Comparison Study of Uptake of Colorectal Cancer Testing between Ethnic Minorities and the General Population in Hong Kong

Background: Colorectal cancer (CRC) is one of the most common cancers. This study aimed to compare the uptake of CRC testing in the general public and in ethnic minorities in Hong Kong. Materials and Methods: This cross-sectional survey covered 2,327 South Asian and Chinese adults aged over 50, recruited from two separate studies. A structured questionnaires were administered by research staff over the telephone or in faceto- face interviews. Results: The uptake rate of CRC testing among South Asians was significantly lower than that of the general population in Hong Kong. Factors associated with the uptake rate were health professional’s recommendation, perception of regular visits to doctor, use of complementary therapy, ethnicity, perceived susceptibility to cancer, presence of chronic illness, and education level. In addition, a significant interaction (p<0.05) between ethnicity and health professionals’ recommendations was found, after adjustment for the main independent factors identified. Conclusions: Older people with lower educational attainment, without chronic illness and those have lower perceived susceptibility to cancer may be targeted for CRC testing promotion in the society. In addition, health professionals can play a highly influential role in promoting such testing, particularly among ethnic minorities.     

Barriers and facilitators for colorectal cancer screening practices in the Latino community: perspectives from community leaders.

BACKGROUND: Colorectal cancer (CRC) is the second-leading cause of cancer-related death in the United States and the third most commonly diagnosed cancer among Latinos. While Latinos represent one of the fastest-growing ethnic groups in the United States, their participation in cancer prevention and treatment trials is low. METHODS: Thirty-six Latino community leaders participated in five focus groups that examined factors affecting CRC screening practices among Latinos. RESULTS: The top four barriers identified were low knowledge and awareness of CRC, language barriers, lack of insurance, and undocumented legal status. Additional barriers included seeking health care only when sick, fatalism, fear, denial that CRC can occur, other needs more pressing than preventive care, and use of home remedies rather than biomedical care. Participants also described strategies that could be used to increase screening rates including mass media, screening reminders, educational programs using visual tools, and interventions tailored to various literacy levels. CONCLUSIONS: To ensure that the specific needs and health beliefs of the Latino community are addressed, future research should incorporate community input to create more tailored and effective cancer educational programs for Latinos.     

Colorectal Cancer Risk Awareness and Screening Uptake among Adults in the United Arab Emirates

United Arab Emirates initiated the colorectal cancer (CRC) screening on 2013. Yet, one of the barriers to participationin CRC screening is lack of knowledge about the importance of CRC, its risk factors, and the benefits that could begained through screening. We aimed in this study to identify knowledge, attitude, and behavioral factors among thepublic that are associated with willingness to undergo CRC screening. A structured bilingual questionnaire in Englishand Arabic was designed by a multidisciplinary team and through a review of the literature. The survey consisted offour functional domains: socio-demographic characteristics, knowledge, attitude, and practice related questions. Itwas encouraging that more than 65% of the total participants surveyed for the study were aware of CRC and theirmain source of information was media (395, 66%). However, the majority (379, 64%) were thinking that CRC is notcommon, and did not hear of the screening test for CRC (401, 67%). An overall evaluation of the answers revealed apoor level of knowledge on risk factors of CRC, and only 40% correctly identified fecal occult blood as main test forCRC prevention. Surprisingly, 95% of participants mentioned that the CRC screening was not recommended to themby a physician. This is the first report analyzing the awareness, attitude and practice of UAE population and assessingthe barriers for CRC screening. Our results demonstrate that better education and communication of the benefits ofearly detection of CRC should be addressed to improve the screening in UAE population. There is need for campaignsand educational programs, both for health care providers and public. Media might play a significant role in this aspectand new policies need to focus more on increasing community awareness on cancer preventive measures in UAE.     

