Janz Nancy K, Wren Patricia A, Schottenfeld David, Guire Kenneth E
Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA.
Prev Med. 2003 Dec;37(6 Pt 1):627-34. doi: 10.1016/j.ypmed.2003.09.016.
Even though colorectal cancer (CRC) screening tests for persons 50 years of age or over are recommended to reduce colorectal cancer mortality, screening rates remain disturbingly low.
Using random digit dialing, 355 telephone interviews were conducted with black and white men and women, 50-79 years of age, who resided in Genesee County, Michigan. The Health Belief Model provided the framework to assess attitudes and practices regarding CRC screening.
For both endoscopic procedures, significantly higher percentages of whites than blacks were aware of the screening procedure (P < 0.05). Overall, fewer than 30% of respondents were adherent to current CRC screening guidelines. Adherence was lowest for black females: 21% for fecal occult blood test, 20% for flexible sigmoidoscopy, and 12% for colonoscopy. Black males compared to black females were about 2.8 times more likely to have had either flexible sigmoidoscopy or colonoscopy (P < 0.05). Physician recommendation was a powerful motivator to screening. Two consistent barriers to screening were the belief that: (a) the test is not needed; and (b) the test is embarrassing.
Interventions directed at physicians and patients are essential to enhance CRC screening rates. CRC survival rates may be improved by physician-guided promotion of screening that focuses on identified barriers.
尽管建议对50岁及以上人群进行结直肠癌（CRC）筛查以降低结直肠癌死亡率，但筛查率仍然低得令人不安。
通过随机数字拨号，对居住在密歇根州杰纳西县、年龄在50 - 79岁之间的黑人和白人男性及女性进行了355次电话访谈。健康信念模型为评估CRC筛查的态度和行为提供了框架。
对于两种内镜检查，知晓筛查程序的白人比例显著高于黑人（P < 0.05）。总体而言，不到30%的受访者遵守当前的CRC筛查指南。黑人女性的依从性最低：粪便潜血试验为21%，乙状结肠镜检查为20%，结肠镜检查为12%。与黑人女性相比，黑人男性进行乙状结肠镜检查或结肠镜检查的可能性约高2.8倍（P < 0.05）。医生的建议是筛查的有力推动因素。筛查的两个一致障碍是：（a）认为不需要进行检查；（b）认为检查令人尴尬。
针对医生和患者的干预措施对于提高CRC筛查率至关重要。通过医生指导的、针对已确定障碍的筛查推广，可能会提高CRC生存率。
