Barriers to colorectal cancer screening: a comparison of reports from primary care physicians and average-risk adults.
BACKGROUND
Barriers to colorectal cancer (CRC) screening are not well understood.


OBJECTIVE
We sought to compare barriers to CRC screening reported by primary care physicians (PCPs) and by average-risk adults, and to examine characteristics of average-risk adults who identified lack of provider recommendation as a major barrier to CRC screening.


METHODS
This was a comparative study using data from the 1999-2000 Survey of Colorectal Cancer Screening Practices and the 2000 National Health Interview Survey (NHIS).


METHODS
We recruited nationally representative samples of PCPs (n= 1235) from the SCCSP and average-risk adults (n = 6497) from the NHIS.


METHODS
We measured barriers to CRC screening identified by PCPs and average-risk adults who were not current with screening.


RESULTS
Both PCPs and average-risk adults identified lack of patient awareness and physician recommendation as key barriers to obtaining CRC screening. PCPs also frequently cited patient embarrassment/anxiety about testing and test cost/lack of insurance coverage, but few adults identified these as major barriers. Of adults not current with testing, those who had visited a doctor in the past year or had health insurance were more likely to report lack of physician recommendation as the main reason they were not up-to-date compared with their counterparts with no doctor visit or health insurance. Only 10% of adults not current with testing and who had a doctor visit in the past year reported receiving a screening recommendation.


CONCLUSIONS
A need exists for continued efforts to educate the public about CRC and the important role of screening in preventing this disease. Practice-based strategies to systematically prompt health care providers to discuss CRC screening with eligible patients also are required.
Klabunde
Carrie N
CN
Health Services and Economics Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland 20892-7344, USA. ck97b@nih.gov
Vernon
Sally W
SW
Nadel
Marion R
MR
Breen
Nancy
N
Seeff
Laura C
LC
Brown
Martin L
ML
D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000517:prevention & control*; D003144:Communication Barriers; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006266:Health Education / Q000592:standards; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000592:standards*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology