Reliability and validity of a questionnaire to measure colorectal cancer screening behaviors: does mode of survey administration matter?

Valid and reliable self-report measures of cancer screening behaviors are important for evaluating efforts to improve adherence to guidelines. We evaluated test-retest reliability and validity of self-report of the fecal occult blood test (FOBT), sigmoidoscopy (SIG), colonoscopy (COL), and barium enema (BE) using the National Cancer Institute colorectal cancer screening (CRCS) questionnaire. A secondary objective was to evaluate reliability and validity by mail, telephone, and face-to-face survey administration modes. Consenting men and women, 51 to 74 years old, receiving care at a multispecialty clinic for at least 5 years who had not been diagnosed with colorectal cancer were stratified by prior CRCS status and randomized to survey mode (n = 857). Within survey mode, respondents were randomized to complete a second survey at 2 weeks, 3 months, or 6 months. Comparing self-report with administrative and medical records, concordance estimates were 0.91 for COL, 0.85 for FOBT, 0.85 for SIG, and 0.92 for BE. Overall sensitivity estimates were 0.91 for COL, 0.82 for FOBT, 0.76 for SIG, and 0.56 for BE. Specificity estimates were 0.91 for COL, 0.86 for FOBT, 0.89 for SIG, and 0.97 for BE. Sensitivity and specificity varied little by survey mode for any test. Report-to-records ratio showed overreporting for SIG (1.1), COL (1.15), and FOBT (1.57), and underreporting for BE (0.82). Reliability at all time intervals was highest for COL; there was no consistent pattern according to survey mode. This study provides evidence to support the use of the National Cancer Institute CRCS questionnaire to assess self-report with any of the three survey modes.     

Agreement between self‐reported and registered colorectal cancer screening: a meta‐analysis

This random‐effects meta‐analysis investigates the accuracy of self‐reported colorectal cancer screening history as a function of screening mode (colonoscopy, flexible sigmoidoscopy, faecal occult blood testing – FOBT, double‐contrast barium enema – DCBE) and survey mode (written, telephone, face‐to‐face). Summary estimates of sensitivity, specificity, positive predictive value (PPV) and area under the receiver operating characteristic curve (AUC) were calculated. Medical record data were used as reference. We included 23 studies comprising 11 592 subjects. Colonoscopy yielded higher AUC [0.948, 95% confidence interval (CI) = 0.918, 0.968] than flexible sigmoidoscopy (0.883, 95% CI = 0.849, 0.911) and FOBT (0.869, 95% CI = 0.833, 0.898). Colonoscopy showed the highest sensitivity (0.888, 95% CI = 0.835, 0.931), whereas specificity was comparable between screening modes (ranging from 0.802 for FOBT to 0.904 for DCBE). AUC was not significantly different between survey modes. Prevalence of screening history correlated positively with sensitivity and negatively with specificity, possibly because of errors in the medical records. In conclusion, the accuracy of self‐reported cancer screening is generally moderate, and higher for colonoscopy than for sigmoidoscopy and FOBT.     

A comparison of self-reported colorectal cancer screening with medical records.

The purpose of this study was to compare self-reports of colorectal cancer (CRC) screening by fecal occult blood test (FOBT), sigmoidoscopy, and colonoscopy with medical records in a multiprovider health care setting. Relatives of CRC patients residing in Ontario, Canada completed a questionnaire indicating whether or not they had ever had any CRC screening tests. Medical records from physician's offices and hospitals were compared with the self reports, and where possible, reasons were obtained for nonmatching reports. Medical records for colonoscopies were readily available from various sources, and self-reports of this procedure were very accurate (kappa statistic for agreement beyond chance = 0.87). For sigmoidoscopy and FOBT, the agreement was poorer (kappa = 0.29 and 0.32, respectively); however, there were difficulties in obtaining records for these two procedures. Sigmoidoscopy procedures that took place many years ago were difficult to document, and physician's offices were unable to provide FOBT reports in many cases. Self-reports of colonoscopy were very accurate in this population, whereas self-reports of sigmoidoscopy and FOBT are somewhat less accurate, although this is likely due to challenges in obtaining a confirmatory record rather than an overreporting of tests. In a multiprovider publicly insured health care setting such as Canada, using self-reported information is likely to provide sufficiently accurate information for colonoscopy, but for other CRC screening tests, there may be difficulty in obtaining true estimates of the frequencies of these procedures.     

