Background: Although recent screening guidelines recommend annual fecal occ
ult blood testing (FOBT) for adults aged greater than or equal to 50, a num
ber of studies report that these tests are underused. Systematic efforts to
increase awareness of colorectal cancer (CRC) and to promote screening par
ticipation are needed to meet national objectives for CRC control.
Methods: This study examined CRC-screening practices and evaluated factors
related to recent participation in screening by FOBT in a sample of women a
ged 50 to 80 who were surveyed about their use of clinical preventive servi
ces at Group Health Cooperative, a managed care organization in western Was
Results: Of the 931 women eligible for analysis, 75% reported ever having b
een screened by FOBT and 48% reported having been screened within 2 years b
efore the survey. Participation in screening did not vary by demographic ch
aracteristics or by perceived or actual risk of CRC. Women with a positive
attitudes toward CRC screening had sevenfold greater odds of recent screeni
ng by FOBT (odds ratio=7.1; 95% confidence interval, 4.4 to 11.6). Only 58%
of study women reported that their physicians encouraged CRC screening, bu
t this factor was strongly related to participation (odds ratio=12.7; 95% c
onfidence interval, 6.6 to 24.4).
Conclusions: We identified several areas in which understanding of CRC risk
may be low. As a whole, these findings suggest that effective strategies t
o control CRC may include efforts to improve knowledge of risk and preventi
on, but must also appeal directly to primary care physicians to identify an
d address their barriers to screening recommendations.