Skip to main content

Advertisement

Log in

Predictors of colorectal cancer screening behaviors among average-risk older adults in the United States

  • Review Article
  • Published:
Cancer Causes & Control Aims and scope Submit manuscript

Abstract

Objective

To critically evaluate recent studies that examined determinants of CRC screening behaviors among average-risk older adults (≥50 years) in the United States.

Methods

A PUBMED (1996–2006) search was conducted to identify recent articles that focused on predictors of CRC initiation and adherence to screening guidelines among average-risk older adults in the United States.

Results

Frequently reported predictors of CRC screening behaviors include older age, male gender, marriage, higher education, higher income, White race, non-Hispanic ethnicity, smoking history, presence of chronic diseases, family history of CRC, usual source of care, physician recommendation, utilization of other preventive health services, and health insurance coverage. Psychosocial predictors of CRC screening adherence are mostly constructs from the Health Belief Model, the most prominent of which are perceived barriers to CRC screening.

Conclusions

Evidence suggests that CRC screening is a complex behavior with multiple influences including personal characteristics, health insurance coverage, and physician–patient communication. Health promotion activities should target both patients and physicians, while focusing on increasing awareness of and accessibility to CRC screening tests among average-risk older adults in the United States.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Christman LK, Abdulla R, Jacobsen PB, Cantor AB, Mayhew DY, Thompson KS et al (2004) Colorectal cancer screening among a sample of community health center attendees. J Health Care Poor Underserved 15(2):281–293

    Article  PubMed  Google Scholar 

  2. Clipp EC, Carver EH, Pollak KI, Puleo E, Emmons KM, Onken J, et al. (2004) Age-related vulnerabilities of older adults with colon adenomas: evidence from Project Prevent. Cancer 100(5):1085–1094

    Article  PubMed  Google Scholar 

  3. Harewood GC, Wiersema MJ, Melton LJ III (2002) A prospective, controlled assessment of factors influencing acceptance of screening colonoscopy. Am J Gastroenterol 97(12):3186–3194

    Article  PubMed  Google Scholar 

  4. James AS, Campbell MK, Hudson MA (2002) Perceived barriers and benefits to colon cancer screening among African Americans in North Carolina: how does perception relate to screening behavior?. Cancer Epidemiol Biomarkers Prev 11(6):529–534

    PubMed  Google Scholar 

  5. Matthews BA, Anderson RC, Nattinger AB (2005) Colorectal cancer screening behavior and health insurance status (United States). Cancer Causes Control 16(6):735–742

    Article  PubMed  Google Scholar 

  6. Ahluwalia IB, Mack KA, Murphy W, Mokdad AH, Bales VS (2001) State-specific prevalence of selected chronic disease-related characteristics—Behavioral risk factor surveillance system

  7. Tomeo CA, Colditz GA, Willett WC, Giovannucci E, Platz E, Rockhill B et al (1999) Harvard Report on Cancer Prevention. Volume 3: prevention of colon cancer in the United States. Cancer Causes Control 10(3):167–180

    Article  PubMed  CAS  Google Scholar 

  8. Janz NK, Wren PA, Schottenfeld D, Guire KE (2003) Colorectal cancer screening attitudes and behavior: a population-based study. Prev Med 37(6 Pt 1):627–634

    Article  PubMed  Google Scholar 

  9. Hawk ET, Levin B (2005) Colorectal cancer prevention. J Clin Oncol 23(2):378–391

    Article  PubMed  Google Scholar 

  10. Harvard Report on Cancer Prevention (1999) Prevention of colon cancer in the United States. Cancer Causes Control 10:167–180

    Article  Google Scholar 

  11. Powe BD, Finnie R, Ko J (2006) Enhancing knowledge of colorectal cancer among African Americans: why are we waiting until age 50? Gastroenterol Nurs 29(1):42–49

    Article  PubMed  Google Scholar 

  12. Sheikh RA, Kapre S, Calof OM, Ward C, Raina A (2004) Screening preferences for colorectal cancer: a patient demographic study. South Med J 97(3):224–230

