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Colorectal Cancer Screening: Consider Patient Preferences

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(ChemotherapyAdvisor) – Universally recommending colonoscopy may actually reduce adherence to colorectal cancer (CRC) screening, especially among racial and ethnic minorities, according to a study in the April 9 issue of Archives of Internal Medicine.

Investigators found that when colonoscopy was recommended, patients were less likely to complete CRC screening than either those for whom fecal occult blood testing (FOBT) was recommended or when a choice between FOBT or colonoscopy was offered. “These results suggest that patient preferences should be considered when making CRC screening recommendations,” they wrote.

They randomized 997 racially and ethnically diverse participants in the San Francisco Community Health Network to recommendation for screening by FOBT, colonoscopy, or their choice of FOBT or colonoscopy. Primary outcome was completion of CRC screening within 12 months after enrollment, defined as performance of colonoscopy, or three FOBT cards plus colonoscopy for any positive FOBT result. Mean age was 58.4 years and 53% were women.

Within 12 months of enrollment, 58% of participants had completed the CRC screening strategy they were assigned or chose. However, a significantly lower proportion of participants in the colonoscopy group completed that procedure (38.2%); in comparison, 67.2% (P<0.001) completed FOBT screening and 68.8% (P<0.001) selected one of the two options.

Whites more often completed colonoscopy and nonwhites, FOBT, they found. African-Americans had the lowest CRC screening completion rate, 48%, while Asians (60.7%) and Latinos (62.9%) had the highest rates. Some of the differences appeared to be driven by language preference. Participants who preferred to speak Spanish, Cantonese, or Mandarin during their interviews were “significantly more likely” to adhere to CRC screening than participants of the same racial/ethnic groups who preferred to speak English.

An invited commentary noted that a “preferred” CRC screening test should include both the physician's and the patient's perspective. “This study also shows that well-informed primary care providers, focused on CRC screening, can have a meaningful impact on their patients' adherence with screening. When it comes to CRC screening, providing an option other than colonoscopy for our patients is not overwhelming, but necessary.”

This work was supported by grants from the National Cancer, the National Institutes of Diabetes and Digestive and Kidney Diseases, and the National Center for Research Resources.

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