Contact: Jay Gusic
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Physician Encouragement, Patient Awareness Of Risk Can Affect Women's Participation In Colorectal Cancer Screening

When physicians actively encourage their older female patients to participate in fecal occult blood testing, patients are more willing to undergo cancer screening, new research shows.

Colorectal cancer (CRC) is the second leading cause of cancer death for men and women in the United States. Nevertheless, when 931 women between the ages of 50 and 80 -- all members of a managed care organization in western Washington State -- were randomly surveyed by telephone, only 58 percent reported that their primary care physician had encouraged them to be screened for CRC.

The telephone survey queried patients about their use of the test, an at-home stool sampling procedure that checks for hidden blood that can be produced by growths in the rectum or colon. This blood is often an early sign of colorectal cancer. One quarter of the women in the study reported that they had never had testing, and fewer than half (48 percent) had been screened in the previous two years.

"The women in our study who were urged to do CRC screening by their physicians were substantially more likely to be screened within the previous two years than the other women we surveyed," said lead researcher Margaret T. Mandelson, PhD. "When women were encouraged by their physicians to do CRC screening, 64 percent did so. In contrast, among individuals who received no encouragement from their physician, only 17 percent undertook the screening."

The researchers also point out that their study found a relationship between patient knowledge about CRC risks and prevention and their willingness to do the procedure. They report their findings in the October 2000 issue of the American Journal of Preventive Medicine

Although 92 percent of the women respondents believed that testing is an effective way to detect early cancers and nearly 80 percent were aware that a high-fat diet increases CRC risk, only about two-thirds of the study group knew that CRC runs in families.

"Those women who were unaware that CRC risk was hereditary were less likely to have recently undergone testing," according to Mandelson. "Our respondents who were uncertain or didn't believe that fecal occult blood testing lowered their risk of dying of colorectal cancer had higher never-been-screened rates than the rest of the study group. They also had an approximately two-thirds lower rate of screening done in the previous two years," she added.

Lack of knowledge about risk factors for CRC was clearly related to rates of participation in the home testing.

Those women who reported positive attitudes about the necessity for CRC screening, in spite of the unpleasant aspects of stool sampling, were seven times more likely to have been recently screened. More than 84 percent of the women who had never been screened said that they would be somewhat likely, or very likely, to do it if their physicians said to.

In general, a strong correlation was demonstrated between older women's past or current participation in screening and the amount of physician encouragement and accurate information about CRC risk and prevention they receive. "Our findings suggest that new strategies to promote CRC screening for women and increased public awareness of the efficacy of fecal occult blood testing can have a beneficial impact on CRC mortality rates," the researchers conclude.

This study was supported by the Centers for Disease Control and Prevention and by a grant from the National Cancer Institute.

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The American Journal of Preventive Medicine, sponsored by the Association of Teachers of Preventive Medicine and the American College of Preventive Medicine, is published eight times a year by Elsevier Science. The Journal is a forum for the communication of information, knowledge, and wisdom in prevention science, education, practice, and policy. For more information about the Journal, contact the editorial office at (619) 594-7344.