Self-Reported Barriers to Colorectal Cancer Screening in a Racially Diverse, Low-Income Study Population

Colorectal cancer (CRC) screening is underutilized, especially in low income, high minority populations. We examined the effect
test-specific barriers have on colonoscopy and fecal immunochemical test (FIT) completion, what rationales are given for non-completion,
and what “switch” patterns exist when participants are allowed to switch from one test to another. Low income adults who were
not up-to-date with CRC screening guidelines were recruited from safety-net clinics and offered colonoscopy or FIT (n = 418).
Follow up telephone surveys assessed test-specific barriers. Test completion was determined from patient medical records.
For subjects who desired colonoscopy at baseline, finding a time to come in and transportation applied more to non-completers
than completers (p = 0.001 and p < 0.001, respectively). For participants who initially wanted FIT, keeping track of cards, never putting stool on cards,
and not remembering to mail cards back applied more to non-completers than completers (p = 0.003, p = 0.006, and p < 0.001, respectively). The most common rationale given for not completing screening was a desire for the other screening
modality: 7 % of patients who initially preferred screening by FIT completed colonoscopy, while 8 % of patients who initially
preferred screening by colonoscopy completed FIT. We conclude that test-specific barriers apply more to subjects who did not
complete CRC screening. As a common rationale for test non-completion is a desire to receive a different screening modality,
our findings suggest screening rates could be increased by giving patients the opportunity to switch tests after an initial
choice is made.