Preferences for colorectal cancer screening tests and screening test use in a large multispecialty primary care practice

BACKGROUND:

The purpose of this study was to identify factors associated with colorectal cancer (CRC) screening test preference and examine the association between test preference and test completed.

METHODS:

Patients (n = 1224) were 50‐70 years, at average CRC risk, and overdue for screening. Outcome variables were preference for fecal occult blood test (FOBT), colonoscopy (COL), sigmoidoscopy (SIG), or barium enema (BE), measured by telephone survey, and concordance between test preference and test completed assessed using medical records.

RESULTS:

Thirty‐five percent preferred FOBT, 41.1% COL, 12.7% SIG, and 5.7% BE. Preference for SIG or COL was associated with having a physician recommendation, greater screening readiness, test‐specific self‐efficacy, greater CRC worry, and perceived pros of screening. Preference for FOBT was associated with self‐efficacy for doing FOBT. Participants who preferred COL were more likely to complete COL compared with those who preferred another test. Of those screened, only 50% received their preferred test. Those not receiving their preferred test most often received COL (52%).

CONCLUSIONS:

Lack of concordance between patient preference and test completed suggests that patients' preferences are not well incorporated into screening discussions and test decisions, which could contribute to low screening uptake. Physicians should acknowledge patients' preferences when discussing test options and making recommendations, which may increase patients' receptivity to screening. Cancer 2011. © 2011 American Cancer Society.     

Participation in Colorectal Cancer Screening Among Chinese Americans

Introduction: Colorectal cancer (CRC) is the second leading cause of cancer deaths in the United States and thethird most common malignant neoplasm worldwide. Chinese Americans are one of the ethnic minority groups whohave the lowest rates of CRC screening. The purpose of this study was to describe CRC screening among lessacculturated Chinese Americans and to identify factors associated with CRC screening. Methods: We performed areview of 383 patients’ medical records at a large community health clinic in Seattle’s metropolitan area betweenJuly 2003 and September 2004. Outcome measurements included receiving fecal occult blood testing (FOBT) in thelast 12 months, sigmoidoscopy in the previous 5 years and/or colonoscopy in the past 10 years. Compliance withCRC screening was assessed by documentation in patients’ medical records. Results: The overall use of CRC screeningper guidelines was 40%. Only 72(19%) patients had their FOBT test in the last 12 months. Eighty one patients (21%)had colonoscopy in the last 10 years and eleven (3%) of the patients had sigmoidoscopy in the last 5 years. Chisquareanalyses revealed no significant differences between users and non-users of FOBT, sigmoidoscopy, andcolonoscopy in terms of age, gender, insurance status or language. Discussion: Participation in CRC screeningamong less acculturated Chinese Americans was lower than rates derived from previous self-reported surveys.Research of effective preventive programs promoting annual FOBT is vital to increasing the use of CRC screeningamong this population.     

Screening tests for colorectal cancer: A menu of options remains relevant

Until the early 1990s, no evidence was available to show that screening for colorectal cancer (CRC) by any means actually saved lives. Subsequently, sufficient evidence for the efficacy of fecal occult blood testing (FOBT) and flexible sigmoidoscopy allowed the US Preventive Services Task Force to publish guidelines for CRC screening. Since that time the major organizations in the United States concerned with screening guidelines have recommended a menu of screening test options including FOBT, flexible sigmoidoscopy, flexible sigmoidoscopy plus FOBT, barium enema, and colonoscopy. No organization, except for the American College of Gastroenterology, has designated any one of these options as “preferred.” Nevertheless, the lay press and many gastroenterology opinion leaders have encouraged Americans to have only one test—colonoscopy. In this review we discuss the rationale for caution in designating one screening test as “the best” and present information on how new stool and serum tests can be used effectively to screen for CRC.     

Prevalence of colorectal cancer screening in a large medical organization.

