ABSTRACT
The most signific;:ml: risk of flexible sigmoidoscopy, provider awareness11 double-contrast barium enema, and colonoscop~· is colonie In the Minnesota colon cancer control study, the comperforation. The risk o·f perforation from flexit•le sigmoi-pliance with annual FOBT in the screened group (11 doscopy has been reported to vary between 1 in 5000 ::md screening opportunities over the length of the study) was 1 in 25 000; the risk from barium enema is reported to be 7 5%; the compliance with biennial FOBT {6 screening as high as 1 in 25 000. The risk of perforation during diag-opportunities) was 78%.1'' Blorn et al13 reported on acceptnostic colonoscopy is reported to be betwe•P.n 0.0?9Sio ::md ance of an invitation for screening sigmoidoscopy in a 0.61%; the risk during therapeutic colonoscopy is population of 60 year olds in Uppsala and Lund, Sweden. reported to be between 0.07% and 0.72%. The mortality Compliance was 47% in Uppsala and 30% in Lund; there rate for complications of screening colonoscopy is esti-was no difference in compliance between male and mated to be :1. per 20 000.8 These risl~s must be weighed female invitees. against tile almost 1 in 2 chances of dying frorn clinically Subram<mian et al14 reviewed some ~50 studies to evaldiagnosed colorectal cancer. uate factors impacting pCJtient adherence with colorectrJI
It should be noted that the above-described modeling cancer screening in the United States. Age was found to calculations are based on using the least-sensitive guaiaG be a signi1iGant factor, impacting adherence in 11 of 14 FORT Al~;o, in contrast to periodic endoscopic screening, studies, with older individuals proving more compliant FOBT needs to be repeated annually to obtain Gumulative than younger ones. Higher education was correlated with program sensitivity (see Chapter 8). undergoing recommende1j screening tests in the majority
of studies. Gender, race, and marital status tended to be What is patient compliance with col1>rectal non-significant Factors, while medical insurance was sigcancer !:>cre•ening re·commendations'? nificantly correlated with adherence, and membership in nespite the evidence regarding the efficacy of screening an HMO w::1s related to higher levels of :;1dherence. Income tests in reducing colo rectal cancer mortality in many com-did not appear to have a consistently significant impact on munities , at present compliance with screening reGom-adherence to c:olorectal cancer screening recornmendamendations is mo(ierate, at best. Vernon5 performed an tions. Acknowledging that cancer is pmventable and curextensive literature review of participation in colorectal able positively impacted on screening behaviors, whereas cancer screening. RatE!S of patient adherence to FOBT fear of cancer and pessimism was reported as a barrier to screening varied widely according to the location of the screening, with fatalism being a strong neg::-Aive predictor screening program {physician practice, community, or work of non-adherence in patients. Family history of colorectal site), whether or not the study tested the impact of a spe-Gancer was positively related to cancer sGreening tests. cific intervention on scn~ening adherence, ::md the country Physician recommendation was foun(i to be strongly in wl1ich the study was performed; the median adherence related to patient adherence, so that patients with a usual rate among studies was 40-·50%. Rescreening rates were source of care and patients having regular doGtor visits found to be lf!SS variable, and r::mged between 60% and were more likely to he more compliant, as well. 90%. Rates of patient adherence to sigmoidoscopy were Lieberman4 demonstrated the potential impact of comlower, and less variable, as well." In the United States, an pliance on reducing color·ectal cancer mortality tl1rough a analysis of the ?001 F:ehavior Risk Surveillanc~e System 1 O-ye;1r screening program. He estimated that a program conducted by the Centers for Disease Control and Preven-combining annual FOBT with triennial flexible sigrnoition showed that only 23.5% of the population surveyecl doscopy with 100% compliance by the population would reported receiving <3n FORT within the previous 1? months ; reduce ~;olorect31 cancer deaths by 66%; with a pop11lation 38. /'% had received lower endoscop~r within the past ti compliance of 50%, colo rectal cancer mortality would be years and 43.4% withi 1 the past 10 years; !;,3.1% hacl reduGed by 33Yo; and with a population Gompliance of received FORT within the previous 1? months and/or lower ?5%, the colorectal -:::ancer mortality would be reduced by endoscopy within :10 years_to During the same period of only 21%.