    Article  PubMed  Google Scholar 

  13. Huang CS, Lal SK, Farraye FA (2005) Colorectal cancer screening in average risk individuals. Cancer Causes Control 16(2):171–188

    Article  PubMed  Google Scholar 

  14. Levin TR, Palitz AM (2002) Flexible sigmoidoscopy: an important screening option for average-risk individuals. Gastrointestinal endoscopy clinics of North America 12(1):23–40, vi

    Google Scholar 

  15. Maciosek MV, Solberg LI, Coffield AB, Edwards NM, Goodman MJ (2006) Colorectal cancer screening: health impact and cost effectiveness. Am J Prev Med 31(1):80–89

    Article  PubMed  Google Scholar 

  16. Cokkinides VE, Chao A, Smith RA, Vernon SW, Thun MJ (2003) Correlates of underutilization of colorectal cancer screening among U.S. adults, age 50 years and older. Prev Med 36(1):85–91

    Article  PubMed  Google Scholar 

  17. Bowie JV, Curbow BA, Garza MA, Dreyling EK, Benz Scott LA, McDonnell KA (2005) A review of breast, cervical, and colorectal cancer screening interventions in older women. Cancer Control 12(Suppl 2):58–69

    PubMed  Google Scholar 

  18. Pignone M, Levin B (2002) Recent developments in colorectal cancer screening and prevention. Am Fam Physician 66(2):297–302

    PubMed  Google Scholar 

  19. Plaza CI, Rane S (2003) Finance issue brief: mandated benefits: colorectal cancer screening coverage requirements: year end report-2003. Issue Brief Health Policy Track Serv 31:1–5

    Google Scholar 

  20. Provenzale D, Gray RN (2004) Colorectal cancer screening and treatment: review of outcomes research. J Natl Cancer Inst Monogr (33):45–55

  21. Screening for colorectal cancer–United States, 1992–1993, and new guidelines (1996) MMWR 45(5):107–110

  22. Sonnenberg A, Delco F (2002) Cost-effectiveness of a single colonoscopy in screening for colorectal cancer. Arch Intern Med 162(2):163–168

    Article  PubMed  Google Scholar 

  23. Borum ML (2001) Colorectal cancer screening. Primary care. 28(3):661–674, viii

    Google Scholar 

  24. Gazelle GS, McMahon PM, Scholz FJ (2000) Screening for colorectal cancer. Radiology 215(2):327–335

    PubMed  CAS  Google Scholar 

  25. Inadomi JM, Sonnenberg A (2000) The impact of colorectal cancer screening on life expectancy. Gastrointest Endosc 51(5):517–523

    Article  PubMed  CAS  Google Scholar 

  26. Mandel JS, Church TR, Ederer F, Bond JH (1999) Colorectal cancer mortality: effectiveness of biennial screening for fecal occult blood. J Natl Cancer Inst 91(5):434–437

    Article  PubMed  CAS  Google Scholar 

  27. Newcomb PA, Norfleet RG, Storer BE, Surawicz TS, Marcus PM (1992) Screening sigmoidoscopy and colorectal cancer mortality. Journal of the J Natl Cancer Inst 84(20):1572–1575

    Article  PubMed  CAS  Google Scholar 

  28. Rudy DR, Zdon MJ (2000) Update on colorectal cancer. Am Fam Physician 61(6):1759–1770, 73–74

    Google Scholar 

  29. Selby JV, Friedman GD, Quesenberry CP Jr, Weiss NS (1992) A case-control study of screening sigmoidoscopy and mortality from colorectal cancer. New Engl J Med 326(10):653–657

    Article  PubMed  CAS  Google Scholar 

  30. Souza RF (2001) A molecular rationale for the how, when and why of colorectal cancer screening. Aliment Pharmacol Therap 15(4):451–462

    Article  CAS  Google Scholar 

  31. Theuer CP, Wagner JL, Taylor TH, Brewster WR, Tran D, McLaren CE, et al. (2001) Racial and ethnic colorectal cancer patterns affect the cost-effectiveness of colorectal cancer screening in the United States. Gastroenterology 120(4):848–856

