Colorectal Cancer Screening

Colorectal cancer (CRC) is the third most common form of cancer in the U.S. and has the third highest mortality rate, and screening clearly reduces mortality. In 2001, only 53% of those eligible had undergone fecal occult blood testing (FOBT) within the preceding year or lower endoscopy within the past 10 years.1 In a recent systematic assessment of the value of clinical preventive services, which are recommended for average risk individuals by the U.S. Preventive Services Task Force (USPSTF), preventive services were ranked based on burden of disease prevented by the service and cost effectiveness. Screening for CRC was one of the highest ranked services (score of 7+ on a scale of 2 to 10) with the lowest delivery rate (<50% nationally) and it was concluded that it should be a national priority to increase rates of CRC screening.2 The provision and receipt of preventive care is complex and takes place within the patient-physician interaction (Figure 1). The patient and the physician are each influenced by predisposing factors (e.g., sociodemographics, health beliefs, and attitudes), enabling factors (skills and resources), and reinforcing factors (such as social support) and that each is also affected by health care system factors and by certain cues to action (such as symptoms or reminders).3 All of these factors influence the patient and/or the physician and influence whether or not the preventive activity occurs. Barriers can occur at any level including the patient, the physician, the system, and cues to action. Figure 1 The systems model of clinical preventive care.