Primary care provider perceptions of barriers to and facilitators of colorectal cancer screening in a managed care setting

BACKGROUND: Colorectal cancer (CRC) screening tests (e.g., fecal occult blood testing [FOBT], flexible sigmoidoscopy [FS], etc.) are underused. Primary care providers (PCPs) play a critical role in screening, but barriers to and facilitators of screening as perceived by PCPs in managed care settings are poorly understood. The objectives of the current study were to describe current CRC screening practices and to explore determinants of test use by PCPs in a managed care setting. METHODS: In 2000, a self-administered survey was mailed to a stratified, random sample of 1340 PCPs in a large, network model health maintenance organization in California. RESULTS: The survey response rate was 67%. PCPs indicated that 79% of their standard-risk patients were screened for CRC. PCP-reported median rates of recommendation for the use of specific screening tests were 90% for FOBT and 70% for FS. In logistic regression models, perceived barriers to the use of FOBT and FS included patient characteristics (e.g., education) and PCP-related barriers (e.g., failure to recall that patients were due for testing). Perceived facilitators of the use of FOBT and FS included interventions targeting certain aspects of the health care system (e.g., reimbursement) and interventions targeting certain aspects of the tests themselves (e.g., provision of evidence of a test's effectiveness). Assignment of high priority to screening, integrated medical group (as opposed to independent practice association) affiliation, and the proportion of patients receiving routine health maintenance examinations were positively associated with reported test use. CONCLUSIONS: CRC screening tests appear to be underused in the managed care setting examined in the current study. The perceived barriers and facilitators that were identified can be used to guide interventions aimed at increasing recommendations for, as well as actual performance of, CRC screening.     

Colorectal Cancer Screening among Asian Americans

Objectives: Colorectal cancer (CRC) is the most commonly diagnosed cancer for all US populations includingAsian Americans. CRC screening has considerable benefits to prevent CRC and reduce mortality. The purposeof this article was to review the published literature on rates of colorectal cancer screening and factors associatedwith colorectal cancer screening practice among Asian Americans. Methods: Through searching electronicreference databases from 2000 to 2013, 30 articles were found on Chinese, Filipino, Japanese, Korean, andVietnamese Americans. Findings: Asian Americans had significantly low ratesfor CRC screening; KoreanAmericans reported the lowest rates, while higher screening rates were found among Japanese Americans.Older age, longer length of stay in the US, and having a physician’s recommendation were the most commonfacilitators to receiving screening. The common inhibiting factors were financial issues, employment status,and worries/fears about the procedure. Conclusions: Despite a number of Asian Americans being vulnerableto CRC, individual Asian subgroups were underserved with CRC screening and intervention. Further studiesshould focus on each individual Asian subgroup and culturally proficient CRC screening intervention programsshould be developed for each.     

Predictors of colorectal cancer screening behaviors among average-risk older adults in the United States

Objective To critically evaluate recent studies that examined determinants of CRC screening behaviors among average-risk older adults (≥50 years) in the United States. Methods A PUBMED (1996–2006) search was conducted to identify recent articles that focused on predictors of CRC initiation and adherence to screening guidelines among average-risk older adults in the United States. Results Frequently reported predictors of CRC screening behaviors include older age, male gender, marriage, higher education, higher income, White race, non-Hispanic ethnicity, smoking history, presence of chronic diseases, family history of CRC, usual source of care, physician recommendation, utilization of other preventive health services, and health insurance coverage. Psychosocial predictors of CRC screening adherence are mostly constructs from the Health Belief Model, the most prominent of which are perceived barriers to CRC screening. Conclusions Evidence suggests that CRC screening is a complex behavior with multiple influences including personal characteristics, health insurance coverage, and physician–patient communication. Health promotion activities should target both patients and physicians, while focusing on increasing awareness of and accessibility to CRC screening tests among average-risk older adults in the United States.     

A Cross-sectional Study of Knowledge,Attitude and Barriers to Colorectal Cancer Screening among Cancer Survivors