    Article  PubMed  CAS  Google Scholar 

  32. Vernon SW (1997) Participation in colorectal cancer screening: a review. J Natl Cancer Inst 89(19):1406–1422

    Article  PubMed  CAS  Google Scholar 

  33. Vijan S, Hwang EW, Hofer TP, Hayward RA (2001) Which colon cancer screening test? A comparison of costs, effectiveness, and compliance. Am J Med 111(8):593–601

    Article  PubMed  CAS  Google Scholar 

  34. Winawer SJ, Stewart ET, Zauber AG, Bond JH, Ansel H, Waye JD et al (2000) A comparison of colonoscopy and double-contrast barium enema for surveillance after polypectomy. National Polyp Study Work Group. New Engl J Med 342(24):1766–1772

    Article  PubMed  CAS  Google Scholar 

  35. Winawer SJ, Zauber AG, Ho MN, O’Brien MJ, Gottlieb LS, Sternberg SS et al (1993) Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. New Engl J Med 329(27):1977–1981

    Article  PubMed  CAS  Google Scholar 

  36. Etzioni DA, Yano EM, Rubenstein LV, Lee ML, Ko CY, Brook RH et al (2006) Measuring the quality of colorectal cancer screening: the importance of follow-up. Dis Colon Rectum 49(7):1002–1010

    Article  PubMed  Google Scholar 

  37. Ko CW, Sonnenberg A (2005) Comparing risks and benefits of colorectal cancer screening in elderly patients. Gastroenterology 129(4):1163–1170

    Article  PubMed  Google Scholar 

  38. Lai SM, Zhang KB, Uhler RJ, Harrison JN, Clutter GG, Williams MA (2006) Geographic variation in the incidence of colorectal cancer in the United States, 1998–2001. Cancer 107(5 Suppl):1172–1180

    Article  PubMed  Google Scholar 

  39. From the Centers for Disease Control and Prevention (2001) Trends in screening for colorectal cancer–United States, 1997 and 1999. Jama 285(12):1570–1571

    Google Scholar 

  40. Increased use of colorectal cancer tests–United States, 2002 and 2004 (2006) MMWR 55(11):308–311

  41. Claes E, Denayer L, Evers-Kiebooms G, Boogaerts A, Philippe K, Tejpar S et al (2005) Predictive testing for hereditary nonpolyposis colorectal cancer: subjective perception regarding colorectal and endometrial cancer, distress, and health-related behavior at one year post-test. Genet Test 9(1):54–65

    Article  PubMed  Google Scholar 

  42. Clavel-Chapelon F, Joseph R, Goulard H (1999) Surveillance behavior of women with a reported family history of colorectal cancer. Prev Med 28(2):174–178

    Article  PubMed  CAS  Google Scholar 

  43. Collins V, Meiser B, Gaff C, St John DJ, Halliday J (2005) Screening and preventive behaviors one year after predictive genetic testing for hereditary nonpolyposis colorectal carcinoma. Cancer 104(2):273–281

    Article  PubMed  Google Scholar 

  44. Manne S, Markowitz A, Winawer S, Guillem J, Meropol NJ, Haller D et al. (2003) Understanding intention to undergo colonoscopy among intermediate-risk siblings of colorectal cancer patients: a test of a mediational model. Prev Med 36(1):71–84

    Article  PubMed  Google Scholar 

  45. Manne S, Markowitz A, Winawer S, Meropol NJ, Haller D, Rakowski W et al (2002) Correlates of colorectal cancer screening compliance and stage of adoption among siblings of individuals with early onset colorectal cancer. Health Psychol 21(1):3–15

    Article  PubMed  Google Scholar 

  46. Ko CW, Kreuter W, Baldwin LM (2002) Effect of Medicare coverage on use of invasive colorectal cancer screening tests. Arch Intern Med 162(22):2581–2586

    Article  PubMed  Google Scholar 

  47. Colorectal cancer test use among persons aged  >  or =50 years–United States, 2001 (2003) MMWR 52(10):193–196

  48. Breen N, Wagener DK, Brown ML, Davis WW, Ballard-Barbash R (2001) Progress in cancer screening over a decade: results of cancer screening from the 1987, 1992, and 1998 National Health Interview Surveys. J Natl Cancer Inst 93(22):1704–1713

