Background: Even though colorectal cancer (CRC) screening tests for persons 50 years of age or over are recommended to reduce colorectal cancer mortality, screening rates remain disturbingly low.
Methods: Using random digit dialing, 355 telephone interviews were conducted with black and white men and women, 50-79 years of age, who resided in Genesee County, Michigan. The Health Belief Model provided the framework to assess attitudes and practices regarding CRC screening.
Results: For both endoscopic procedures, significantly higher percentages of whites than blacks were aware of the screening procedure (P < 0.05). Overall, fewer than 30% of respondents were adherent to current CRC screening guidelines. Adherence was lowest for black females: 21% for fecal occult blood test, 20% for flexible sigmoidoscopy, and 12% for colonoscopy. Black males compared to black females were about 2.8 times more likely to have had either flexible sigmoidoscopy or colonoscopy (P < 0.05). Physician recommendation was a powerful motivator to screening. Two consistent barriers to screening were the belief that: (a) the test is not needed; and (b) the test is embarrassing.
Conclusions: Interventions directed at physicians and patients are essential to enhance CRC screening rates. CRC survival rates may be improved by physician-guided promotion of screening that focuses on identified barriers.