Introduction: Understanding behaviour of cancer survivors is imperative as they are at risk of recurrence or second cancers. Colorectal cancer (CRC) is one of the most common cancers globally. We aim to determine the uptake rate, barriers and predictors of CRC screening among cancer survivors. Methods: Within a public hospital in Singapore, 150 non-CRC survivors were enrolled. Questionnaire on knowledge, screening behaviour, motivators and barriers towards CRC screening was administered. Results: Majority were survivors of breast (69.3%), prostate (7.3%), endometrial (4%) and ovarian (4%) cancers. More than half had high knowledge scores for CRC symptoms, screening tests and risk factors. About a third had received physician’s recommendation on CRC screening. Approximately half had undergone screening. The most common barriers to CRC screening were lack of symptoms and physician’s recommendation. Cancer survivors with higher education, higher household income, family history and those who perceived “great need” or “some need” were more likely to have undergone screening (56.4% vs 30.6%, p=0.003; 62.2% vs 41.9%, p=0.022; 70.6% vs 45.1%, p=0.048; 70.8% vs 27.4%, p<0.001). Physician’s recommendation (76.4% vs 31.6%, p<0.001) and high CRC symptom knowledge (55.8% vs 34.5%, p=0.012) were associated with increased likelihood of screening.On multivariate analysis, physician’s recommendation, higher household income and survivors’ perceived need to undergo screening remained strong predictors for CRC screening (p<0.001; p=0.010; p<0.001). Conclusion: The uptake rate of CRC screening among non-CRC survivors was modest. Physicians need to be more active in discussing CRC screening with cancer survivors as part of the survivorship care plan.     

Factors associated with colorectal cancer screening intent and uptake among adult Non-Hispanic Black men

Non-Hispanic (NH) Black men in the United States have the lowest five-year colorectal cancer (CRC) survival rate across all racial/ethnic and sex subgroups and are less likely than their NH White counterparts to complete CRC screening. We hypothesized that greater masculinity barriers to medical care (MBMC) would be negatively associated with CRC screening uptake. Employing a survey design, we examined the MBMC scale and other psychosocial factors influencing CRC screening intent and uptake in a sample of 319 NH Black men aged 45 to 75 years residing in Minnesota, Ohio, and Utah. A series of ordinary least squares and logistic regression models were run with intention and uptake as the outcome variable while controlling for various demographic characteristics. Independent variables in all models included average score on the MBMC; CRC screening knowledge, beliefs and values; and barriers to and social support for CRC screening. Social support, marital status, and age were positively associated with CRC screening intention. Increased CRC screening knowledge and older age were associated with a greater likelihood of completing a stool-based screening test for CRC. Fewer masculinity-related and CRC screening barriers were associated with a greater likelihood of undergoing a sigmoidoscopy or colonoscopy. Contrary to our primary hypothesis, lesser MBMC-related perceptions were associated with increased CRC screening uptake among NH Black men. Our findings inform future CRC promotion programs and emphasize the need for multilevel interventions tailored toward this marginalized population to reduce disparities in screening and survival.     

Colorectal cancer care knowledge mapping: identifying priorities for knowledge translation research

OBJECTIVE: We do not know the extent and nature of knowledge translation (KT) in oncology. This study examined colorectal cancer (CRC) health services research, and engaged researchers and decision makers in prioritizing KT research gaps. METHODS: MEDLINE was searched from 1996 to 2006 for CRC health services research in Canada, Australia, the United Kingdom, and United States. Studies were tabulated by indicator, type of research and country to reveal gaps. Researchers and decision makers prioritized gaps via questionnaire, then generated research questions for top-ranked gaps at a one-day workshop. RESULTS: A total of 132 articles were categorized and 29 individuals attended the workshop. We lack knowledge about factors influencing rates of many indicators. Researchers and decision makers prioritized KT research on factors that could either influence the utilization of screening or enhance the quality of surgical outcomes. They acknowledged lack of research capacity and policy support as barriers, and confusion about the concept of KT. CONCLUSIONS: Several opportunities were revealed for improving the quality of CRC screening and surgery. Greater coordination of, and support for KT research is required to address these gaps. Further research should evaluate different methods of achieving KT between researchers and decision makers for research planning.     