The primary objective of this study was to determine the prevalence of colorectal cancer (CRC) screening among eligible patients in a large medical practice. A secondary objective was to compare CRC screening rates obtained from medical records with physician self-reported CRC screening recommendation. We conducted a retrospective record review of 214 patients ages > or = 50 years of a large multispecialty medical organization in Houston, Texas, for receipt of fecal occult blood test (FOBT), flexible sigmoidoscopy (SIG), and/or colonoscopy (COL). We estimated prevalence using two definitions: (a) FOBT in past year or SIG in past 5 years or COL in past 10 years; and (b) FOBT in past year and SIG in past 5 years or COL in past 10 years. Age, gender, race/ethnicity, family history, number of chronic conditions, and index visit were independent variables. Contingency table and logistic regression analysis were used to test for associations between outcomes and independent variables. Our study population was 48% male with a mean age of 63 years (range: 53-84 years). One-quarter of the records showed FOBT by 3-day kit (51 of 214) and 27% by digital rectal exam (57 of 214). SIG was recorded in 32% of records. Half (54%) of the records had documentation of CRC screening according to definition no. 1 and 19% according to definition no. 2. Screening rates from medical record review were lower than those derived from physician self-report. Our findings underscore the need for interventions to improve CRC screening in primary care settings.     

Determinants of colorectal cancer screening behavior among Chinese Americans

Colorectal cancer (CRC) is the most commonly diagnosed cancer among Chinese Americans and is the third leading cause of cancer death in this population. The objectives of this study were to determine the rates of CRC screening (via fecal occult blood test (FOBT), flexible sigmoidoscopy (FSIG), and colonoscopy) among Chinese Americans and predictors of utilizing these screening procedures. Participants (N = 206) completed a self-administered questionnaire assessing cancer screening behaviors and beliefs about perceived risk of developing cancer and treatment efficacy. A series of logistic regressions indicated that physician recommendation to obtain CRC screening significantly predicted whether Chinese Americans undergo FOBT, FSIG, or colonoscopy screening (p < 0.001). Acculturation and perceived risk of developing CRC did not predict obtaining any of the screening procedures. FOBT was the most commonly reported screening method used by respondents (65%), followed by FSIG (54%) and colonoscopy (49%). These findings highlight the need to make physicians more aware of the impact their recommendations have in determining CRC screening behavior among Chinese Americans.     

Predictors of colorectal cancer screening from patients enrolled in a managed care health plan

BACKGROUND: Despite the growing recognition of the importance of colorectal cancer (CRC) screening in reducing cancer mortality, national screening rates are low, indicating a critical need to understand the barriers and remedies for underutilization of CRC screening tests. METHODS: Using results from independent cross-sectional telephone surveys with patients aged>or=50 years performed before (2000; n=498) and after (2003; n=482) a quality improvement intervention for CRC screening within a large managed care health plan, the trends and predictors of CRC screening with fecal occult blood test (FOBT) and/or endoscopy (flexible sigmoidoscopy/colonoscopy) were examined from a patient perspective. RESULTS: In 2000, patient reported screening rates within guidelines were 38% for any test, 23% for endoscopy, and 22% for FOBT. In 2003, screening rates increased to 50% for any test, 39% for endoscopy, and 24% for FOBT. Having discussed CRC with a doctor significantly increased the odds of being screened (FOBT: odds ratio [OR], 2.09 [95% confidence interval (95% CI), 1.47-2.96]; endoscopy: OR, 2.33 [95% CI, 1.67-3.26]; and any test: OR, 2.86 [95% CI, 2.06-3.96]), and reporting barriers to CRC in general decreased the odds of being screened (FOBT: OR, 0.76 [95% CI, 0.60-0.95]; endoscopy: OR, 0.74 [95% CI, 0.60-0.92]; and any test: OR, 0.66 [95% CI, 0.54-0.80]). CONCLUSIONS: Although screening rates increased over the 3-year period, evidence was found of ongoing underutilization of CRC screening. The 2 strongest determinants of obtaining CRC screening were provider influence and patient barriers related to CRC screening in general, pointing to the need for multilevel interventions that target both the provider and patient.     

