Patient Knowledge Regarding Colorectal Cancer Risk, Opinion of Screening, and Preferences for a Screening Test

https://doi.org/10.1067/j.cpradiol.2017.12.011Get rights and content

Aims

To assess patient knowledge about colorectal cancer incidence and prognosis as well as willingness to undergo screening with various tests (eg, optical colonoscopy, stool-based tests, computed tomographic colonography (CTC)).

Materials and Methods

A survey was administered to consecutive patients of a general academic-based internal medicine clinic.

Results

Survey response rate was 86.3%. A majority of respondents (55%) reported being aware of general information about colorectal cancer, and 99% indicated a belief that colorectal cancer screening was a good idea. A majority of respondents (73%) were willing to undergo optical colonoscopy, and some were willing to undergo stool-based tests (48%), or CT colonography CTC (40%). A majority reported being more willing to undergo a colorectal cancer screening test if the test did not involve radiation (86%), did not involve insertion of a tube or device into the rectum (78%), did not involve a pre‐proceduralpreprocedural bowel cleansing regimen (73%), or did not involve sedation (60%).

Conclusion

Improved patient education about the negligible radiation risk associated with CTC or development of a non‐invasive imaging test that did not involve a preprocedural bowel cleansing regimen may increase rates of colorectal cancer screening.

Introduction

Colorectal cancer is the second leading cause of cancer-related death in the United States and will result in an estimated 50,000 deaths in 2017.1 Colorectal cancer screening can prevent cancer and improve outcomes by detecting precancerous polyps and by identifying earlier stage, more treatable disease. Large randomized clinical trials have shown decreased colorectal cancer specific mortality with screening.2 It has been estimated that between 236,000 and 550,000 colorectal cancers were prevented by screening during the past 3 decades in the United States with an overall decrease in colorectal cancer incidence and a shift from late to early stage cancers being detected.3

Various societies including the American Cancer Society and the United States Preventative Services Task Force (USPSTF) have published recommendations for colorectal cancer screening. These recommendations are generally presented as lists of options including structural examinations of the colon (eg, optical colonoscopy and computed tomographic colonography [CTC]) and stool-based tests (eg, fecal occult blood tests [FOBT] and fecal DNA tests).4 Average risk individuals are advised to undergo screening between the ages of 50 and 75.4

However, rates of colorectal cancer screening in the United States are suboptimal, with only 62.4% of respondents aged 50-75 reporting having undergone a recent colorectal cancer screening test (eg, FOBT within the past year, FOBT within the past 3 years and flexible sigmoidoscopy within the past 5 years, optical colonoscopy within the past 10 years) in the most recently reported National Health Interview Survey.5 Screening rates for colorectal cancer were less than those for breast cancer (71.5%) and cervical cancer (83.0%) in this same survey.5

The purpose of this investigation was to assess patients’ knowledge regarding colon cancer incidence and prognosis, opinions regarding screening, and preferences for a screening test, and to assess for differences based on sex, age, race, and ethnicity.

Section snippets

Materials and Methods

This study was reviewed by our university’s Institutional Review Board (IRB) and was deemed IRB exempt as no identifiable patient information was collected. The survey included questions designed to assess respondents’ knowledge about colorectal cancer incidence and prognosis. Surveys were distributed to consecutive patients of an academic-based general internal medicine clinic at time of appointment check-in at the Seavey Clinic (Emory Healthcare, Atlanta, GA). Patients completed the survey

Results

Two hundred and forty-nine surveys were distributed, and 239 surveys were returned of which 24 were returned blank (response rate 86.3% [215/249]). Respondent demographics are reported in Table 2.

A majority of respondents (55%) reported being aware of general information about colorectal cancer incidence and survival rates. There was a significant difference as a function of age with those < 50 years more likely to respond “no” (72%) as compared to those in older groups (50-59 = 42%; 60-60 =

Discussion

Although colorectal cancer is largely a preventable disease, approximately 50,000 Americans die due to colorectal cancer annually with a projected treatment costs of $17.4 billion in the United States in 2020.6 Less than two-thirds of Americans report being up to date with colorectal cancer screening.5 Our survey results indicate that nearly 100% of respondents believe that colorectal cancer screening is a good idea, though 45% were unaware of basic information about colorectal cancer incidence

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