Journal of Community Health

, Volume 33, Issue 1, pp 10–21 | Cite as

Previous Cancer Screening Behavior as Predictor of Endoscopic Colon Cancer Screening Among Women Aged 50 and Over, in NYC 2002

  • Rafael Guerrero-Preston
  • Christina Chan
  • David Vlahov
  • Maria K. Mitchell
  • Stephen B. Johnson
  • Harold Freeman
Original paper


Colon cancer screening rates in women are low. Whether screening for breast and cervical cancer is associated with colon cancer screening behavior is unknown but could provide linkage opportunities. To identify the extent to which both breast and cervical cancer screening increases uptake of colon cancer screening among women in New York City. Women at least 50 years old completed questionnaires for the New York Cancer Project. Analyses compared rates of endoscopic colon cancer screening with adherence to screening recommendations for breast and cervical cancer. Of the 3,386 women, 87.8% adhered to breast and cervical cancer screening guidelines, yet only 42.1% had received endoscopic colon cancer screening. Most women with colon cancer screening (95%) also reported past mammogram and Pap-smear. In multivariable analysis, women who adhered to the other two procedures were more likely to have had colon cancer screening than women with no prior history (OR = 4.4; CI = 2.36, 8.20), after accounting for age, race/ethnicity, insurance status, family history of cancer and income. Significant predictors of endoscopic colon cancer screening included: age over 65 years (OR = 1.63; CI = 1.23, 2.15) with 50–65 years old as the reference, any health insurance (OR = 2.18; CI = 1.52, 3.13) and a family history of cancer (OR = 1.38; CI = 1.17, 1.61). Colorectal cancer screening remains low, even among women who undergo other cancer screening tests. Opportunities to link cancer screening tests to encourage colon cancer screening merit closer attention.


Cancer screening behavior Predictors of colon cancer screening behavior Social and health care determinants 



This research was supported in part by funds from the federal government NCI grant number 5T32CA009529-20, NIA grant number 2P30AG-15294; and NCMHD grant number 5S21MD008130-02.