HPV Vaccine Knowledge and Beliefs Among Cambodian American Parents and Community Leaders

Background: The cervical cancer incidence rate among Cambodian American women is 15.0 per 100,000,compared to 7.7 per 100,000 among non-Latina white women. HPV infection has been identified as a universalrisk factor for cervical cancer. The HPV vaccine was recently approved in the United States for females aged 9-26 years. There is little information about HPV vaccination knowledge and beliefs in Southeast Asian communities.Methods: We conducted 13 key informant interviews with Cambodian community leaders, as well as four focusgroups with Cambodian parents (37 participants). Two of the focus groups included fathers and two of the focusgroups included mothers. Interview and focus group questions addressed HPV vaccine barriers and facilitators.Results: Participants had limited knowledge about HPV infection and the HPV vaccine. Barriers to HPVvaccination included a lack of information about the vaccine, as well as concerns about vaccine safety, effectiveness,and financial costs. The most important facilitators were a health care provider recommendation for vaccinationand believing in the importance of disease prevention. Discussion: Future cervical cancer control educationalprograms for Cambodians should promote use of the HPV vaccine for age-eligible individuals. Health careproviders who serve Cambodian communities should be encouraged to recommend HPV vaccination.     

Breast Cancer Survival among South Asian Women in California (United States)

Background Very little is known about cancer survival patterns among the growing South Asian community in the United States. Methods Breast cancer survival patterns were evaluated among South Asians using California Cancer Registry data from 1988 to 1998, and breast cancer survival among South Asians was compared to non-Hispanic Whites and other Asian subgroups. The analysis included all female, invasive, histologically confirmed breast cancer cases diagnosed from 1988 to 1998. The outcome of interest was death due to breast cancer. The Kaplan–Meier method was used to calculate 5- and 10-year survival probabilities. Results South Asians were less likely to be diagnosed with early stage carcinomas relative to non-Hispanic Whites, Chinese and Japanese individuals. In unadjusted analyses, South Asians experienced poorer survival than non-Hispanic Whites at later survival times. The 5- and 10-year unadjusted survival probabilities for South Asians were 84% and 76%, respectively, compared to those for non-Hispanic Whites, which were 87% and 80%, respectively. There was no significant difference in survival between South Asians and non-Hispanic Whites after multivariate adjustment. Conclusions These data suggest the need for targeted efforts to improve early stage diagnosis among South Asian women. Further research into the factors that influence survival among South Asians is also needed.     

Factors affecting attitudes toward colorectal cancer screening in the primary care population

Background:

Colorectal cancer (CRC) is a major cause of death in the United Kingdom. Regular screening could significantly reduce CRC-related morbidity and mortality. However, screening programmes in the United Kingdom have to date seen uptake rates of less than 60%. Attitudes towards screening are the primary factors determining patient uptake.

Methods:

A questionnaire was sent to people aged 50–69 years who were registered with general practices in the West Midlands. A total of 11 355 people (53%) completed the questionnaire. Multivariable logistic regression analyses were performed to identify those factors (gender, age, ethnicity, deprivation, number of symptoms, and their duration) that most strongly contributed to negative/positive attitudes in the primary care population.

Results:

Fourteen percent of respondents had a negative attitude towards screening. Men, older people, and those with Indian ethnic backgrounds were more likely to have negative attitudes toward screening, whereas people with Black-Caribbean ethnic background, people with multiple symptoms and those reporting abdominal pain, bleeding, and tiredness were more likely to have a positive attitude.

Conclusion:

Culturally relevant screening strategies should aim to increase knowledge of the symptoms and signs related to bowel cancer among South Asian ethnic groups in the United Kingdom. It is also important to find ways to increase the acceptability of screening among asymptomatic patients.     

Systematic review of barriers and facilitators to clinical trial enrollment among adolescents and young adults with cancer: Identifying opportunities for intervention

Adolescents and young adults (AYAs) are underrepresented in cancer clinical trials (CCTs). Limited trial enrollment slows progress in improving survival rates and prevents the collection of valuable biospecimens. A systematic literature review was conducted to assess barriers and facilitators to AYA enrollment in CCTs and to identify opportunities to improve enrollment. The PubMed MEDLINE, Web of Science, Scopus, and PsycINFO databases were searched to identify studies relevant to AYA CCT enrollment. Eligibility criteria included the qualitative and/or quantitative evaluation of barriers and facilitators to AYA enrollment. One hundred fifty-five unique publications were identified; 13 were included in the final analysis. Barriers to AYA enrollment in CCTs included a lack of existing trials applicable to the patient population, limited access to available CCTs, and a lack of physician awareness of relevant trials. Facilitators of enrollment included optimizing the research infrastructure, improving the awareness of available CCTs among providers, and enhancing communication about CCTs between providers and patients. In conclusion, the limited available research reports institution- and patient-level barriers and facilitators to AYA CCT enrollment. Because of persistent disparities in AYA enrollment, there is an urgent need to further identify the barriers and facilitators to AYA CCT enrollment to determine actionable areas for intervention.     

