Colorectal cancer lifetime risk accuracy and behavior change intentions before and after risk assessment

Abstract

Purpose

This study examined accuracy of perceived lifetime risk of colorectal cancer prior to and following receipt of cancer risk assessment (CRA) feedback among average risk adults. The specific aims were to identify predictors of improved risk perceptions and assess whether improvement in perceived lifetime risk accuracy was associated with changes in behavioral intentions for physical activity, diet, and colorectal cancer screening.

Methods

Adults with no known history of colorectal cancer (n = 419) were enrolled in a study examining the impact of colorectal cancer risk assessment feedback. Risk perceptions and behavioral intentions were ascertained before and after risk assessment administration.

Results

Accuracy of perceived lifetime risk significantly improved after CRA feedback, often as a result of lowered perceived risk. Those who were White, married, attended some college, and had higher numeracy were more likely to report accurate lifetime risk post-CRA. No differences in behavioral intentions were reported between those with and without improved accuracy.

Conclusion

Minorities and those with low numeracy were less likely to report accurate perceptions post-CRA. Although improved accuracy was not associated with increased behavioral intentions as expected, it is reassuring that intentions for health behaviors were not inhibited as perceived risk decreased.

This is a preview of subscription content, access via your institution.

References

  1. 1.

    American Cancer Society (2020) Cancer facts & figures 2020. American Cancer Society, Atlanta

    Google Scholar 

  2. 2.

    American Cancer Society (2020) Colorectal cancer facts & figures 2020–2022. American Cancer Society, Atlanta

    Google Scholar 

  3. 3.

    Edwards BK, Ward E, Kohler BA, Eheman C, Zauber AG, Anderson RN, Jemal A, Schymura MJ, Lansdorp-Vogelaar I, Seeff LC, van Ballegooijen M (2010) Annual report to the nation on the status of cancer, 1975–2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer 116(3):544–573

    Article  Google Scholar 

  4. 4.

    American Cancer Society (2019) Cancer prevention & early detection facts & figures 2019–2020. American Cancer Society, Atlanta

    Google Scholar 

  5. 5.

    Meester RG, Doubeni CA, Zauber AG, Goede SL, Levin TR, Corley DA, Jemal A, Lansdorp-Vogelaar I (2015) Public health impact of achieving 80% colorectal cancer screening rates in the United States by 2018. Cancer 121(13):2281–2285

    Article  Google Scholar 

  6. 6.

    Colditz G, Stein C (2004) Handbook of cancer risk assessment and prevention. Jones and Bartlett Publishers, Sudbury

    Google Scholar 

  7. 7.

    Health Information Nation Trends Survey (2006) HINTS Briefs. Available from: http://hints.cancer.gov/docs/Briefs/HINTS_Brief-2.pdf. Accessed on 30 Oct 2016

  8. 8.

    Janz NK, Becker MH (1984) The health belief model: a decade later. Health Educ Behav 11(1):1–47

    CAS  Google Scholar 

  9. 9.

    Rogers RW (1983) Cognitive and physiological processes in fear appeals and attitude change: a revised theory of protection motivation. Social psychophysiology. Guilford Press, New York, pp 153–176

    Google Scholar 

  10. 10.

    Weinstein ND (1988) The precaution adoption process. Health Psychol 7(4):355

    CAS  Article  Google Scholar 

  11. 11.

    Freedman AN, Seminara D, Gail MH, Hartge P, Colditz GA, Ballard-Barbash R, Pfeiffer RM (2005) Cancer risk prediction models: a workshop on development, evaluation, and application. J Natl Cancer Inst 97(10):715–723

    Article  Google Scholar 

  12. 12.

    Walker JG, Licqurish S, Chiang PP, Pirotta M, Emery JD (2015) Cancer risk assessment tools in primary care: a systematic review of randomized controlled trials. Ann Family Med 13(5):480–489

    CAS  Article  Google Scholar 

  13. 13.

    Sequist TD, Zaslavsky AM, Colditz GA, Ayanian JZ (2011) Electronic patient messages to promote colorectal cancer screening: a randomized controlled trial. Arch Internal Med 171(7):636–641

    Article  Google Scholar 

  14. 14.

    Clipp EC, Carver EH, Pollak KI, Puleo E, Emmons KM, Onken J, Farraye FA, McBride CM (2004) Age-related vulnerabilities of older adults with colon adenomas. Cancer 100(5):1085–1094

    Article  Google Scholar 

  15. 15.

    Turbitt E, Roberts MC, Taber JM, Waters EA, McNeel TS, Biesecker BB, Klein WM (2019) Genetic counseling, genetic testing, and risk perceptions for breast and colorectal cancer: results from the 2015 National Health Interview Survey. Prev Med 123:12–19

    Article  Google Scholar 

  16. 16.

