title: Factors associated with colon cancer screening: the role of patient factors and physician counseling.
abstract: BACKGROUND
  The prevalence of colon cancer screening is nationally low. The relative contribution of patient factors and physician counseling patterns to the low prevalence of screening is unclear.
  
  
  METHODS
  We used multivariable analysis to examine the prevalence of colon cancer screening nationally and the reasons for this low prevalence using data from the 2000 National Health Interview Survey, a nationally generalizable survey of US households.
  
  
  RESULTS
  Among 11,427 respondents to the Cancer Control Supplement, 16% reported annual fecal occult blood testing (FOBT) and 29% reported having undergone a sigmoidoscopy in the last 5 years or a colonoscopy in the last 10 years. After adjusting for age, sex, body mass index (BMI), healthcare access, and region of the country, Hispanics were less likely to undergo FOBT [OR 0.7 (95% CI 0.6-0.9)] and sigmoidoscopy or colonoscopy [OR 0.8 (95% CI 0.7-0.9)] compared to Whites. Respondents with lower education levels were also less likely to undergo screening. These factors were not associated with being less adherent to physician recommendations for screening. Nevertheless, non-Whites and those less educated were less likely to receive counseling from their health provider about colon cancer screening. Among respondents who did not undergo FOBT, 64% were unaware they needed the test; only 2% cited pain and discomfort as a deterrent, but 94% were not counseled by their physician about the test. Among those who did not undergo sigmoidoscopy or colonoscopy, 72% were unaware that they needed the test and only 1% was deterred by pain and discomfort; 92% were not counseled by their physician.
  
  
  CONCLUSIONS
  The low prevalence of screening for colorectal cancer appears to be due to lack of awareness and inadequate provider counseling rather than poor patient acceptance for screening. Systematic counseling about colorectal cancer screening will likely improve screening rates and reduce disparities by race/ethnicity and education.
authors.affiliation: Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Rose 115, Boston, MA 02215, USA. cweekuo@bidmc.harvard.edu
authors.forename: Christina C
authors.initials: CC
authors.lastname: Wee
authors.forename: Ellen P
authors.initials: EP
authors.lastname: McCarthy
authors.forename: Russell S
authors.initials: RS
authors.lastname: Phillips
mesh_terms: D017677:Age Distribution; D000368:Aged; D001294:Attitude to Health / Q000208:ethnology*; D015331:Cohort Studies; D003110:Colonic Neoplasms / Q000453:epidemiology* / Q000517:prevention & control; D003113:Colonoscopy / Q000706:statistics & numerical data; D037001:Directive Counseling / Q000592:standards* / Q000639:trends; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D015999:Multivariate Analysis; D009780:Occult Blood; D010358:Patient Participation; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D012307:Risk Factors; D017678:Sex Distribution; D012812:Sigmoidoscopy / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology