Colorectal cancer screening among primary care patients: does risk affect screening behavior?

J Community Health. 2011 Aug;36(4):605-11. doi: 10.1007/s10900-010-9348-0.


Lifestyle factors including smoking, obesity, and diabetes can increase colorectal cancer (CRC) risk. Controversy exists regarding screening rates in individuals at increased CRC risk. To examine the effect of risk on CRC screening in primary care, cross-sectional data collected during January 2006-July 2007 from 720 participants in 24 New Jersey primary care practices were analyzed. Participants were stratified by risk: high (personal/family history of CRC, history of polyps, inflammatory bowel disease), increased (obesity, Type II diabetes, current/former smokers), and average. Outcomes were up-to-date with CRC screening, receiving a physician recommendation for screening, and recommendation adherence. Chi-square and generalized linear modeling were used to determine the effect of independent variables on risk group and risk group on outcomes. Thirty-seven percent of participants were high-risk, 46% increased-risk, and 17% average-risk. Age, race, insurance, education, and health status were related to risk. High-risk participants had increased odds of being up-to-date with screening (OR 3.14 95% CI 1.85-5.32) and adhering to physician recommendation (OR 7.18 95% CI 3.58-14.4) compared to average-risk. Increased-risk participants had 32% decreased odds of screening (OR 0.68, 95% CI 0.42-1.08). Low screening rates among increased-risk individuals highlight the need for screening interventions targeting these patients.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Alcohol Drinking / epidemiology
  • Attitude to Health*
  • Colonic Polyps / epidemiology
  • Colonic Polyps / prevention & control
  • Colorectal Neoplasms / diagnosis
  • Colorectal Neoplasms / epidemiology*
  • Colorectal Neoplasms / prevention & control*
  • Confidence Intervals
  • Cross-Sectional Studies
  • Diagnostic Tests, Routine / psychology
  • Diagnostic Tests, Routine / statistics & numerical data*
  • Female
  • Health Services Needs and Demand / statistics & numerical data*
  • Health Status
  • Humans
  • Male
  • Mass Screening / statistics & numerical data
  • Middle Aged
  • New Jersey
  • Odds Ratio
  • Primary Health Care / organization & administration
  • Smoking / epidemiology
  • Socioeconomic Factors