoogle Scholar
  49. 49.
    Jandorf, L., Gutierrez, Y., Lopez, J., Christie, J., & Itzkowitz, S. (2005). Use of a patient navigator to increase colorectal cancer screening in an urban neighborhood health clinic. Journal of Urban Health, 82(2), 216–224.PubMedCrossRefGoogle Scholar
  50. 50.
    Bredesen, P. (2010). Fresh medicine: How to fix reform and build a sustainable health care system. Boston: Atlantic Monthly Press.Google Scholar
  51. 51.
    Tanner, M., & Institute, C. (2010). Bad medicine: a guide to the real costs and consequences of the new health care law. Washington, DC: Cato Institute.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Benjamin W. Quick
    • 1
  • Christina M. Hester
    • 1
  • Kristin L. Young
    • 1
    • 2
  • K. Allen Greiner
    • 1
  1. 1.Research Division, Department of Family MedicineUniversity of Kansas Medical CenterKansas CityUSA
  2. 2.Department of Epidemiology, Carolina Population CenterUniversity of North CarolinaChapel HillUSA

Personalised recommendations