Treatment options and racial/ethnic backgrounds can determine the likelihood of patients’ adherence to recommendations for colorectal cancer screening, according to recent results.
Researchers randomly placed 997 participants into groups receiving recommendations for either fecal occult blood testing (FOBT), colonoscopy, or a choice between the two tests. All patients had an average risk of developing colorectal cancer. Completion of screening within 12 months of enrollment was the primary outcome; investigators also analyzed whether demographics could be associated with completion of the tests.
Across all three groups, 58% completed the screening process. Within the group offered both screening options, 38% of participants completed FOBT and 31% had colonoscopies performed. The group only offered colonoscopy was significantly less likely to undergo testing than both the FOBT group (38% vs. 67%, P<.001) and the group offered a choice between the two (vs. 69%, P<.001).
Investigators found that African-American patients were less likely to complete screening (48.0%) while Asians and Latinos had the highest completion rates (60.7% and 62.9%, respectively). White patients were more likely to undergo colonoscopy than nonwhite patients when given a choice between treatments (OR=3.2, 95% CI, 1.7-6.1), and less likely to undergo FOBT (OR=0.3, 95% CI, 0.1-0.6). In the group that only received FOBT recommendation, Asians (OR=2.6, 95% CI, 1.2-5.3) and Latinos (OR=2.1, 95% CI, 1.0-4.2) were both more likely to complete screening than white participants.
Other factors associated with adherence to screening included advanced age, possession of health insurance and language preference. Participants whose interviews were conducted in Spanish or Cantonese or Mandarin were more likely to complete screening than patients of the same ethnicity interviewed in English.
“This study found that limiting the recommendation for CRC screening to colonoscopy can result in a lower completion rate for CRC screening,” the researchers wrote. “Furthermore, we found significant differences in adherence to competing CRC screening tests between racial/ethnic groups … Further research will determine whether these single-point observations can be translated to programmatic adherence and whether shared decision-making or decision aids may increase screening completion.”