Beliefs, risk perceptions, and gaps in knowledge as barriers to colorectal cancer screening in older adults

OBJECTIVES: To assess beliefs and perceptions of risk about colorectal cancer (CRC) and gaps in knowledge about screening in adults aged 65 to 89. DESIGN: A population-based survey. SETTING: United States. PARTICIPANTS: A total of 1,148 respondents with no history of CRC, representing an estimated population of 31.6 million persons, who were stratified according to screening behavior (up to date (n=457) vs not up to date (n=691)) and age (65-74 vs 75-89). MEASUREMENTS: The Health Information National Trends Survey (2003) questionnaire. RESULTS: An estimated 25% of adults aged 65 to 89 had not heard of the fecal occult blood test, 17% had not heard of sigmoidoscopy or colonoscopy, and 42% were not up to date with either screening modality. Not visiting a healthcare provider in the previous year, not knowing about tests available for colon cancer, perceiving the arrangements to be checked for detecting colon cancer to be difficult, and not having an opinion about it and its cost, were significantly associated with not being up to date (each P<.03). Persons who were not up to date were frequently unaware of the importance of CRC screening, and often reported lack of a provider's recommendation to be screened (>75%). Lack of knowledge and awareness were more prevalent in those aged 75 to 89 than those aged 65 to 74. CONCLUSION: Lack of knowledge and awareness and the absence of a physician's recommendation to be tested might explain not being up to date with CRC screening in adults in these age groups. These findings suggest a potential value for better communication between older adults and their providers regarding screening for CRC, when appropriate.