Screening Recommendation Adherence Among First-Degree Relatives of People With Colorectal Cancer

Purpose: To determine what factors are associated with colorectal cancer (CRC) screening adherence among first-degree relatives (FDRs) of people with CRC.Methods: The study used data from the 2015 National Health Interview Survey, a nationally representative survey in the US. Self-reported CRC screening rates were compared between FDRs and their peers without a family history of CRC. Participants were considered to be adherent if they had undergone any of the following: fecal immonchemical test within the prior 1 year, sigmoidscopy or computed tomography colongraphy within 5 years, or colonoscopy within 10 years. Multivariable models of CRC screening adherence were created for both cohorts and the results compared. Results: The analysis included 11,381 people age 50-75 at time of survey. Overall, 62% of participants were adherent to screening recommendations. FDR of people with CRC were more likely to be adherent (76% compared to 61%, p < 0.001). In the multivariable models, a FDR with CRC was associated with an 86% increase in odds of being adherent to recommendations (aOR 1.86; 95% CI 1.59-2.59). Race, ethnicity, and socioeconomic variables were all associated with adherence. Models were largely similar between FDRs of people with CRC and the general public. Conclusions: Approximately one-quarter of FDRs of people with CRC are not adherent to screening recommendations. Further outreach is needed for members of minority races and the Hispanic community and additional efforts are needed to increase the accessibility of CRC screening for those with more limited finances and the uninsured.

Factors Associated with Breast Cancer Screening Adherence among Church-Going African American Women

Relative to White women, African American/Black women are at an increased risk of breast cancer mortality. Early detection of breast cancer through mammography screening can mitigate mortality risks; however, screening rates are not ideal. Consequently, there is a need to better understand factors associated with adherence to breast cancer screening guidelines to inform interventions to increase mammography use, particularly for groups at elevated mortality risk. This study used the Andersen Behavioral Model of Health Services Use to examine factors associated with adherence to National Comprehensive Cancer Network breast cancer screening guidelines amongst 919 African American, church-going women from Houston, Texas. Logistic regression analyses measured associations between breast cancer screening adherence over the preceding 12 months (adherent or non-adherent) and predisposing (i.e., age, education, and partner status), enabling (i.e., health insurance status, annual household income, employment status, patient-provider communication, and social support), and need (i.e., personal diagnosis of cancer, family history of cancer, and risk perception) factors, separately and conjointly. Older age (predisposing: OR = 1.015 (1.007–1.023)), having health insurance and ideal patient–provider communication (enabling: OR = 2.388 (1.597–3.570) and OR = 1.485 (1.080–2.041)), and having a personal diagnosis of cancer (need: OR = 2.244 (1.058–4.758)) were each associated with greater odds of screening adherence. Only having health insurance and ideal patient-provider communication remained significantly associated with screening adherence in a conjoint model; cancer survivorship did not moderate associations between predisposing/enabling factors and screening adherence. Overall, results suggest that interventions which are designed to improve mammography screening rates amongst African American women might focus on broadening health insurance coverage and working to improve patient–provider communication. Implications for multi-level intervention approaches, including the role of churches in their dissemination, are proposed.