    Hay J, Coups E, Ford J (2006) Predictors of perceived risk for colon cancer in a national probability sample in the United States. J Health Commun 11(S1):71–92

    Article  Google Scholar 

  17. 17

    Emmons KM, Wong ME, Puleo E, Weinstein N, Fletcher R, Colditz G (2004) Tailored computer-based cancer risk communication: correcting colorectal cancer risk perception. J Health Commun 9(2):127–141

    Article  Google Scholar 

  18. 18.

    Weinstein ND, Atwood K, Puleo E, Fletcher R, Colditz G, Emmons KM (2004) Colon cancer: risk perceptions and risk communication. J Health Commun 9(1):53–65

    Article  Google Scholar 

  19. 19.

    Jeon J, Du M, Schoen RE, Hoffmeister M, Newcomb PA, Berndt SI, Caan B, Campbell PT, Chan AT, Chang-Claude J, Giles GG (2018) Determining risk of colorectal cancer and starting age of screening based on lifestyle, environmental, and genetic factors. Gastroenterology 154(8):2152–2164

    Article  Google Scholar 

  20. 20

    Miller CA, ElstonLafata J, Thomson MD (2020) The effects of personalizing colorectal cancer risk communication on risk perceptions and health behavior intentions: a randomized trial of average-risk adults. J Cancer Educ. https://doi.org/10.1007/s13187-020-01694-5

    Article  PubMed  Google Scholar 

  21. 21

    Miller CA, Guidry JP, Dahman B, Thomson MD (2020) A tale of two diverse qualtrics samples: information for online survey researchers. Cancer EpidemiolBiomarkPrev 29:731–735

    Google Scholar 

  22. 22.

    American Cancer Society (2016) What are the key statistics about colorectal cancer? Available from: http://www.cancer.org/cancer/colonandrectumcancer/detailedguide/colorectal-cancer-key-statistics

  23. 23.

    Vernon SW, Meissner H, Klabunde C, Rimer BK, Ahnen DJ, Bastani R, Mandelson MT, Nadel MR, Sheinfeld-Gorin S, Zapka J (2004) Measures for ascertaining use of colorectal cancer screening in behavioral, health services, and epidemiologic research. Cancer EpidemiolBiomarkPrev 13(6):898–905

    Google Scholar 

  24. 24.

    Orom H, O’Quin KE, Reilly S, Kiviniemi MT (2015) Perceived cancer risk and risk attributions among African-American residents of a low-income, predominantly African-American neighborhood. Ethn Health 20(6):543–556

    Article  Google Scholar 

  25. 25.

    Orom H, Kiviniemi MT, Underwood W, Ross L, Shavers VL (2010) Perceived cancer risk: why is it lower among nonwhites than whites? Cancer EpidemiolBiomarkPrev 19(3):746–754

    Google Scholar 

  26. 26.

    Orom H, Kiviniemi MT, Shavers VL, Ross L, Underwood W (2013) Perceived risk for breast cancer and its relationship to mammography in Blacks, Hispanics, and Whites. J Behav Med 36(5):466–476

    Article  Google Scholar 

  27. 27.

    Hann KE, Freeman M, Fraser L, Waller J, Sanderson SC, Rahman B, Side L, Gessler S, Lanceley A (2017) Awareness, knowledge, perceptions, and attitudes towards genetic testing for cancer risk among ethnic minority groups: a systematic review. BMC Public Health 17(1):503

    Article  Google Scholar 

  28. 28.

    Lipkus IM, Samsa G, Rimer BK (2001) General performance on a numeracy scale among highly educated samples. Med DecisMak 21(1):37–44

    CAS  Google Scholar 

  29. 29.

    Donelle L, Arocha JF, Hoffman-Goetz L (2008) Health literacy and numeracy: key factors in cancer risk comprehension. Chronic Dis Can 29(1):1–8

    CAS  Article  Google Scholar 

  30. 30.

    Jackson CS, Oman M, Patel AM, Vega KJ (2016) Health disparities in colorectal cancer among racial and ethnic minorities in the United States. J Gastrointest Oncol 7(Suppl 1):S32

    PubMed  PubMed Central  Google Scholar 

Download references

Funding

Financial support for this study was provided in part by a predoctoral training award from the Susan G. Komen Foundation (Grant No. GTDR14302086) and a National Cancer Institute T32 award (Grant No. 2T32CA093423).

Author information

Affiliations

Authors

Corresponding author

Correspondence to Carrie A. Miller.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Miller, C.A., Barnes, A.J., Fuemmeler, B.F. et al. Colorectal cancer lifetime risk accuracy and behavior change intentions before and after risk assessment. Cancer Causes Control (2021). https://doi.org/10.1007/s10552-021-01394-5

Download citation

Keywords

  • Risk communication
  • Colorectal cancer
  • Risk perception
  • Behavioral intention