    Article  PubMed  CAS  Google Scholar 

  49. Ahluwalia IB, Mack KA, Murphy W, Mokdad AH, Bales VS (2003) State-specific prevalence of selected chronic disease-related characteristics–Behavioral Risk Factor Surveillance System, 2001. MMWR Surveill Summ 52(8):1–80

    PubMed  Google Scholar 

  50. Nelson DE, Bolen J, Marcus S, Wells HE, Meissner H (2003) Cancer screening estimates for U.S. metropolitan areas. Am J Prev Med 24(4):301–309

    Article  PubMed  Google Scholar 

  51. Trends in screening for colorectal cancer–United States, 1997 and 1999. (2001) MMWR 50(9):162–166

  52. Coughlin SS, Thompson TD (2004) Colorectal cancer screening practices among men and women in rural and nonrural areas of the United States, 1999. J Rural Health Spring 20(2):118–124

    Article  Google Scholar 

  53. Goodman MJ, Ogdie A, Kanamori MJ, Canar J, O’Malley AS (2006) Barriers and facilitators of colorectal cancer screening among Mid-Atlantic Latinos: focus group findings. Ethnic Dis 16(1):255–261

    Google Scholar 

  54. Honda K, Gorin SS (2005) Modeling pathways to affective barriers on colorectal cancer screening among Japanese Americans. J Behav Med 28(2):115–124

    Article  PubMed  Google Scholar 

  55. James TM, Greiner KA, Ellerbeck EF, Feng C, Ahluwalia JS (2006) Disparities in colorectal cancer screening: a guideline-based analysis of adherence. Ethnic Dis 16(1):228–233

    Google Scholar 

  56. Rustgi AK (2004) Breaking the barriers to colorectal cancer screening. Gastroenterology 126(5):1232–1233

    Google Scholar 

  57. Marcus AC, Mason M, Wolfe P, Rimer BK, Lipkus I, Strecher V et al (2005) The efficacy of tailored print materials in promoting colorectal cancer screening: results from a randomized trial involving callers to the National Cancer Institute’s Cancer Information Service. J Health Commun 10(Suppl 1):83–104

    Article  PubMed  Google Scholar 

  58. Ferreira MR, Dolan NC, Fitzgibbon ML, Davis TC, Gorby N, Ladewski L et al (2005) Health care provider-directed intervention to increase colorectal cancer screening among veterans: results of a randomized controlled trial. J Clin Oncol 23(7):1548–1554

    Article  PubMed  Google Scholar 

  59. Gilbert A, Kanarek N (2005) Colorectal cancer screening: physician recommendation is influential advice to Marylanders. Prev Med 41(2):367–379

    Article  PubMed  Google Scholar 

  60. Tessaro I, Mangone C, Parkar I, Pawar V (2006) Knowledge, barriers, and predictors of colorectal cancer screening in an Appalachian church population. Prev Chronic Dis 3(4):A123

    PubMed  Google Scholar 

  61. Rao RS, Graubard BI, Breen N, Gastwirth JL (2004) Understanding the factors underlying disparities in cancer screening rates using the Peters-Belson approach: results from the 1998 National Health Interview Survey. Med Care 42(8):789–800

    Article  PubMed  Google Scholar 

  62. Codori AM, Petersen GM, Miglioretti DL, Boyd P (2001) Health beliefs and endoscopic screening for colorectal cancer: potential for cancer prevention. Prev Med 33(2 Pt 1):128–136

    PubMed  CAS  Google Scholar 

  63. Lieberman D (2005) Race, gender, and colorectal cancer screening. Am J Gastroenterol 100(12):2756–2758

    Article  PubMed  Google Scholar 

  64. Busch S (2003) Elderly African American women’s knowledge and belief about colorectal cancer. Abnf J 14(5):99–103

    PubMed  Google Scholar 

  65. Ioannou GN, Chapko MK, Dominitz JA (2003) Predictors of colorectal cancer screening participation in the United States. Am J Gastroenterol 98(9):2082–2091