Colorectal carcinoma screening among Hispanics and non-Hispanic whites in a rural setting

BACKGROUND: Colorectal carcinoma ranks as the second most common cancer and the second leading cause of cancer death in the United States. Hispanics are less likely than their non-Hispanic white counterparts to have ever received a fecal occult blood test (FOBT) or sigmoidoscopy/colonoscopy. Little is known about the barriers to screening in the Hispanic population. METHODS: The authors used baseline data from a community randomized trial of cancer prevention to compare screening prevalence and the associations between reported barriers and screening participation between Hispanics (n = 137) and non-Hispanic whites (n = 491) age > or = 50 years. RESULTS: Hispanics were less likely than non-Hispanic whites to have ever received an FOBT (P = 0.003) or sigmoidoscopy/colonoscopy (P = 0.001). No significant difference across ethnic groups was observed in the prevalence of recent screening using FOBT (29.8% for Hispanics vs. 34.5% for non-Hispanic whites; P = 0.41), but recent use of sigmoidoscopy/colonoscopy was lower for Hispanics (24.1% for Hispanics vs. 33.7% for non-Hispanic whites; P 0.06). Lacking health care coverage or having few years of education were directly associated with failure to ever receive an FOBT or sigmoidoscopy/colonoscopy. CONCLUSIONS: Interventions to improve adherence to colorectal carcinoma screening recommendations among Hispanics should target initial screening examinations, particularly among those lacking health care coverage or having low levels of education.     

Healthy Colon,Healthy Life (<Emphasis Type="Italic">Colon Sano</Emphasis>, <Emphasis Type="Italic">Vida Sana</Emphasis>): Colorectal Cancer Screening Among Latinos in Santa Clara,California

Colorectal cancer (CRC) screening rates are low among Latinos. To identify factors associated with CRC screening, we conducted a telephone survey of Latino primary care patients aged 50–79 years. Among 1,013 participants, 38% were up-to-date (UTD) with fecal occult blood test (FOBT); 66% were UTD with any CRC screening (FOBT, sigmoidoscopy, or colonoscopy). Individuals less than 65, females, those less acculturated, and patients of female physicians were more likely to be UTD with FOBT. CRC screening among Latinos is low. Younger patients, women, and patients of female physicians receive more screening.     

Perceived barriers and benefits to colon cancer screening among African Americans in North Carolina: how does perception relate to screening behavior?

This study investigated perceived barriers and benefits, as conceptualized by the Health Belief Model,in relation to screening for colorectal cancer (CRC) among African-American adults participating in a church-based health promotion program. CRC is one of the most common cancers and is the second leading cause of cancer death for men and women. Screening can be effective at detecting cancer at treatable stages, but a large proportion of people at risk have not been screened or are not screened regularly, as recommended by national guidelines. In this study, logistic regression was used to assess the relation of barriers and benefits to self-reported history of fecal occult blood testing (FOBT), flexible sigmoidoscopy, and colonoscopy. Barriers were significantly negatively related to recent FOBT and recent sigmoidoscopy. Benefits were significantly related to having a recent sigmoidoscopy and a recent colonoscopy but not to recent FOBT. Results suggest that the way people perceive sigmoidoscopy and colonoscopy may differ from FOBT with respect to the relative importance of perceived benefits versus barriers. Findings are discussed within the context of these Health Belief Model constructs and implications for health promotion programming.     

Changes in colorectal cancer screening use after introduction of alternative screening offer in Germany: Prospective cohort study

In October 2002, screening colonoscopy was added to the German colorectal cancer (CRC) screening program as an alternative to fecal occult blood test (FOBT). We aimed to evaluate the change in CRC screening use after introduction of the dual screening offer and to assess determinants of screening use. Data were drawn from a population-based cohort study initiated during 2000–2002 in Germany (n = 5,845, age range at recruitment: 50–75 years). We conducted both cross-sectional and longitudinal analyses to obtain uptake rates of CRC screening based on four waves of data. Age-group specific proportions of participants having had FOBT within 2 years remained essentially unchanged at 61–67% between 2000 and 2002 (1st wave) and 2005–2007 (3rd wave). The proportions of participants having undergone screening colonoscopy within 10 years increased from 23–29% to 46–57%, leading to a substantial overall increase in being up-to-date with CRC screening from 66–68% to 77–80%. In 2008–2010 (4th wave), FOBT use declined and colonoscopy use continued to increase. Obesity was significantly associated with lower prevalence of being up-to-date with FOBT (odds ratio [OR] at 8-year follow-up 0.68; 95% confidence interval [CI], 0.58–0.80) and screening colonoscopy (OR, 0.73; 95% CI, 0.62–0.86). Also, smokers were less likely to have ever used FOBT (OR, 0.54; 95% CI, 0.40–0.75) or colonoscopy (OR, 0.75; 95% CI, 0.63–0.90) compared to nonsmokers. After the introduction of dual screening offer, the overall adherence to CRC screening steeply increased, mainly due to an increase in screening colonoscopy uptake. Screening tests kept being underused by obese people and smokers who are at elevated CRC risk.     