  1. 1.
    Hawk, E. T., Limburg, P. J., & Viner, J. L. (2002). Epidemiology and prevention of colorectal cancer. Surgical Clinics of North America, 82, 905–941.PubMedCrossRefGoogle Scholar
  2. 2.
    DOHMH (2002). The City of New York: Summary of vital statistics. NYC Department of Health Mental Hygiene.Google Scholar
  3. 3.
    Feldman, G. E., McCord, C. W., Bassett, M. T., & Frieden, T. R. (2003). Screening for colorectal cancer. Journal of American Medical Association, 290, 191–192.CrossRefGoogle Scholar
  4. 4.
    Walsh, J. M., Posner, S. F., & Perez-Stable, E. J. (2002). Colon cancer screening in the ambulatory setting. Preventive Medicine, 35, 209–218.PubMedCrossRefGoogle Scholar
  5. 5.
    Hiatt, R. A, Perez-Stable, E. J., Quesenberry, C., Jr., Sabogal, F., Otero-Sabogal, R., & McPhee, S. J. (1995). Agreement between self-reported early cancer detection practices and medical audits among Hispanic and non-Hispanic white health plan members in northern California. Preventive Medicine, 24, 278–285.PubMedCrossRefGoogle Scholar
  6. 6.
    Breen, N., Wagener, D. K., Brown, M. L., & Davis, W. W. (2001). Ballard-Barbash R. Progress in cancer screening over a decade: Results of cancer screening from the 1987, 1992, and 1998 National Health Interview Surveys. Journal of National Cancer Institute, 93, 1704–1713.CrossRefGoogle Scholar
  7. 7.
    Carlos, R. C., Fendrick, A. M., Patterson, S. K., & Bernstein, S. J. (2005). Associations in breast and colon cancer screening behavior in women. Academic Radiology, 12, 451–458.PubMedCrossRefGoogle Scholar
  8. 8.
    Meissner, H. I., Breen, N., Klabunde, C. N., & Vernon, S. W. (2006). Patterns of colorectal cancer screening uptake among men and women in the United States. Cancer Epidemiology, Biomarkers and Prevention, 15, 389–394.PubMedCrossRefGoogle Scholar
  9. 9.
    Menon, U., Champion, V. L., Larkin, G. N., Zollinger, T. W., Gerde, P. M., & Vernon, S. W. (2003). Beliefs associated with fecal occult blood test and colonoscopy use at a worksite colon cancer screening program. Journal of Occupational and Environmental Medicine, 45, 891–898.PubMedCrossRefGoogle Scholar
  10. 10.
    Levin, B., Smith, R. A., Feldman, G. E., Colditz, G. A., Fletcher, R. H., & Nadel, M., et al. (2002). Promoting early detection tests for colorectal carcinoma and adenomatous polyps: A framework for action: the strategic plan of the National Colorectal Cancer Roundtable. Cancer, 95, 1618–1628.PubMedCrossRefGoogle Scholar
  11. 11.
    Tabbarah, M., Nowalk, M. P., Raymund, M., Jewell, I. K., & Zimmerman, R. K. (2005). Barriers and facilitators of colon cancer screening among patients at faith-based neighborhood health centers. Journal of Community Health, 30, 55–74.PubMedCrossRefGoogle Scholar
  12. 12.
    Irby, K., Anderson, W. F., Henson, D. E., & Devesa, S. S. (2006). Emerging and widening colorectal carcinoma disparities between Blacks and Whites in the United States (1975–2002). Cancer Epidemiology and Biomarkers Prevention, 15, 792–797.CrossRefGoogle Scholar
  13. 13.
    Morello-Frosch, R., & Shenassa, E. D. (2006). The environmental “riskscape” and social inequality: implications for explaining maternal and child health disparities. Environmental Health Perspectives, 114, 1150–1153.PubMedCrossRefGoogle Scholar
  14. 14.
    Bowie, J. V., Curbow, B. A., Garza, M. A., Dreyling, E. K., Benz Scott, L. A., & McDonnell, K. A. (2005). A review of breast, cervical, and colorectal cancer screening interventions in older women. Cancer Control, 12, 58–69.PubMedGoogle Scholar
  15. 15.
    Vlahov, D., Ahern, J., Vazquez, T., Johnson, S., Philips, L. A., & Nash, D., et al. (2005). Racial/ethnic differences in screening for colon cancer: Report from the New York Cancer Project. Ethnicity & Disease, 15, 76–83.Google Scholar
  16. 16.
    Puschel, K., Thompson, B., Coronado, G. D., Lopez, L. C., & Kimball, A. M. (2001). Factors related to cancer screening in Hispanics: A comparison of the perceptions of Hispanic community members, health care providers, and representatives of organizations that serve Hispanics. Health Education & Behavior, 28, 573–590.CrossRefGoogle Scholar
  17. 17.
    Singh, G. K. (2003). Area deprivation and widening inequalities in US mortality, 1969–1998. American Journal of Public Health, 93, 1137–1143.PubMedGoogle Scholar
  18. 18.
    Mitchell, M. K., Gregersen, P. K., Johnson, S., Parsons, R., & Vlahov D. (2004). The New York Cancer Project: Rationale, organization, design, and baseline characteristics. Journal of Urban Health, 81, 301–310.PubMedGoogle Scholar
  19. 19.
    Smith, R. A., Cokkinides, V., & Eyre, H. J. (2006) American Cancer Society guidelines for the early detection of cancer, 2006. CA Cancer Journal for Clinicians, 56, 11–25.CrossRefGoogle Scholar
  20. 20.
    Klabunde, C. N., Vernon, S. W., Nadel, M. R., Breen, N., Seeff, L. C., & Brown, M. L. (2005). Barriers to colorectal cancer screening: A comparison of reports from primary care physicians and average-risk adults. Medical Care, 43, 939–944.PubMedCrossRefGoogle Scholar
  21. 21.