    Article  PubMed  Google Scholar 

  66. Fisher DA, Dougherty K, Martin C, Galanko J, Provenzale D, Sandler RS (2004) Race and colorectal cancer screening: a population-based study in North Carolina. North Carolina Med J 65(1):12–15

    Google Scholar 

  67. Honda K (2004) Factors associated with colorectal cancer screening among the US urban Japanese population. Am J Publ Health 94(5):815–822

    Google Scholar 

  68. Sun WY, Basch CE, Wolf RL, Li XJ (2004) Factors associated with colorectal cancer screening among Chinese-Americans. Prev Med 39(2):323–329

    Article  PubMed  Google Scholar 

  69. Walsh JM, Kaplan CP, Nguyen B, Gildengorin G, McPhee SJ, Perez-Stable EJ (2004) Barriers to colorectal cancer screening in Latino and Vietnamese Americans. Compared with non-Latino white Americans. J Gen Intern Med 19(2):156–166

    Article  PubMed  Google Scholar 

  70. Honda K, Kagawa-Singer M (2006) Cognitive mediators linking social support networks to colorectal cancer screening adherence. J Behav Med 29(5):449–460

    Article  PubMed  Google Scholar 

  71. Janz NK, Lakhani I, Vijan S, Hawley ST, Chung LK, Katz SJ (2007) Determinants of colorectal cancer screening use, attempts, and non-use. Prev Med 44:452–458

    Article  PubMed  Google Scholar 

  72. Klabunde CN, Schenck AP, Davis WW (2006) Barriers to colorectal cancer screening among Medicare consumers. Am J Prev Med 30(4):313–319

    Article  PubMed  Google Scholar 

  73. Carlos RC, Underwood W III, Fendrick AM, Bernstein SJ (2005) Behavioral associations between prostate and colon cancer screening. J Am Coll Surg 200(2):216–223

    Article  PubMed  Google Scholar 

  74. Meissner HI, Breen N, Klabunde CN, Vernon SW (2006) Patterns of colorectal cancer screening uptake among men and women in the United States. Cancer Epidemiol Biomarkers Prev 15(2):389–394

    Article  PubMed  Google Scholar 

  75. Pollack LA, Blackman DK, Wilson KM, Seeff LC, Nadel MR (2006) Colorectal cancer test use among Hispanic and non-Hispanic U.S. populations. Prev Chronic Dis 3(2):A50

    PubMed  Google Scholar 

  76. Sirovich BE, Schwartz LM, Woloshin S (2003) Screening men for prostate and colorectal cancer in the United States: does practice reflect the evidence? Jama 289(11):1414–1420

    Article  PubMed  Google Scholar 

  77. Carlos RC, Fendrick AM, Abrahamse PH, Dong Q, Patterson SK, Bernstein SJ (2005) Colorectal cancer screening behavior in women attending screening mammography: longitudinal trends and predictors. Women Health Issue 15(6):249–257

    Article  Google Scholar 

  78. Molina L, Carlos RC, Mark Fendrick A, Abrahamse PH, Dong Q, Bernstein SJ (2004) Completion of colorectal cancer screening in women attending screening mammography. Acad Radiol 11(11):1237–1241

    Article  PubMed  Google Scholar 

  79. Lemon S, Zapka J, Puleo E, Luckmann R, Chasan-Taber L (2001) Colorectal cancer screening participation: comparisons with mammography and prostate-specific antigen screening. Am J Publ Health 91(8):1264–1272

    CAS  Google Scholar 

  80. Tang TS, Solomon LJ, McCracken LM (2001) Barriers to fecal occult blood testing and sigmoidoscopy among older Chinese-American women. Cancer Pract 9(6):277–282

    Article  PubMed  CAS  Google Scholar 

  81. Yip MP, Tu SP, Chun A, Yasui Y, Taylor VM (2006) Participation in colorectal cancer screening among Chinese Americans. Asian Pac J Cancer Prev 7(4):645–650

