Elsevier

Preventive Medicine

Volume 38, Issue 6, June 2004, Pages 669-675
Preventive Medicine

A survey of women regarding factors affecting colorectal cancer screening compliance

https://doi.org/10.1016/j.ypmed.2004.02.015Get rights and content

Abstract

Background. Women participate in colorectal cancer (CRC) screening less often than men. Our study objective was to understand factors related to women's use of CRC screening. We examined the personal health, medical care, and psychosocial responses to CRC and screening use of a community-based sample of women.

Methods. Women aged 50–80 years at average CRC risk completed a telephone questionnaire. We asked about demographics, past use of CRC and other cancer screening tests, preventive health measures, source of primary care, and comorbidities. We also inquired about attitudes and risk perceptions regarding CRC, knowledge about CRC screening, and other frequent health concerns. Logistic regression identified predictors of screening compliance.

Results. Four hundred six women (52% of women contacted, average age 63 years) provided responses. Sixty-five percent had completed some form of CRC screening in the past 5 years. Four factors were positively related to CRC screening: increasing age [adjusted odds ratio (AOR) = 1.05, (95% CI 1.03, 1.08)], perceived CRC risk [AOR = 1.92, (95% CI 1.19, 3.16)], belief that screening reduces CRC risk (AOR = 2.49, 95% CI 1.45, 4.27), and belief in following screening guidelines [AOR = 4.95, (95% CI 2.07, 11.90)]. Belief that screening would be painful [AOR = 0.52, (95% CI 0.32, 0.84)] was inversely related.

Conclusions. Fear about CRC screening-related pain was the strongest impediment to screening, whereas positive attitudes about the value of CRC screening were strongly related to compliance. Addressing fears and emphasizing positive messages by providers should be included in programs promoting CRC screening in women.

Introduction

Colorectal cancer (CRC) affects about 1 in 20 Americans with similar incidence rates for men and women [1]. Despite demonstrated effectiveness, CRC screening rates for both genders are generally less than 50% [2]. This low CRC screening rate is particularly surprising for women in view of their high rates of participation in breast and cervical cancer screening [3]. However, recent studies suggest that women are less likely than men to utilize various CRC screening methods [2], [4]. Inadequate use of CRC screening by women is poorly understood, but may relate to research findings that women often incorrectly believe that CRC affects mostly men [5]. To facilitate adherence to CRC screening guidelines, it is important to understand the role of factors such as comorbidity and source of primary care, as well as to understand how women's patterns of psychosocial response influence CRC screening behaviors [6], [7], [8], [9], [10].

To address these research questions, we performed a telephone survey of female residents of Delaware, aged 50 years or older and at average risk for CRC. Delaware offers an excellent location for a population-based health survey with a well-defined, diverse population totaling approximately 700,000 persons. Despite its size, the state's demographics closely parallel those of the United States in its distribution by gender, ethnic, educational, and socioeconomic characteristics [11]. The study was designed to identify informational gaps and other predictors of acceptance of CRC screening that could inform the development of tailored educational messages for women eligible for CRC screening.

Section snippets

Methods

We prepared a 70-item questionnaire designed for telephone-based administration. After IRB approval was obtained from Fox Chase Cancer Center, a professional polling group, based at the University of Delaware, administered all questionnaires from January to March 2002. We used a random-digit dialing approach to identify households in Delaware's single area code [12]. Women aged 50 years and older were asked to participate in the survey because their age group is eligible for CRC screening.

Demographics

Demographic information regarding the 406 women in the study is displayed in Table 1. The average age of the respondents was 63 years (range 50–80). Slightly more than 80% described themselves as White, paralleling Delaware as a whole. About 50% reported at least some college education. Ten percent reported a history of a parent with CRC, while 4% reported a sibling or child with that history. Nearly 65% of the women were married at the time of the survey. Table 1 also notes, for these same

Discussion

Despite increasing public awareness, CRC screening rates for women remain low and continue to lag behind other screening measures like mammography or Pap smear [3]. Overall, less than 40% of adults 50 and older had a sigmoidoscopy or colonoscopy in the last 5 years and fewer than 25% participated in FOBT in the past year [2].

Using this study's definition of screening adherence, 65% of the 406 respondents indicated that they had had one of these recommended screening tests within the past 5

Acknowledgements

This study was supported in part by NIH Grant CA87831 (DSW).

References (29)

  • J.M Donovan et al.

    Colorectal cancer in women: an underappreciated but preventable risk

    J. Women's Health

    (1998)
  • S Fontana et al.

    The delivery of preventive services in primary care practices according to chronic disease status

    Am. J. Public Health

    (1997)
  • K Gerlach et al.

    Cancer coverage in women's magazines; what information are women receiving?

    J. Cancer Educ.

    (1997)
  • C Kiefe et al.

    Chronic disease as a barrier to breast and cervical cancer screening

    J. Gen. Intern. Med.

    (1998)
  • Cited by (49)

    • Sex differences in the impact of Affordable Care Act Medicaid expansion on colorectal cancer screening

      2020, Preventive Medicine
      Citation Excerpt :

      Hall et al., 2018) For un- or under-insured women, other cancer screenings or health care needs may take priority. Some previous studies found that women were less likely to undergo CRC screening; women are less likely to be referred for CRC screening than for breast or cervical cancer screening (Etzioni et al., 2004; McGregor et al., 2007; Meissner et al., 2006) and tend to be more embarrassed, anxious, and stressed about endoscopic procedures than men (Beydoun and Beydoun, 2008; Brawarsky et al., 2003; Eloubeidi et al., 2003; Farraye et al., 2004; Friedemann-Sanchez et al., 2007; Griffin et al., 2009; Herold et al., 1997; McQueen et al., 2006; Meissner et al., 2006; Peterson et al., 2007; Slattery et al., 2004; Weinberg et al., 2004; Yager et al., 2014). Despite the prevailing evidence of sex as a significant factor influencing patterns of CRC screening, there is no evidence of the impact of insurance changes on CRC screening among low-income non-elderly adults by sex.

    • Rural-urban differences in the long-term risk of colorectal cancer after adenoma removal: A population-based study

      2014, Digestive and Liver Disease
      Citation Excerpt :

      These findings are consistent with the overall better compliance of women to medical health care, and suggest that the high risk of CRC when there is a family history is now well known to the general population, whether in rural or urban areas. Indeed, previous studies have reported that compliance with screening programmes varied according to the level of perceived risk of cancer [16–18], which may be higher in women and in patients with a family history of CRC [19]. Little is known about the geographical determinants of colonoscopic surveillance after polypectomy.

    • Timing of Procedure and Compliance With Outpatient Endoscopy Among an Underserved Population in an Inner-City Tertiary Institution

      2012, Annals of Epidemiology
      Citation Excerpt :

      A history of truancy for clinic appointments is also a predictor of noncompliance for scheduled outpatient endoscopy (3). Lack of perceived risk for colorectal cancer, fear of pain, concerns about modesty, bowel preparation, cost, competing demands, and long waiting times have also been found to contribute to lack of adherence (2, 4). Endoscopy suites have attempted various maneuvers to decrease the number of no-shows.

    View all citing articles on Scopus
    View full text