Colorectal Cancer Screening in Older Men and Women: Qualitative Research Findings and Implications for Intervention

As part of the formative research for developing interventions to increase colorectal cancer screening in men and women aged 50 and older, 14 focus groups were conducted to identify (1) knowledge, attitudes, and beliefs about colorectal cancer and colorectal cancer screening, (2) barriers to screening, and (3) strategies for motivating and supporting behavior change. Participants had either private insurance or Medicare and reported different levels of experience with colorectal cancer screening. Overall, they were poorly informed about colorectal cancer and the possible benefits of screening, reporting little or no information from physicians or mass media, negative attitudes toward screening procedures, and fear of cancer. Despite references to the subject matter as embarrassing or private, both men and women, African Americans and whites, appeared to talk candidly and comfortably in the permissive context of the focus group. This study's findings suggest that public education campaigns, decision aids, and targeted interventions are urgently needed to put colorectal cancer screening on the public's radar screen, to increase awareness of the prevention and early detection benefits of screening, and to encourage people 50 and older—and the health care providers who serve them—to make screening a high priority.     

Perceptions of Cervical Cancer Threat,Benefits, and Barriers of Papanicolaou Smear Screening Programs for Women in Iran

ABSTRACT

Objectives: The main purpose was to assess associations between HBM variables and participation in cervical cancer screening programs in a sample of Iranian women.

Methods: A total of 333 married women of childbearing age were recruited with cluster sampling. The study was conducted from spring 2002 to spring 2003 and a self-report questionnaire and structured interview were designed to measure the four HBM constructs and Iranian women's knowledge about Pap smear screening.

Results: A total of 68.5% reported having undergone at least one Pap test. Women were more likely to participate in Pap smears when they had access to knowledge about cervical cancer and screening programs. Furthermore, the perceived benefit and barrier variables of the Health belief model were two factors related to participation in Pap smear testing.

Conclusions: Health care professionals must provide women with more information about cervical cancer and the benefits of participating in cervical cancer screening programs.     

大肠癌筛查策略和进展

大肠癌是目前世界上主要的恶性肿瘤之一,在我国的发病率和死亡率逐年上升。目前已证明对自然人群筛查可以有效降低大肠癌的发病率和死亡率,很多发达国家都开展了基于自然人群的大肠癌筛查工作,并取得了一定的成效。本文通过介绍目前常用的自然人群大肠癌筛查方法、目标人群的纳入标准以及筛查周期的制定,总结了国内外大肠癌筛查策略以及进展,对我国大肠癌筛查工作面临的挑战进行分析,为我国大肠癌筛查策略的制定提供建议。     

Public Perceptions of Celebrity Cancer Deaths: How Identification and Emotions Shape Cancer Stigma and Behavioral Intentions

Celebrity cancer deaths can focus public attention on the disease like few events can. However, not all celebrities or their families are open about the exact cause of death. Anecdotal reports suggest that some do not reveal the exact cause of death due to fears of stigma associated with the specific type of cancer. However, empirical evidence regarding whether or how the cause of death actually impacts public perceptions and behaviors is lacking. A three (cause of death: nonspecified cancer, liver cancer, or lung cancer) by two (celebrity obituary: David Bowie or Alan Rickman) fully factorial between-subjects online experiment (N = 390) tested a proposed model of effects on identification, discrete emotional reactions, stigma-related perceptions, and behavioral intentions. Results suggest that specific causes of death do not have a direct impact on stigma but they can alter identification and emotional reactions, such as compassion and anxiety, which subsequently shape stigma-related perceptions and behavioral intentions.     

Analysis of Colorectal Cancer Screening Regimens

We analyze several colorectal cancer screening methods. We begin with an existing deterministic model of the colorectal cancer growth-and-development model. Using judgments from two knowledgeable experts on colorectal cancer, we incorporate probability distributions for important parameters in the model. The analysis proceeds in three phases: First is a straightforward Monte Carlo simulation that includes uncertainty about structural parameters, the results of which identify five dominant screening strategies in terms of the expected number of cancers prevented and expected cost per life-year saved. The next part of the analysis develops a two-attribute utility function to rank order the screening regimens. The results show the same top five, with the top-ranked strategy being colonoscopy every three years. Sensitivity analysis demonstrates the robustness of the results.     