    PubMed  Google Scholar 

  82. Hay JL, Ford JS, Klein D, Primavera LH, Buckley TR, Stein TR et al (2003) Adherence to colorectal cancer screening in mammography-adherent older women. J Behav Med 26(6):553–576

    Article  PubMed  Google Scholar 

  83. Lafata JE, Divine G, Moon C, Williams LK (2006) Patient–physician colorectal cancer screening discussions and screening use. Am J Prev Med 31(3):202–209

    Article  PubMed  Google Scholar 

  84. Shah M, Zhu K, Potter J (2006) Hispanic acculturation and utilization of colorectal cancer screening in the United States. Cancer Detect Prev 30(3):306–312

    Article  PubMed  Google Scholar 

  85. Thompson B, Coronado G, Neuhouser M, Chen L (2005) Colorectal carcinoma screening among Hispanics and non-Hispanic whites in a rural setting. Cancer 103(12):2491–2498

    Article  PubMed  Google Scholar 

  86. Brouse CH, Basch CE, Wolf RL, Shmukler C (2004) Barriers to colorectal cancer screening: an educational diagnosis. J Cancer Educ 19(3):170–173

    Article  PubMed  Google Scholar 

  87. Farraye FA, Wong M, Hurwitz S, Puleo E, Emmons K, Wallace MB et al (2004) Barriers to endoscopic colorectal cancer screening: are women different from men? Am J Gastroenterol 99(2):341–349

    Article  PubMed  Google Scholar 

  88. Dulai GS, Farmer MM, Ganz PA, Bernaards CA, Qi K, Dietrich AJ, et al. (2004) Primary care provider perceptions of barriers to and facilitators of colorectal cancer screening in a managed care setting. Cancer 100(9):1843–1852

    Article  PubMed  Google Scholar 

  89. Klabunde CN, Vernon SW, Nadel MR, Breen N, Seeff LC, Brown ML (2005) Barriers to colorectal cancer screening: a comparison of reports from primary care physicians and average-risk adults. Med Care 43(9):939–944

    Article  PubMed  Google Scholar 

  90. Brouse CH, Basch CE, Wolf RL, Shmukler C, Neugut AI, Shea S (2003) Barriers to colorectal cancer screening with fecal occult blood testing in a predominantly minority urban population: a qualitative study. Am J Publ Health 93(8):1268–1271

    Article  Google Scholar 

  91. Farraye FA, Horton K, Hersey H, Trnka Y, Heeren T, Provenzale D (2004) Screening flexible sigmoidoscopy using an upper endoscope is better tolerated by women. Am J Gastroenterol 99(6):1074–1080

    Article  PubMed  Google Scholar 

  92. Janz NK, Champion VL, Strecher VJ (2002) The health belief model. In: Glanz K, Rimer BK, Lewis FM (eds) Health behavior and health education, 3rd edn. John Wiley & Sons Inc, San Francisco

  93. Prochaska JO, DiClemente CC (1983) Stages and processes of self-change of smoking: toward an integrative model of change. J Consult Clin Psychol 51(3):390–395

    Article  PubMed  CAS  Google Scholar 

  94. Prochaska JO, Redding CA, Evers K (2002) The Transtheoretical model and stages of change. In: Glanz K, Rimer BK, Lewis FM (eds) Health behavior and health education—theory, research and practice. 3rd edn. John Wiley & Sons Inc, San Francisco

  95. Myers RE, Ross E, Jepson C, Wolf T, Balshem A, Millner L et al (1994) Modeling adherence to colorectal cancer screening. Prev Med 23(2):142–151

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The authors would like to acknowledge the Hardin Library for Health Sciences at the University of Iowa and the Welch Library at Johns Hopkins Medical Institutions for providing the needed references and sources. Conflict of Interest: None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to May A. Beydoun.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Beydoun, H.A., Beydoun, M.A. Predictors of colorectal cancer screening behaviors among average-risk older adults in the United States. Cancer Causes Control 19, 339–359 (2008). https://doi.org/10.1007/s10552-007-9100-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10552-007-9100-y

Key words

Navigation