The Intention and Uptake of Colorectal Cancer Screening after a Brief Health Education Program in a Malaysian Primary Care Setting: A Population-Based Study

Colorectal cancer (CRC) is the most common cancer in men and the second most common cancer in women in Malaysia. A major challenge for CRC screening programs is to improve the screening participation rates. In Malaysia, the most critical barrier to the uptake of CRC screening is the lack of patient awareness. This study aimed to determine the intention and the uptake of CRC screening, and to explore the related motivators and barriers after raising awareness with a brief health education. Methods: An analytical cross-sectional study was conducted in a government health clinic of Penang from March to August 2019. Asymptomatic clinic attendees aged 50-75 years who had no prior awareness of CRC screening were recruited by systematic random sampling technique. Participants first received a standardised one to one health education, followed by an interview using a standardised questionnaire to assess their CRC screening intention and the relevant motivators and barriers. A submission of a sample for immunochemical faecal occult blood test (iFOBT) was considered as an uptake of the CRC screening. Results: A total of 546 participants participated in this study. The mean age of the participants was 62.8 (SD=6.36). Majority of them were females (57.3%), Chinese (78.6%), who had attained primary or higher education (92.0%) and had comorbidities (87.0%).  After a brief health education, 231 participants (42.3%) agreed to undergo iFOBT. The actual screening uptake rate in this study was 28%. Perceived benefit of the test (84.4%) was the most common motivators, while self-perceived non-vulnerability was the biggest impediment to CRC screening intention. Physicians’ recommendation was the perceived most effective way in raising CRC awareness. Conclusion: Participants prefer physicians to provide health education. Standardised brief health education is inadequate to stimulate CRC screening adherence. Future interventions will require in-depth understanding of patients’ beliefs, risk perception, and affective responses.     

Influence of family history and preventive health behaviors on colorectal cancer screening in African Americans

BACKGROUND: African Americans (AAs) have low rates of colorectal cancer (CRC) screening. To the authors' knowledge, factors that influence their participation, especially individuals with a family history of CRC ("family history"), are not well understood. METHODS: A secondary analysis of the 2002 Maryland Cancer Survey data examined predictors of risk-appropriate, timely CRC screening ("screening") in AAs with a family history and in individuals without a family history. Predictors that were evaluated included age, sex, family history, mammogram or prostate-specific antigen (PSA) screening, body mass index, activity, fruit/vegetable consumption, alcohol, smoking, perceived risk of cancer, education, employment, insurance, access to a healthcare provider, and healthcare provider recommendation of fecal occult blood test (FOBT) and/or sigmoidoscopy/colonoscopy. RESULTS: In individuals without a family history of CRC (N = 492), recommendation for FOBT (odds ratio [OR] of 11.90; 95% confidence interval [95% CI], 6.84-20.71) and sigmoidoscopy/colonscopy (OR of 7.06; 95% CI, 4.11-12.14), moderate/vigorous activity (OR of 1.74; 95% CI, 1.06-2.28), and PSA screening history (OR of 2.68; 95% CI, 1.01-7.81) were found to be predictive of screening. In individuals with a family history (N = 88), recommendation for sigmoidoscopy/colonscopy (OR of 24.3; 95%, CI 5.30-111.34) and vigorous activity (OR of 5.21; 95% CI, 1.09-24.88) were found to be predictive of screening. However, family history did not predict screening when the analysis was controlled for age, education, and insurance. AAs who had a family history were less likely to screen compared with their white counterparts (N = 293) and compared with AAs who were at average risk for CRC (P < .05). CONCLUSIONS: Regardless of family history, healthcare provider recommendation and activity level were important predictors of screening. Lower screening rates were observed in AAs who had a family history compared with individuals who did not. The authors believe that, for AAs who have a family history, further examination of barriers and facilitators to CRC screening within the cultural context is warranted.