Open Access Research article

Individual- and provider-level factors associated with colorectal cancer screening in accordance with guideline recommendation: a community-level perspective across varying levels of risk

Ryan J Courtney145*, Christine L Paul14, Robert W Sanson-Fisher14, Finlay A Macrae2, Mariko L Carey14, John Attia34 and Mark McEvoy34

Author Affiliations

1 The Priority Research Centre for Health Behaviour,School of Medicine and Public Health, Faculty of Health, The University of Newcastle, Callaghan, Australia

2 Department of Colorectal Medicine and Genetics, The Royal Melbourne Hospital, Melbourne, Australia

3 The Centre for Clinical Epidemiology and Biostatistics, Faculty of Health, The University of Newcastle, Newcastle, Australia

4 Hunter Medical Research Institute, New Lambton, NSW, 2305, Australia

5 University of New South Wales, National Drug & Alcohol Research Centre, Sydney, NSW, 2052, Australia

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BMC Public Health 2013, 13:248  doi:10.1186/1471-2458-13-248

Published: 20 March 2013

Abstract

Background

Participation rates in colorectal cancer screening (CRC) are low. Relatively little is known about screening uptake across varying levels of risk and across population groups. The purpose of the current study was to identify factors associated with (i) ever receiving colorectal cancer (CRC) testing; (ii) risk-appropriate CRC screening in accordance with guidelines; and (iii) recent colonoscopy screening.

Methods

1592 at-risk persons (aged 56–88 years) were randomly selected from the Hunter Community Study (HCS), Australia. Participants self-reported family history of CRC was used to quantify risk in accordance with national screening guidelines.

Results

1117 participants returned a questionnaire; 760 respondents were eligible for screening and analysis. Ever receiving CRC testing was significantly more likely for persons: aged 65–74 years; who had discussed with a doctor their family history of CRC or had ever received screening advice. For respondents “at or slightly above average risk”, guideline-appropriate screening was significantly more likely for persons: aged 65–74 years; with higher household income; and who had ever received screening advice. For respondents at “moderately or potentially high risk”, guideline-appropriate screening was significantly more likely for persons: with private health insurance and who had discussed their family history of CRC with a doctor. Colonoscopy screening was significantly more likely for persons: who had ever smoked; discussed their family history of CRC with a doctor; or had ever received screening advice.

Conclusions

The level of risk-appropriate screening varied across populations groups. Interventions that target population groups less likely to engage in CRC screening are pivotal for decreasing screening inequalities.