Journal of General Internal Medicine

, Volume 26, Issue 10, pp 1124–1130

Adherence to Physician Recommendation to Colorectal Cancer Screening Colonoscopy Among Hispanics

  • Ghalib Jibara
  • Lina Jandorf
  • Monica B. Fodera
  • Katherine N. DuHamel
Original Research



Colorectal cancer (CRC) is the second most commonly diagnosed cancer among Hispanics in the United States (US), yet the use of CRC screening is low in this population. Physician recommendation has consistently shown to improve CRC screening.


To identify the characteristics of Hispanic patients who adhere or do not adhere to their physician’s recommendation to have a screening colonoscopy.


A cross-sectional study featuring face-to-face interviews by culturally matched interviewers was conducted in primary healthcare clinics and community centers in New York City.


Four hundred Hispanic men and women aged 50 or older, at average risk for CRC, were interviewed. Two hundred and eighty (70%) reported receipt of a physician’s recommendation for screening colonoscopy and are included in this study.


Dependent variable: self report of having had screening colonoscopy. Independent variables: sociodemographics, healthcare and health promotion factors.


Of the 280 participants, 25% did not adhere to their physician’s recommendation. Factors found to be associated with non-adherence were younger age, being born in the US, preference for completing interviews in English, higher acculturation, and greater reported fear of colonoscopy testing. The source of colonoscopy recommendation (whether it came from their usual healthcare provider or not, and whether it occurred in a community or academic healthcare facility) for CRC screening was not associated with adherence.


This study indicates that potentially identifiable subgroups of Hispanics may be less likely to follow their physician recommendation to have a screening colonoscopy and thus may decrease their likelihood of an early diagnosis and prompt treatment. Raising physicians’ awareness to such patients’ characteristics could help them anticipate patients who may be less adherent and who may need additional encouragement to undergo screening colonoscopy.


colon cancer colorectal cancer screening Hispanics physician recommendation colonoscopy 