    Kinney, A. Y., Bloor, L. E., Martin, C., & Sandler, R. S. (2005). Social ties and colorectal cancer screening among Blacks and Whites in North Carolina. Cancer Epidemiology and Biomarkers Prevention, 14, 182–189.Google Scholar
  22. 22.
    Vernon, S. W., Meissner, H. I., & Miller, S. M. (2006). The role of behavioral science in cancer prevention research: Planning the next steps in the collaborative process. Cancer Epidemiology and Biomarkers Prevention, 15, 413–415.CrossRefGoogle Scholar
  23. 23.
    Jagot, C. (2004). The importance of improving awareness of colorectal cancer. Nursing Times, 100, 30–31.PubMedGoogle Scholar
  24. 24.
    Giovannucci, E. (2002). Modifiable risk factors for colon cancer. Gastroenterology Clinics of North America, 31, 925–943.PubMedCrossRefGoogle Scholar
  25. 25.
    Wardle, J., McCaffery, K., Nadel, M., & Atkin W. (2004). Socioeconomic differences in cancer screening participation: Comparing cognitive and psychosocial explanations. Social Science and Medicine, 5, 249–261.Google Scholar
  26. 26.
    Singh, G., Miller, B., Hankey, B., & Edwards, B. (2003). Area socioeconomic variations in U.S. cancer incidence, mortality, stage, treatment, and survival, 1975–1999. NCI Cancer Surveillance Monograph Series, Number 4 Bethesda, MD: National Cancer Institute, NIH Publication No. 03–5417 2003.Google Scholar
  27. 27.
    Greiner, K. A., James, A. S., Born, W., Hall, S., Engelman, K. K., & Okuyemi, K. S., et al. (2005). Predictors of fecal occult blood test (FOBT) completion among low-income adults. Preventive Medicine, 41, 676–684.PubMedCrossRefGoogle Scholar
  28. 28.
    Hiatt, R. A., Pasick, R. J., Stewart, S., Bloom, J., Davis, P., & Gardiner, P., et al. (2001). Community-based cancer screening for underserved women: Design and baseline findings from the Breast and Cervical Cancer Intervention Study. Preventive Medicine, 33, 190–203.PubMedCrossRefGoogle Scholar
  29. 29.
    Gornick, M. E., Eggers, P. W., & Riley, G. F. (2004). Associations of race, education, and patterns of preventive service use with stage of cancer at time of diagnosis. Health Services Research, 39, 1403–1427.PubMedCrossRefGoogle Scholar
  30. 30.
    Lipscomb, J., & Snyder, C. F. (2002). The Outcomes of Cancer Outcomes Research: Focusing on the National Cancer Institute’s quailty-of-care initiative. Medical Care, 40, III-3–III-10.CrossRefGoogle Scholar
  31. 31.
    Kirsner, R. S., Ma, F., Fleming, L., Federman, D. G., Trapido, E., & Duncan, R., et al. (2006). The effect of medicare health care delivery systems on survival for patients with breast and colorectal cancer. Cancer Epidemiology and Biomarkers Prevention, 15, 769–773.CrossRefGoogle Scholar
  32. 32.
    Leng, J. C., Thorpe, L. E., Feldman, G. E., Thomas, P. A., & Frieden, T. R. (2005). The volume and capacity of colonoscopy procedures performed at New York City hospitals in 2002. Preventing Chronic Disease, 2, A09.PubMedGoogle Scholar
  33. 33.
    Wee, C. C., McCarthy, E. P., & Phillips, R. S. (2005). Factors associated with colon cancer screening: The role of patient factors and physician counseling. Preventive Medicine, 41, 23–29.PubMedCrossRefGoogle Scholar
  34. 34.
    Provenzale, D., & Gray, R. (2004). Colorectal cancer screening and treatment: Review of outcomes research. Journal of National Cancer Institute, Monographs, 33, 45–55.CrossRefGoogle Scholar
  35. 35.
    Ayanian, J. Z., Chrischilles, E. A., Fletcher, R. H., Fouad, M. N., Harrington, D. P., & Kahn, K. L., et al. (2004). Understanding cancer treatment and outcomes: The Cancer Care Outcomes Research and Surveillance Consortium. Journal of Clinical Oncology, 22, 2992–2996.PubMedCrossRefGoogle Scholar
  36. 36.
    Schoenfeld, P., Cash, B., Flood, A., Dobhan, R., Eastone, J., & Coyle, W., et al. (2005). Colonoscopic screening of average-risk women for colorectal neoplasia. New England Journal of Medicine, 352, 2061–2068.PubMedCrossRefGoogle Scholar
  37. 37.
    Lieberman, D. (2004). Colonoscopy: As good as gold? Annals of Internal Medicine, 141, 401–403.PubMedGoogle Scholar
  38. 38.
    Thorpe, L. E., Mostashari, F., Hajat, A., Nash, D., Karpati, A., Weber, T., et al. (2005) Colon cancer screening practices in New York City, 2003: Results of a large random-digit dialed telephone survey. Cancer, 104, 1075–1082.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Rafael Guerrero-Preston
    • 1
    • 2
    • 3
  • Christina Chan
    • 3
  • David Vlahov
    • 3
  • Maria K. Mitchell
    • 4
  • Stephen B. Johnson
    • 5
  • Harold Freeman
    • 6
  1. 1.Department of EpidemiologyJoseph A. Mailman School of Public Health at Columbia University New YorkUSA
  2. 2.Department of Environmental HealthJoseph A. Mailman School of Public Health at Columbia University New YorkUSA
  3. 3.Center for Urban Epidemiologic StudiesThe New York Academy of Medicine New YorkUSA
  4. 4.AMDeC Foundation New YorkUSA
  5. 5.Department of Biomedical InformaticsColumbia University New YorkUSA
  6. 6.Ralph Lauren Center for Cancer Care and Prevention New YorkUSA

Personalised recommendations