Barriers to colorectal cancer screening: a case-control study.
OBJECTIVE
To investigate barriers to colorectal cancer (CRC) screening in a community population.


METHODS
We conducted a community-based case-control study in an urban Chinese population by questionnaire. Cases were selected from those completing both a fecal occult blood test (FOBT) case and colonoscopy in a CRC screening program in 2004. Control groups were matched by gender, age group and community. Control 1 included those having a positive FOBT but refusing a colonoscopy. Control 2 included those who refused both an FOBT and colonoscopy.


RESULTS
The impact of occupation on willingness to attend a colorectal screening program differed by gender. P for heterogeneity was 0.009 for case vs control group 1, 0.01 for case versus control group 2, and 0.80 for control group 1 vs 2. Poor awareness of CRC and its screening program, characteristics of screening tests, and lack of time affected the screening rate. Financial support, fear of pain and bowel preparation were barriers to a colonoscopy as a screening test. Eighty-two percent of control group 1 and 87.1% of control group 2 were willing attend if the colonoscopy was free, but only 56.3% and 53.1%, respectively, if it was self-paid. Multivariate odds ratios for case vs control group 1 were 0.10 among those unwilling to attend a free colonoscopy and 0.50 among those unwilling to attend a self-paid colonoscopy.


CONCLUSIONS
Raising the public awareness of CRC and its screening, integrating CRC screening into the health care system, and using a painless colonoscopy would increase its screening rate.
Cai
Shan-Rong
SR
Cancer Institute, Zhejiang University, Hangzhou, Zhejiang Province, China.
Zhang
Su-Zhan
SZ
Zhu
Hong-Hong
HH
Zheng
Shu
S
D000328:Adult; D000368:Aged; D001294:Attitude to Health; D016022:Case-Control Studies; D003113:Colonoscopy / Q000191:economics / Q000523:psychology; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000453:epidemiology; D055088:Early Detection of Cancer; D005260:Female; D006266:Health Education; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009780:Occult Blood; D010353:Patient Education as Topic