  1. 1.
    American Cancer Society: Cancer facts and figures for Hispanics/Latinos 2009–2011. Available at: Accessed April 11, 2011.
  2. 2.
    Guerra CE, Schwartz JS, Armstrong K, Brown JS, Halbert CH, Shea JA. Barriers of and facilitators to physician recommendation of colorectal cancer screening. J Gen Intern Med. 2007;22(12):1681–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Smith RA, Cokkinides V, Brooks D, Saslow D, Brawley OW. Cancer screening in the United States, 2010: a review of current American Cancer Society guidelines and issues in cancer screening. CA Cancer J Clin. 2010;60(2):99–119.PubMedCrossRefGoogle Scholar
  4. 4.
    Winawer S, Fletcher R, Rex D, et al. Colorectal cancer screening and surveillance: clinical guidelines and rationale-Update based on new evidence. Gastroenterology. 2003;124(2):544–60.PubMedCrossRefGoogle Scholar
  5. 5.
    Pignone M, Levin B. Recent developments in colorectal cancer screening and prevention. Am Fam Physician. 2002;66(2):297–302.PubMedGoogle Scholar
  6. 6.
    Pignone M, Rich M, Teutsch SM, Berg AO, Lohr KN. Screening for colorectal cancer in adults at average risk: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2002;137(2):132–41.PubMedGoogle Scholar
  7. 7.
    National Cancer Institute. SEER cancer statistics review, 1975–2007. Available at: Accessed April 11, 2011.
  8. 8.
    Edwards BK, Ward E, Kohler BA, et al. Annual report to the nation on the status of cancer, 1975–2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer. 2010;116(3):544–73.PubMedCrossRefGoogle Scholar
  9. 9.
    Hoffman-Goetz L, Breen NL, Meissner H. The impact of social class on the use of cancer screening within three racial/ethnic groups in the United States. Ethn Dis. 1998;8(1):43–51.PubMedGoogle Scholar
  10. 10.
    Gilliland F, Hunt W, Key C. Trends in the survival of American Indian, Hispanic, and Non-Hispanic white cancer patients in New Mexico and Arizona, 1969–1994. Cancer. 1998;82(9):1769–83.PubMedCrossRefGoogle Scholar
  11. 11.
    Green AR, Peters-Lewis A, Percac-Lima S, et al. Barriers to screening colonoscopy for low-income Latino and white patients in an urban community health center. J Gen Intern Med. 2008;23(6):834–40.PubMedCrossRefGoogle Scholar
  12. 12.
    Cameron KA, Francis L, Wolf MS, Baker DW, Makoul G. Investigating Hispanic/Latino perceptions about colorectal cancer screening: A community-based approach to effective message design. Patient Educ Couns. 2007;68(2):145–152.PubMedCrossRefGoogle Scholar
  13. 13.
    Pollack LA, Blackman DK, Wilson KM, Seeff LC, Nadel MR. Colorectal cancer test use among Hispanic and non-Hispanic U.S. populations. Prev Chronic Dis. 2006;3(2):A50.PubMedGoogle Scholar
  14. 14.
    James TM, Greiner KA, Ellerbeck EF, Feng C, Ahluwalia JS. Disparities in colorectal cancer screening: a guideline based analysis of adherence. Ethnic Dis. 2006;16(1):228–233.Google Scholar
  15. 15.
    Meissner HI, Breen N, Klabunde CN, Vernon SW. Patterns of colorectal cancer screening uptake among men and women in the United States. Cancer Epidemiol Biomarkers Prev. 2006;15(2):389–394.PubMedCrossRefGoogle Scholar
  16. 16.
    Thompson B, Coronado G, Neuhouser M, Chen L. Colorectal carcinoma screening among Hispanics and non-Hispanic whites in a rural setting. Cancer. 2005;103(12):2491–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Ioannou GN, Chapko MK, Dominitz JA. Predictors of colorectal cancer screening participation in the United States. Am J Gastroenterol. 2003;98(9):2082–2091.PubMedCrossRefGoogle Scholar
  18. 18.
    Fernandez ME, Wippold R, Torres-Vigil I, et al. Colorectal cancer screening among Latinos from U.S. cities along the Texas–Mexico border. Cancer Causes Control. 2008;19:195–206.PubMedCrossRefGoogle Scholar
  19. 19.
    Geiger TM, Miedema BW, Geana MV, Thaler K, Rangnekar NJ, Cameron GT. Improving rates for screening colonoscopy: analysis of the health information national trends survey (HINTS I) data. Surg Endosc. 2008;22:527–533.PubMedCrossRefGoogle Scholar
  20. 20.
    Sequist TD, Zaslavsky AM, Marshall R, Fletcher RH, Ayanian JZ. Patient and physician reminders to promote colorectal cancer screening: a randomized controlled trial. Arch Intern Med. 2009;169(4):364–371.PubMedCrossRefGoogle Scholar
  21. 21.
    Lane DS, Messina CR, Cavanagh MF, Chen JJ. A provider intervention to improve colorectal cancer screening in county health centers. Med Care. 2008;46:S109–16.PubMedCrossRefGoogle Scholar
  22. 22.
    Zapka JG, Puleo E, Vickers-Lahti M, Luckmann R. Healthcare system factors and colorectal cancer screening. Am J Prev Med. 2002;23(1):28–35.PubMedCrossRefGoogle Scholar
  23. 23.
    Nease DE Jr, Ruffin MT 4th, Klinkman MS, Jimbo M, Braun TM, Underwood JM. Impact of a generalizable reminder system on colorectal cancer screening in diverse primary care practices. Med Care. 2008;46(9 Suppl 1):S86–73.Google Scholar
  24. 24.
    Wei EK, Ryan CT, Dietrich AJ, Colditz GA. Improving colorectal cancer screening by targeting office systems in primary care practices. Arch Intern Med. 2005;165:661–6.PubMedCrossRefGoogle Scholar
  25. 25.
    Klabunde CN, Lanier D, Breslau ES, et al. Improving colorectal cancer screening in primary care practice: innovative strategies and future directions. J Gen Intern Med. 2007;22:1195–1205.PubMedCrossRefGoogle Scholar
  26. 26.
