More
than 143,000 people in the United States are diagnosed with colorectal
cancer each year and 57,000 die of the disease. Close relatives — brothers,
sisters or children — of those patients have a higher risk of developing
the cancer than someone without a family history. The U.S. government
strongly recommends that everyone over 50 should get screened and that
close relatives
of colorectal cancer patients should be screened at younger ages.
Lisa Madlensky, Ph.D., now at the University of California at San Diego
Cancer Center, and colleagues from Toronto's Mount Sinai Hospital interviewed
368 relatives of colorectal cancer patients, asking them if they had been
screened for the disease and what they thought about screening.
Of those interviewed, 236 had taken one of three screening
tests — colonoscopy,
sigmoidoscopy or fecal occult blood test — and 132 had not. Madlensky’s
team checked the responses against medical records to insure accuracy.
Their study appears in the fall issue of the American
Journal of Preventive Medicine.
Madlensky says that screened relatives shared a number
of characteristics. “The
encouragement of physicians and lack of perceived barriers to colonoscopy
demonstrated the strongest associations with screening,” she says.
Screened relatives tended to be older than the unscreened relatives and
saw greater benefits to screening and fewer obstacles to testing. Subjects
who had three or more relatives with the disease or who had discussed it
with family members after the initial diagnosis were more likely to have
been screened.
Unscreened relatives tended to see greater barriers to getting screened.
They cited impediments like fear, concern about discomfort during the procedure,
and an absence of symptoms, Madlensky says.
“Waiting for symptoms to appear may mean waiting until it is too
late,” she says. “Colorectal cancer is very treatable when
it is detected at an early stage, but usually there are no symptoms then.”
More people in this group might accept screening if improved educational
methods addressed these anxieties, she added.
Other factors had little impact in persuading these vulnerable relatives
to accept screening.
Advice from a relative did not carry much weight. Half of the people in
the unscreened group had been urged by relatives to be tested, but still
chose not to.
Socioeconomic factors like education or income played no role in the decision
to be screened because most surveyed were Canadian citizens, who all have
national health insurance.
Public awareness campaigns had little effect. Most participants had heard
or seen some sort of information about colorectal cancer, but this was
not associated with the decision for screening.
“Many subjects indicated that they only noticed such materials after
their relative’s diagnosis and that before that event, they had ‘no
reason to pay attention,’” Madlensky says. She concludes
that public awareness campaigns may not be the best way to convince this
higher
risk group to get screened.
But since the recommendation of the family physician does seem so critical,
Madlensky suggests working with doctors to raise the level of screening
among unscreened relatives.
Support for this project came from the Canadian Institutes of Health Research
and the Canadian Cancer Society. Madlensky conducted the research in collaboration
with John McLaughlin, Ph.D., Steve Gallinger, M.D., MaryJane Esplen, Ph.D.,
and Vivek Goel, M.D., as part of the Colorectal Cancer Interdisciplinary
Health Research Team at the Samuel Lunenfeld Research Institute at Toronto's
Mount Sinai Hospital.