Investigating the Effects of Cancer Risk and Efficacy Perceptions on Cancer Prevention Adherence and Intentions

This study examined the interaction between comparative cancer risk and efficacy perceptions on individuals' adherence for colon, prostate, and breast cancer screenings, intentions to get these screenings in the future, and intentions to adopt health lifestyle behaviors in the next year. A national probability sample of 2,226 adults ages 40 to 70 was surveyed. Overall, a positive interaction effect was found between comparative risk and efficacy on several outcomes. There were some methodological limitations worth noting, but the findings do have implications for health campaigns, particularly the need to increase efficacy beliefs about reducing cancer risks within the general population.     

Assessing Colorectal Cancer Knowledge Among Puerto Rican Hispanics: Implications for Cancer Prevention and Control

In Puerto Rico, colorectal cancer (CRC) incidence and mortality rates are increasing. Moreover, adherence rates to CRC screening (52.2%) are still below the goals (70.5%) established by Healthy People 2020. Lack of knowledge is described as a significant barrier to adherence to CRC screening. The aim of this study was to assess CRC knowledge and screening rates among Puerto Rican Hispanics. Participants aged 40–85 years were recruited from the internal medicine outpatient clinics at the University of Puerto Rico. Demographic characteristics and knowledge about CRC, including risk factors and CRC screening tests, were obtained through face-to-face interviews. A mean CRC knowledge score was calculated based on correct responses to 13 validated questions. Mean knowledge scores were evaluated according to demographic characteristics using the Wilcoxon-Mann-Whitney test. A total of 101 participants were recruited with mean age of 63 (±10.6) years. Fifty-eight (58%) of participants were females, 59% reported ≥12 years of education, and 71% reported ever screening for CRC. The mean CRC knowledge score was significantly lower (p?<?0.05) among participants with lower annual family income, those who had never received a recommendation for CRC screening by a healthcare provider, and those who had no history of CRC screening. Knowledge about CRC must be improved in Puerto Rico. Efforts must be made to promote and develop culturally appropriate CRC educational strategies. Future studies should focus on identifying other barriers and factors that may limit CRC screening in the Puerto Rican Hispanic population.     

Brief Report: Exploration of Colorectal Cancer Risk Perceptions Among Latinos

To explore colorectal cancer risk perceptions among Latinos. Focus groups discussions among Spanish-speaking Latinos conducted between February and July 2007 with 37 men and women who were age-eligible for colorectal cancer screening. Predominant themes of perceived colorectal cancer risk included: general cancer risks, risks related to nutrition and the digestive tract, and risks related to sexual practices. Participants frequently referred to the role of diet in keeping the colon “clean,” suggesting that retained feces increase colorectal cancer risk. Among both men and women, rectal sex was commonly associated with increased colorectal cancer risk. Some Latinos may hold misperceptions about colorectal cancer risks, including an association between rectal sex and colon cancer, that may impact their screening behaviors. Clinicians and public health officials should consider these potential risk misperceptions and explore for other risk misperceptions when counseling and educating patients about colorectal cancer screening.     

Cancer Perceptions of South African Mothers and Daughters: Implications for Health Promotion Programs

Cancer is one of the leading causes of death worldwide. A major reason why women do not obtain cancer screening procedures relates to the high levels of fear associated with cancer. In this study, we explored South African mothers’ and daughters’ reaction to the word “cancer” specifically. The study sample included 157 randomly selected mother and adolescent daughter pairs from an urban community in Cape Town, South Africa. Mothers and their adolescent daughters had very similar responses to the term “cancer.” We found that most South African mothers and daughters had a fear-based attitude toward the illness. When we asked mothers what they immediately thought of upon hearing “cancer,” a majority of women (69%) thought of death, and another 43% thought of suffering and the detrimental consequences of the illness. Similarly, 50% of the daughters also thought of death, and 42% thought of the detrimental aspects of cancer. Fatalistic attitudes and negative emotional reactions have important implications in cancer prevention and need to be addressed within a public health context.     

