Adherence with colorectal cancer screening guidelines: a review

Objective. To review screening rates and factors impacting patient utilization of colorectal cancer screening tests. Methods. We searched Medline, CancerLit, and PsycInfo for articles on colorectal cancer screening adherence. US studies on average-risk individuals were reviewed to identify: (1) utilization/adherence rates, (2) predictors of patient adherence, (3) correlation between long-term adherence and type of test selected, (4) predictors of physician recommendation of screening tests, and (5) patterns in the type of test recommended by physicians. Results. In 2000, only 34% of the US population obtained screening within recommended time frames (fecal occult blood test annually, flexible sigmoidoscopy every 5 years, or colonoscopy every 10 years). Positive attitude toward screening and physician recommendation result in high adherence while fear of finding cancer and the belief that cancer is fatal result in low adherence. Physician specialty impacts the type of test recommended, while perceived lack of patient adherence is not a consistent barrier to recommending screening tests. Matching individuals with their choice of screening test and newer technology, such as virtual colonoscopy, may help increase adherence. Conclusion. Additional studies are required on differences in adherence between tests, whether patient preferences impact adherence, and how the physician-patient relationship can be fostered to increase adherence. (C) 2004 The Institute For Cancer Prevention and Elsevier Inc. All rights reserved.