Validity of self-reported colorectal cancer screening behavior.

End points for trials promoting cancer screening are often based on self-reported screening behavior. This study was designed to evaluate and optimize the reliability of a computer-assisted telephone interview for collecting self-reported colorectal cancer screening behavior. Cases who had received a fecal occult blood test (FOBT), flexible sigmoidoscopy, and/or colonoscopy, and controls who had no record of colorectal screening were identified among 40-75-year-old members of the Denver Kaiser Permanente Health Care Program and were contacted by telephone. Sensitivities and specificities of self-reported screening were calculated by comparison of subjects' recall with Kaiser Permanente records. The questionnaire was revised based upon results of the pilot phase of the study. Using the revised questionnaire, the sensitivity of self-reported screening was 96.2% for the FOBT, 94.9% for flexible sigmoidoscopy, 88.7% for colonoscopy, and 96.2% for either endoscopic screening test. The specificity of self-reported screening was 85.9% for the FOBT, 92.2% for flexible sigmoidoscopy, 96.8% for colonoscopy, and 92.0% for either endoscopic screening test. No marked differences in the accuracy of the self-reports were detected as a function of gender, age, ethnicity, or family history of colorectal cancer of the participants. Self-reports of colon cancer screening behavior can be reliably used as end points for intervention trials when carefully phrased questions are used.     

Long‐term risk of colorectal cancer after negative colonoscopy in a Danish gFOBT screening cohort

Faecal occult blood test (FOBT) screening for colorectal cancer (CRC) is implemented in several countries. Approximately half of all screen positive persons have negative colonoscopy, but consensus is lacking on how these persons should be followed up. Health authorities in Denmark and The Netherlands recommend suspending screening for 8–10 years, while patients in UK are invited to screening after 2 years. In this cohort‐study, we followed 166,277 individuals invited to FOBT‐screening in 2005–2006 and a reference group comprising the remaining 1,240,348 Danes of the same age. We linked Danish population and health service registers to obtain information about colonoscopy outcome and incident CRC. We estimated CRC risk by colonoscopy outcome (adenoma, other colorectal pathology or negative colonoscopy) for the reference group, the screening group, and subgroups. Persons with positive screening FOBT followed by negative colonoscopy had the same long‐term CRC risk as persons with adenoma detected due to a positive screening FOBT (aHR 1.33, 95% CI: 0.65–2.71). We found no difference in the long‐term CRC risk between persons with negative colonoscopy after a positive FOBT screening test and the unscreened reference population (aHR 1.05, 95% CI: 0.62–1.78). Since FOBT screen positive persons in our study remained at average risk of CRC despite of a negative index colonoscopy, we question the safety of suspending FOBT screening for this group. It needs to be monitored whether recent efforts to improve colonoscopy quality have been successful in ensuring low CRC risk after negative colonoscopy also in FOBT positive persons.     

Psychosocial risk profiles among black male Veterans Administration patients non-adherent with colorectal cancer screening

Objective: This study identifies unique psychosocial characteristics among African American men that put the men at risk for non‐adherence to colorectal cancer (CRC) screening (colonoscopy, sigmoidoscopy, and fecal occult blood tests (FOBT)). Subgroups sharing similar psychosocial characteristics may be targeted with specific intervention strategies aimed at increasing participation in screening, which could lead to increased early detection and decreased morbidity and mortality. Methods: The male African American veterans in our sample (n = 260) had a mean age of 57.3 (SD = 7.3) years. Our study employs latent class analysis, a quantitative‐based, audience segmentation method to identify homogeneous subgroups of African American men with similar psychosocial characteristics related to CRC screening, potentially in need of different health information and intervention strategies. Latent class regression was used to examine the relationships among latent class structure and demographic characteristics. Results: There were four psychosocial risk classes across the three screening tests. A significant subset of men had psychosocial characteristics indicative of willingness to be screened for each test (colonscopy = 21.8%, sigmoidoscopy = 31.5%, and FOBT = 10.8%), although they were currently non‐adherent. Men who received a past screening test, had greater than a high school education, or were married were more likely to be represented in a latent class indicative of being prepared for getting colonoscopy or sigmoidoscopy. Sociodemographic variables were unrelated to FOBT latent class structure. Conclusions: Segmenting our sample of male African American veterans based on psychosocial risk characteristics can inform the development of more precisely targeted interventions for African American men who are non‐adherent for CRC screening. Copyright © 2010 John Wiley & Sons, Ltd.     

