Cai Shan-Rong, Zhang Su-Zhan, Zhu Hong-Hong, Zheng Shu
Cancer Institute, Zhejiang University, Hangzhou, Zhejiang Province, China.
World J Gastroenterol. 2009 May 28;15(20):2531-6. doi: 10.3748/wjg.15.2531.
To investigate barriers to colorectal cancer (CRC) screening in a community population.
We conducted a community-based case-control study in an urban Chinese population by questionnaire. Cases were selected from those completing both a fecal occult blood test (FOBT) case and colonoscopy in a CRC screening program in 2004. Control groups were matched by gender, age group and community. Control 1 included those having a positive FOBT but refusing a colonoscopy. Control 2 included those who refused both an FOBT and colonoscopy.
The impact of occupation on willingness to attend a colorectal screening program differed by gender. P for heterogeneity was 0.009 for case vs control group 1, 0.01 for case versus control group 2, and 0.80 for control group 1 vs 2. Poor awareness of CRC and its screening program, characteristics of screening tests, and lack of time affected the screening rate. Financial support, fear of pain and bowel preparation were barriers to a colonoscopy as a screening test. Eighty-two percent of control group 1 and 87.1% of control group 2 were willing attend if the colonoscopy was free, but only 56.3% and 53.1%, respectively, if it was self-paid. Multivariate odds ratios for case vs control group 1 were 0.10 among those unwilling to attend a free colonoscopy and 0.50 among those unwilling to attend a self-paid colonoscopy.
Raising the public awareness of CRC and its screening, integrating CRC screening into the health care system, and using a painless colonoscopy would increase its screening rate.
调查社区人群中结直肠癌（CRC）筛查的障碍。
我们通过问卷调查在中国城市人群中开展了一项基于社区的病例对照研究。病例选自2004年CRC筛查项目中完成粪便潜血试验（FOBT）及结肠镜检查的人群。对照组按性别、年龄组和社区进行匹配。对照组1包括FOBT结果为阳性但拒绝接受结肠镜检查的人群。对照组2包括既拒绝FOBT又拒绝结肠镜检查的人群。
职业对参加结直肠癌筛查项目意愿的影响因性别而异。病例组与对照组1的异质性P值为0.009，病例组与对照组2的异质性P值为0.01，对照组1与对照组2的异质性P值为0.80。对CRC及其筛查项目的认知不足、筛查检查的特点以及时间不足影响了筛查率。经济支持、对疼痛的恐惧和肠道准备是结肠镜检查作为筛查手段的障碍。如果结肠镜检查免费，对照组1的82%和对照组2的87.1%愿意参加，但如果是自费，分别只有56.3%和53.1%愿意参加。病例组与对照组1相比，不愿参加免费结肠镜检查者的多变量优势比为0.10，不愿参加自费结肠镜检查者的多变量优势比为0.50。
提高公众对CRC及其筛查的认识，将CRC筛查纳入医疗保健系统，并采用无痛结肠镜检查将提高其筛查率。
