title: Barriers to colorectal cancer screening: a case-control study.
abstract: 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.
authors.affiliation: Cancer Institute, Zhejiang University, Hangzhou, Zhejiang Province, China.
authors.forename: Shan-Rong
authors.initials: SR
authors.lastname: Cai
authors.forename: Su-Zhan
authors.initials: SZ
authors.lastname: Zhang
authors.forename: Hong-Hong
authors.initials: HH
authors.lastname: Zhu
authors.forename: Shu
authors.initials: S
authors.lastname: Zheng
mesh_terms: 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