title: Colonoscopy screening among US adults aged 40 or older with a family history of colorectal cancer.
abstract: BACKGROUND
  Colonoscopy screening reduces colorectal cancer (CRC) incidence and mortality. CRC screening is recommended at age 50 for average-risk people. Screening of first-degree relatives of CRC patients is recommended to begin at age 40 or 10 years before the age at diagnosis of the youngest relative diagnosed with CRC. CRC incidence has increased recently among younger Americans while it has declined among older Americans. The objective of this study was to determine whether first-degree relatives of CRC patients are being screened according to recommended guidelines.
  
  
  METHODS
  We studied colonoscopy screening rates among the US population reporting a CRC family history using 2005 and 2010 National Health Interview Survey data.
  
  
  RESULTS
  Of 26,064 study-eligible respondents, 2,470 reported a CRC family history; of those with a family history, 45.6% had a colonoscopy (25.2% in 2005 and 65.8% 2010). The colonoscopy rate among first-degree relatives aged 40 to 49 in 2010 (38.3%) was about half that of first-degree relatives aged 50 or older (69.7%). First-degree relatives were nearly twice as likely as nonfirst-degree relatives to have a colonoscopy (adjusted odds ratio [AOR], 1.7; 95% confidence interval, 1.5-1.9), but those aged 40 to 49 were less likely to have a colonoscopy than those in older age groups (AOR, 2.6 for age 50-64; AOR, 3.6 for age ≥65). Interactions with age, insurance, and race/ethnicity were not significant. Having health insurance tripled the likelihood of screening.
  
  
  CONCLUSIONS
  Despite a 5-fold increase in colonoscopy screening rates since 2005, rates among first-degree relatives younger than the conventional screening age have lagged. Screening promotion targeted to this group may halt the recent rising trend of CRC among younger Americans.
authors.affiliation: University of South Carolina, Columbia, South Carolina.
authors.forename: Meng-Han
authors.initials: MH
authors.lastname: Tsai
authors.affiliation: Department of Health Services Policy and Management, University of South Carolina, Arnold School of Public Health, 915 Greene St, Room 352, Columbia, SC 29208. Email: sxirasagar@sc.edu.
authors.forename: Sudha
authors.initials: S
authors.lastname: Xirasagar
authors.affiliation: University of South Carolina, Columbia, South Carolina.
authors.forename: Yi-Jhen
authors.initials: YJ
authors.lastname: Li
authors.affiliation: Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Piet C
authors.initials: PC
authors.lastname: de Groen
mesh_terms: D000328:Adult; D000368:Aged; D003113:Colonoscopy / Q000523:psychology* / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000235:genetics*; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005006:Ethnicity / Q000523:psychology / Q000706:statistics & numerical data; D005191:Family Characteristics; D005260:Female; D006306:Health Surveys; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D008297:Male; D008403:Mass Screening / Q000523:psychology* / Q000706:statistics & numerical data; D008875:Middle Aged; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology