Behavioral associations between prostate and colon cancer screening

Abstract

Background: Despite the controversy over the utility of routine prostate-specific antigen (PSA) screening in reducing prostate cancer-specific mortality, it has gained widespread use throughout the United States. Although colorectal cancer (CRC) screening reduces CRC mortality and appears to be cost effective, CRC screening adherence is suboptimal. To better understand screening behaviors among men, the Behavioral Risk Factors Surveillance Survey was used to identify potential relationships that would allow interventions to enhance CRC screening.

Study design: We included in our analysis 22,304 men, 50 years and older, who participated in the 2002 Behavioral Risk Factors Surveillance Survey. Chi-square and multivariate analyses were performed to determine the independent correlates of adherence to CRC screening. Independent variables evaluated were age, race, educational level, employment status, income, health insurance, the presence of a personal physician, self-reported general health, current smoking status, and receiving a PSA test.

Results: Men were more adherent with PSA screening than CRC screening (50.4% versus 47.6%;p < 0.002). In multivariate analysis, adherence to PSA screening (adjusted odds ratio [OR] 3.24, p < 0.001) exerted the largest independent effect on CRC screening adherence. Other positive correlates of adherence to CRC screening were having health insurance (adjusted OR 1.39, p < 0.01) and a personal physician (adjusted OR 2.01, p < 0.01). Age predicted CRC screening with an inverse-U correlation. Failure to adhere to CRC screening was associated with self-reported good health (adjusted OR 0.87, p < 0.01) and being a current smoker (adjusted OR 0.65, p < 0.01). Even in men who were compliant with PSA testing, CRC screening remained suboptimal (65%).

Conclusions: More men received PSA testing than CRC screening. Men who received PSA testing were more likely to adhere to CRC screening. Taken together, PSA testing may represent a "teachable moment" for a behavior-related intervention aimed at reducing the risk of colon cancer. Targeting men who already accept one form of cancer screening can potentially increase CRC screening adherence.