title: Screening behavior of individuals at high risk for colorectal cancer.
abstract: OBJECTIVE
  Periodic colonoscopy is an effective means of reducing the incidence and mortality of colorectal cancer in individuals with a family history of the disease. The aims of this study were to determine the degree of compliance and to identify the factors related significantly to noncompliance with periodic screening in this high-risk population.
  
  
  METHODS
  A total of 178 individuals who had undergone genetic counseling for colorectal cancer between 1986 and 1998 and who had been advised to undergo periodic screening because of familial colorectal cancer (FCRC) or hereditary nonpolyposis colorectal cancer (HNPCC) were invited to complete a self-report questionnaire on psychosocial issues and screening experiences. Compliance data were derived from medical records and via self-report.
  
  
  RESULTS
  A total of 149 individuals (84%) participated in the study. Noncompliance with screening advice was rare (in 3% of cases), but significant delays (more than 1 year) in undergoing screening were observed in approximately 25% of the cases. The number of perceived barriers to screening (eg, discomfort, embarrassment) was the only variable related significantly to noncompliance/screening delay (odds ratio, 1.2; 95% confidence interval, 1.1-1.3). Use of sedatives during the procedure and receipt of a reminder letter seemed to facilitate better compliance.
  
  
  CONCLUSIONS
  Although few high-risk individuals abstain from screening entirely, approximately one in 4 deviates significantly from the recommended frequency of screening. Increased compliance may be achieved by reducing the discomfort and embarrassment associated with the procedure and by the use of reminder letters.
authors.affiliation: Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute - Antoni van Leewenhoek Hospital, Amsterdam, The Netherlands. e.bleiker@nkl.nl
authors.forename: Eveline M A
authors.initials: EM
authors.lastname: Bleiker
authors.forename: Fred H
authors.initials: FH
authors.lastname: Menko
authors.forename: Babs G
authors.initials: BG
authors.lastname: Taal
authors.forename: Irma
authors.initials: I
authors.lastname: Kluijt
authors.forename: Lidwina D V
authors.initials: LD
authors.lastname: Wever
authors.forename: Miranda A
authors.initials: MA
authors.lastname: Gerritsma
authors.forename: Hans F A
authors.initials: HF
authors.lastname: Vasen
authors.forename: Neil K
authors.initials: NK
authors.lastname: Aaronson
mesh_terms: D000328:Adult; D003113:Colonoscopy / Q000523:psychology*; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000235:genetics / Q000517:prevention & control*; D003710:Demography; D004522:Educational Status; D005260:Female; D005817:Genetic Counseling; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000523:psychology*; D010349:Patient Compliance; D016312:Treatment Refusal