Brief Articles
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. May 28, 2009; 15(20): 2531-2536
Published online May 28, 2009. doi: 10.3748/wjg.15.2531
Barriers to colorectal cancer screening: A case-control study
Shan-Rong Cai, Su-Zhan Zhang, Hong-Hong Zhu, Shu Zheng
Shan-Rong Cai, Su-Zhan Zhang, Shu Zheng, Cancer Institute, Zhejiang University, 88 Jiefang Rd., Hangzhou 310009, Zhejiang Province, China
Hong-Hong Zhu, Division of Epidemiology, Department of Community Health, Saint Louis University School of Public Health, 3545 Lafayette Ave., St Louis, Missouri, 63104 United States; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland 21205, United States
Author contributions: Cai SR directed the study, managed the data analysis, and prepared the majority of the manuscript; Zhang SZ co-supervised the field activities and designed the study’s analytic strategy; Zhu HH collected and analyzed the data, prepared the introduction and discussion parts and edited the whole manuscript; Zheng S designed the study, co-supervised the field activities and performed quality assurance and control.
Correspondence to: Dr. Shu Zheng, Former President of Zhejiang Medical University, Zhejiang University Cancer Institute, 88 Jiefang Rd., Hangzhou 310009, Zhejiang Province, China.
Telephone: +86-571-87784501
Fax: +86-571-87214404
Received: February 20, 2009
Revised: April 12, 2009
Accepted: April 19, 2009
Published online: May 28, 2009

AIM: To investigate barriers to colorectal cancer (CRC) screening in a community population.

METHODS: We conducted a community-based case-control study in an urban Chinese population by questionnaire. Cases were selected from those completing both a fecal occult blood test (FOBT) case and colonoscopy in a CRC screening program in 2004. Control groups were matched by gender, age group and community. Control 1 included those having a positive FOBT but refusing a colonoscopy. Control 2 included those who refused both an FOBT and colonoscopy.

RESULTS: The impact of occupation on willingness to attend a colorectal screening program differed by gender. P for heterogeneity was 0.009 for case vs control group 1, 0.01 for case versus control group 2, and 0.80 for control group 1 vs 2. Poor awareness of CRC and its screening program, characteristics of screening tests, and lack of time affected the screening rate. Financial support, fear of pain and bowel preparation were barriers to a colonoscopy as a screening test. Eighty-two percent of control group 1 and 87.1% of control group 2 were willing attend if the colonoscopy was free, but only 56.3% and 53.1%, respectively, if it was self-paid. Multivariate odds ratios for case vs control group 1 were 0.10 among those unwilling to attend a free colonoscopy and 0.50 among those unwilling to attend a self-paid colonoscopy.

CONCLUSION: Raising the public awareness of CRC and its screening, integrating CRC screening into the health care system, and using a painless colonoscopy would increase its screening rate.

Keywords: Colorectal cancer screening, Barrier, Community-based case-control study, Colonoscopy, Fecal occult blood test