title: Validity of four self-reported colorectal cancer screening modalities in a general population: differences over time and by intervention assignment.
abstract: Little is known about the validity of self-reported colorectal cancer screening. To date, few published studies have validated all four screening modalities per recommended guidelines or included a general population-based sample, and none has assessed validity over time and by intervention condition. To estimate the validity of self-reported screening, a random sample of 200 adults, ages > or =50 years, was selected from those completing annual surveys on screening behavior as part of an intervention study. Approximately 60% of the validation sample authorized medical record review. Sensitivity, specificity, and positive and negative predictive values were calculated for baseline and year 1 follow-up reports for each test and for overall screening adherence. Sensitivity at baseline ranged from 86.9% (flexible sigmoidoscopy) to 100% (colonoscopy). Sensitivity at follow-up was slightly lower. Adjusting for validity measures, the sample overreported screening prevalence at baseline for each of the four modalities. At follow-up, overreporting was greatest for fecal occult blood test (13.0%). Overreporting across intervention conditions was highest for fecal occult blood test (10.8% for control; 24.8% for the most intense intervention) and overall screening adherence (10.9% for control; 14.3% for the most intense intervention). Sensitivity and specificity of self-reported colorectal cancer screening compared with medical records were high; however, adjusting self-reported screening rates based on relative error rates reduced screening prevalence estimates. Those exposed to more intense interventions to modify screening behavior seemed more likely to overestimate their screening rates compared with those who were not exposed.
authors.affiliation: Department of Epidemiology and Community Health, School of Medicine, Virginia Commonwealth University, Richmond, VA 23298, USA. rmjones2@vcu.edu
authors.forename: Resa M
authors.initials: RM
authors.lastname: Jones
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Mongin
authors.forename: DeAnn
authors.initials: D
authors.lastname: Lazovich
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Church
authors.forename: Mark W
authors.initials: MW
authors.lastname: Yeazel
mesh_terms: D000368:Aged; D001466:Barium Sulfate; D003113:Colonoscopy / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D004733:Enema / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000706:statistics & numerical data*; D008499:Medical Records; D008875:Middle Aged; D008910:Minnesota; D009780:Occult Blood; D010349:Patient Compliance; D015203:Reproducibility of Results; D012812:Sigmoidoscopy / Q000706:statistics & numerical data*
chemical_list: D001466:Barium Sulfate