Does colorectal cancer risk perception predict screening behavior? A systematic review and meta-analysis

Abstract

Although health behavior theories postulate that risk perception should motivate colorectal cancer (CRC) screening, this relationship is unclear. This meta-analysis aims to examine the relationship between CRC risk perception and screening behavior, while considering potential moderators and study quality. A search of six databases yielded 58 studies (63 effect sizes) that quantitatively assessed the relationship between CRC risk perception and screening behavior. Most included effect sizes (75 %) reported a positive association between CRC risk perception and screening behavior. A random effects meta-analysis yielded an overall effect size of z = 0.13 (95 % CI 0.10-0.16), which was heterogeneous (I (2) = 99 %, τ(2) = 0.01). Effect sizes from high-quality studies were significantly lower than those from lower quality studies (z = 0.02 vs. 0.16). We found a small, positive relationship between CRC risk perception and reported screening behavior, with important identified heterogeneity across moderators. Future studies should focus on high quality study design.

Keywords: Colorectal neoplasms; Early detection of cancer; Meta-analysis; Patient-reported outcomes; Perceived risk.

Figure 1

PRISMA Flow Chart

Figure 2

Forest Plot of Meta-Analysis Effect Sizes

Figure 3

Funnel Plot with Pseudo 95% Confidence Limits