Information Seeking and Scanning about Colorectal Cancer Screening among Black and White Americans,Ages 45–74: Comparing Information Sources and Screening Behaviors

Cancer information seeking and scanning predict a variety of preventive health behaviors. However, previous work has rarely gauged seeking and scanning of specific cancer screening information. Moreover, colorectal cancer prevalence and mortality rates are higher among black than white Americans and it remains unclear if these groups differ in their cancer screening information acquisition patterns. We surveyed black and white Americans between 45 and 74 years of age to investigate rates, sources, and correlates of colorectal cancer screening (CRCS) information seeking and scanning. Black and white Americans had similar likelihoods of engaging in information seeking and scanning regarding CRCS. However, black Americans reported using significantly more sources for CRCS information seeking and scanning than did white Americans. Both screening test-specific information seeking and scanning are associated with stool-based tests, but only information seeking is associated with flexible sigmoidoscopy or colonoscopy. We discuss study implications for reaching out to different racial groups to promote colorectal cancer screening behavior.     

Colorectal Cancer Screening and State Health Insurance Mandates

Colorectal cancer (CRC) is the third most deadly cancer in the USA. CRC screening is the most effective way to prevent CRC death, but compliance with recommended screenings is very low. In this study, we investigate whether CRC screening behavior changed under state mandated private insurance coverage of CRC screening in a sample of insured adults from the 1997 to 2008 Behavioral Risk Factor Surveillance Survey (BRFSS). We present difference‐in‐difference‐in‐differences (DDD) estimates that compare insured individuals age 51 to 64 to Medicare age‐eligible individuals (ages 66 to 75) in mandate and non‐mandate states over time. Our DDD estimates suggest endoscopic screening among men increased by 2 to 3 percentage points under mandated coverage among 51 to 64 year olds relative to their Medicare age‐eligible counterparts. We find no clear evidence of changes in screening behavior among women. DD estimates suggest no evidence of a mandate effect on either type of CRC screening for men or women. Copyright © 2014 John Wiley & Sons, Ltd.     

Colorectal Cancer Screening Among Chinese American Immigrants

The purpose of this study was to examine the factors determining fecal occult blood test (FOBT) uptake in Chinese American immigrants. This study used a prospective, cross-sectional design with convenience sampling. An educational session on colorectal cancer screening (CRS) was provided to the participants during a health fair, and each participant was offered a no-cost FOBT kit. Data was collected over two consecutive years during three different health fairs. A questionnaire was used to collect demographic data. A total of 113 participants were recruited and 72% of them returned the FOBT kit. There was a significant association between having a primary-care physician (PCP) and having CRS in the past, even after controlling for age, gender and the length of time in the US (P = .009). Participants who visited a doctor for health maintenance were less likely to participate in the FOBT, compared to participants who never visited a doctor or who only visited a doctor when they were sick (P = .001). The length of time in the US had a significant effect on having a PCP (P = .002). However, having a PCP or having CRS in the past was not associated with participating in the screening and so was feeling at risk for CRC. In fact, 49% of Chinese women and 45% of Chinese men felt no risk of CRC. Future research and interventions that address knowledge deficits and focus on recent immigrants and their access to health care may have the potential to increase CRS among Chinese American immigrants.     

Colorectal Cancer Screening Among Korean Americans: A Systematic Review

The incidence of colorectal cancer (CRC) among Korean Americans (KAs) has increased in recent years, even as the rate in nearly ever other population group in the United States has decreased. Reversing this trend will require improving screening rates, but a variety of sociocultural factors may inhibit this goal. We conducted a systematic review of the published literature on cancer screening among KAs, and identified thirteen eligible studies that examined CRC screening. KAs have CRC screening rates that are significantly lower than the national average. Only about one in four KAs ages 50 and older reports having ever had a fecal ocult blood test (FOBT) and only about 40 % have ever had a sigmoidoscopy or colonoscopy. KA adults are also significantly less likely than the general US population to say they have heard of FOBT, sigmoidoscopy, or colonoscopy. In the KA population, screening rates are higher among adults with higher socioeconomic status, greater acculturation to the United States, more cancer knowledge, more social support, and better access to healthcare services. Improving cultural and financial access to health education and healthcare services may increase CRC screening among KAs and reduce the incidence of the disease.