© 1997 by Oxford University Press
Journal Of The National Cancer Institute, Vol 89, 1406-1422, Copyright © 1997 by Oxford University Press
SW Vernon
The purpose of this review is to evaluate the published literature on
adherence to colorectal cancer (CRC) screening with fecal occult blood
testing (FOBT) and sigmoidoscopy. Specifically, the review addresses the
following: 1) prevalence of FOBT and sigmoidoscopy; 2) interventions to
increase adherence to FOBT and sigmoidoscopy; 3) correlates or predictors
of adherence to FOBT and sigmoidoscopy; and 4) reasons for nonadherence.
Other objectives are to put the literature on CRC screening adherence in
the context of recently reported findings from experimental interventions
to change prevention and early detection behaviors and to suggest
directions for future research on CRC screening adherence. CRC screening
offers the potential both for primary and for secondary prevention. Data
from the 1992 National Health Interview Survey show that 26% of the
population more than 49 years of age report FOBT within the past 3 years
and 33% report ever having had sigmoidoscopy. The Year 2000 goals set forth
in Healthy People 2000 are for 50% of the population more than 49 years of
age to report FOBT within the past 2 years and for 40% to report that they
ever had sigmoidoscopy. Thus, systematic efforts to increase CRC screening
are warranted. To date, attempts to promote CRC screening have used both a
public health model that targets entire communities, e.g., mass media
campaigns, and a medical model that targets individuals, e.g., general
practice patients. Most of these efforts, however, did not include
systematic evaluation of strategies to increase adherence. The data on FOBT
show that the median adherence rate to programmatic offers of FOBT is
between 40% and 50%, depending on the type of population offered the test,
e.g., patients or employees. Approximately, 50% of those initially offered
testing in unselected populations will respond to minimal prompts or
interventions. A salient issue for FOBT, however, is whether or not the
behavior can be sustained over time. Fewer studies examined adherence to
sigmoidoscopy. Adherence was highest in relatives of CRC cases and in
employer-sponsored programs offered to workers at increased risk of CRC. At
present, we know very little about the determinants of CRC screening
behaviors, particularly as they relate to rescreening.
REVIEWS
Participation in colorectal cancer screening: a review
University of Texas Health Science Center, Houston School of Public Health 77225, USA.
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