    Sabatino SA, Habarta N, Baron RC, et al. Interventions to increase recommendation and delivery of screening for breast, cervical, and colorectal cancers by healthcare providers. Am J Prev Med. 2008;35(1S):S67–S74.PubMedCrossRefGoogle Scholar
  27. 27.
    Ling BS, Schoen RE, Trauth JM, et al. Physicians encouraging colorectal screening: a randomized controlled trial of enhanced office and patient management on compliance with colorectal cancer screening. Arch Intern Med. 2009;169(1):47–55.PubMedCrossRefGoogle Scholar
  28. 28.
    Ayanian JZ, Sequist TD, Zaslavsky AM, Johannes RS. Physician reminders to promote surveillance colonoscopy for colorectal adenomas: a randomized controlled trial. J Gen Intern Med. 2008;23(6):762–7.PubMedCrossRefGoogle Scholar
  29. 29.
    Sansbury LB, Klabunde CN, Mysliwiec P, Brown ML. Physicians’ use of nonphysician healthcare providers for colorectal cancer screening. Am J Prev Med. 2003;25(3):179–186.PubMedCrossRefGoogle Scholar
  30. 30.
    Hudson SV, Ohman-Strickland P, Cunningham R, Ferrante JM, Hahn K, Crabtree BF. The effects of teamwork and system support on colorectal cancer screening in primary care practices. Cancer Detect Prev. 2007;31(5):417–23.PubMedCrossRefGoogle Scholar
  31. 31.
    Seres KA, Kirkpatrick AC, Tierney WM. The utility of an evidence-based lecture and clinical prompt as methods to improve quality of care in colorectal cancer screening. Am J Gastroenterol. 2009;104(2):420–5.PubMedCrossRefGoogle Scholar
  32. 32.
    Ye J, Xu Z, Aladesanmi O. Provider recommendation for colorectal cancer screening: examining the role of patients’ socioeconomic status and health insurance. Cancer Epidemiol. 2009;33(3–4):207–11.PubMedCrossRefGoogle Scholar
  33. 33.
    Janz NK, Lakhani I, Vijan S, Hawley ST, Chung LK, Katz SJ. Determinants of colorectal cancer screening use, attempts, and non-use. Prev Med. 2007;44(5):452–8.PubMedCrossRefGoogle Scholar
  34. 34.
    Jerant A, Kravitz RL, Rooney M, Amerson S, Kreuter M, Franks P. Effects of a tailored interactive multimedia computer program on determinants of colorectal cancer screening: A randomized controlled pilot study in physician offices. Patient Educ Couns. 2007;66(1):67–74.PubMedCrossRefGoogle Scholar
  35. 35.
    Jandorf L, Ellison J, Villagra C, et al. Understanding the barriers and facilitators of colorectal cancer screening among low income immigrant Hispanics. J Immigr Minor Health. 2010;12(4):462–9.PubMedCrossRefGoogle Scholar
  36. 36.
    Lieberman DA, Weiss DG, Haford WV, et al. One-time screening for colorectal cancer with combined fecal-occult testing and examination of the distal colon. N Eng J Med. 2001;345(8):555–60.CrossRefGoogle Scholar
  37. 37.
    Levin B, Lieberman D, McFarland B, et al. 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. Ca Cancer J Clin. 2008;30(2):133–46.Google Scholar
  38. 38.
    Cokkinides VE, Chao A, Smith RA, Vernon SW, Thun MJ. Correlates of underutilization of colorectal cancer screening among U.S. adults, age 50 years and older. Prev Med. 2003;36:85–91.PubMedCrossRefGoogle Scholar
  39. 39.
    Myers RE, Trock BJ, Lerman C, Wolf T, Ross E, Engstrom PF. Adherence to colorectal cancer screening in an HMO population. Prev Med. 1998;19:502–14.CrossRefGoogle Scholar
  40. 40.
    Safran DG, Kosinski M, Tarlov AR, et al. The primary care assessment survey: tests of data quality and measurement performance. Med Care. 1998;36(5):728–39.PubMedCrossRefGoogle Scholar
  41. 41.
    Marin G, Sabogal F, Marin BV, Otero-Sabogal R, Perez-Stable EJ. Development of a short acculturation scale for Hispanics. Hisp J Behav Sci. 1987;9(2):183–205.CrossRefGoogle Scholar
  42. 42.
    Thompson HS, Valdimarsdottir HB, Jandorf L, Redd W. Perceived disadvantages and concerns about abuses of genetic testing for cancer risk: differences across African American, Latina and Caucasian women. Patient Educ Couns. 2003;51:217–27.PubMedCrossRefGoogle Scholar
  43. 43.
    Thompson HS, Valdimarsdottir HB, Winkel G, Jandorf L, Redd W. The group-based medical mistrust scale: psychometric properties and association with breast cancer screening. Prev Med. 2004;38:209–18.PubMedCrossRefGoogle Scholar
  44. 44.
    Manne S, Markowitz A, Winawer S, et al. Correlates of colorectal cancer screening compliance and stage of adoption among siblings of individuals with early onset colorectal cancer. Health Psychol. 2002;21:3–15.PubMedCrossRefGoogle Scholar
  45. 45.
    Natale-Pereira A, Marks J, Vega M, Mouzon D, Hudson SV, Salas-Lopez D. Barriers and facilitators for colorectal cancer screening practices in the Latino community: perspectives from community leaders. Cancer Control. 2008;15(2):157–65.PubMedGoogle Scholar
  46. 46.
    Shah M, Zhu K, Potter J. Hispanic acculturation and utilization of colorectal cancer screening in the United States. Cancer Detect Prev. 2006;30(3):306–12.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2011

Authors and Affiliations

  • Ghalib Jibara
    • 1
  • Lina Jandorf
    • 2
  • Monica B. Fodera
    • 3
  • Katherine N. DuHamel
    • 2
    • 3
  1. 1.Department of Surgery/Division of Surgical OncologyMount Sinai School of MedicineNew YorkUSA
  2. 2.Department of Oncological SciencesMount Sinai School of MedicineNew YorkUSA
  3. 3.Department of Psychiatry and Behavioral SciencesMemorial Sloan-Kettering Cancer CenterNew YorkUSA

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