Research article

Adherence to colorectal cancer screening guidelines in Canada

Maida J Sewitch¹ , Caroline Fournier² , Antonio Ciampi³ and Alina Dyachenko⁴

¹Department of Medicine, McGill University, Montreal, Canada

²Division of Clinical Epidemiology, Research Institute of the McGill University Health Center, Montreal, Canada

³Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada

⁴Department of Epidemiology and Community Studies, St. Mary's Hospital Center, Montreal, Canada

author email corresponding author email

BMC Gastroenterology 2007, 7:39doi:10.1186/1471-230X-7-39

Published:	2 October 2007

Abstract

Background

To identify correlates of adherence to colorectal cancer (CRC) screening guidelines in average-risk Canadians.

Methods

2003 Canadian Community Health Survey Cycle 2.1 respondents who were at least 50 years old, without past or present CRC and living in Ontario, Newfoundland, Saskatchewan, and British Columbia were included. Outcomes, defined according to current CRC screening guidelines, included adherence to: i) fecal occult blood test (FOBT) (in prior 2 years), ii) endoscopy (colonoscopy/sigmoidoscopy) (prior 10 years), and iii) adherence to CRC screening guidelines, defined as either (i) or (ii). Generalized estimating equations regression was employed to identify correlates of the study outcomes.

Results

Of the 17,498 respondents, 70% were non-adherent CRC screening to guidelines. Specifically, 85% and 79% were non-adherent to FOBT and endoscopy, respectively. Correlates for all outcomes were: having a regular physician (OR = (i) 2.68; (ii) 1.91; (iii) 2.39), getting a flu shot (OR = (i) 1.59; (ii) 1.51; (iii) 1.55), and having a chronic condition (OR = (i) 1.32; (ii) 1.48; (iii) 1.43). Greater physical activity, higher consumption of fruits and vegetables and smoking cessation were each associated with at least 1 outcome. Self-perceived stress was modestly associated with increased odds of adherence to endoscopy and to CRC screening guidelines (OR = (ii) 1.07; (iii) 1.06, respectively).

Conclusion

Healthy lifestyle behaviors and factors that motivate people to seek health care were associated with adherence, implying that invitations for CRC screening should come from sources that are independent of physicians, such as the government, in order to reduce disparities in CRC screening.