Noninvasive diagnostic modalities for early detection of colorectal cancer

Colorectal cancer (CRC) screening strategies currently approved are colonoscopy every 10 years, annual fecal occult blood testing (FOBT), flexible sigmoidoscopy every 5 years, annual FOBT plus flexible sigmoidoscopy, and double-contrast barium enema every 5 years. Colonoscopy has been shown to be preferable, but it is invasive, needs bowel preparation, entails a risk of perforation, and is highly operator-dependent. Several noninvasive strategies are being developed as alternatives to colonoscopy. CT colonography (CTC), also known as virtual colonoscopy, has widely variable results but has been shown to have acceptable cost-effectiveness at either 5-year or 10-year intervals, whether it is performed using two-dimensional or three-dimensional techniques. Fecal immunochemical tests have now been shown to have clearly superior performance compared with guaiac-based testing and may become the FOBT of choice. Stool DNA (sDNA) testing has been improved by the addition to the commercial assay of gel-based DNA capture and buffering solutions for DNA stabilization. Simplified sDNA assays (for vimentin methylation and long DNA only) may also improve sensitivity. Advances in our understanding of the molecular genetic changes involved in neoplastic transformation have led to new noninvasive methods to detect tumors. The future of CRC screening will be driven by the performance characteristics of these technologies, which will be more clearly understood as additional data emerge.     

Screening for colorectal cancer--now and the near future

When used appropriately, screening for colorectal cancer (CRC) can reduce disease-related morbidity and mortality. Current methods include fecal occult blood testing (FOBT), flexible sigmoidoscopy [FS], barium enema, and colonoscopy; all are cost-effective techniques. Unfortunately, offering an array of options has not increased screening utilization, which continues to lag behind that of other common cancers. Newer techniques, particularly virtual colonoscopy (VC) and stool DNA testing, may offer attractive alternatives for healthcare provider recommendation and patient use.     

Use of colonoscopy for colorectal cancer screening: evidence from the 2000 National Health Interview Survey.

BACKGROUND: The use of colonoscopy as a primary screening tool for colorectal cancer is gaining momentum owing to several studies suggesting superior effectiveness and the recent, favorable decision by Medicare to cover all routine screening colonoscopies. This study documents the use of colonoscopy versus other tests to screen for colorectal cancer. MATERIALS AND METHODS: Data from the 2000 National Health Interview Survey were analyzed. Fecal occult blood test (FOBT), sigmoidoscopy, and colonoscopy done for any reason and for routine screening only were analyzed for those >/=50 years without previously diagnosed colorectal cancer (n = 12,505). RESULTS: The proportion of the total eligible population receiving any of the recommended tests for all possible reasons and for screening purposes only is 34.6% and 25.1%, respectively. For routine screening purposes, the test most commonly utilized was FOBT (55.6%) followed by colonoscopy (29.1%) and sigmoidoscopy (15.3%). When usage was assessed for all reasons, FOBT was still most commonly utilized (45.8%) followed by colonoscopy (38.7%) and sigmoidoscopy (15.5%). The elderly, non-White males and those with private insurance have a higher probability of receiving colonoscopy than FOBT. Several regional differences exist, including higher probability of undergoing sigmoidoscopy versus colonoscopy in the West. CONCLUSIONS: Only one fourth (upper limit one third) of the study population complied with colorectal cancer screening recommendations. Nearly one third of the routine screening tests done in 2000 were colonoscopies. This study provides baseline values that can be used to project future colonoscopy demand and identify potential supply barriers.     

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.