SAN DIEGOFirst-degree relatives of colorectal cancer patients
are at increased risk of getting the disease themselves, and it is
generally recommended that they have colorectal cancer screening
beginning at age 40. A new study suggests that educational
interventions by phone and mail may increase screening rates in this
Surprisingly, first-degree relatives of colon cancer patients
often underestimate the risks, particularly lower-income patients and
those whose affected relatives are older, said Dennis J. Ahnen,
MD, professor of gastroenterology, University of Colorado.
Dr. Ahnen presented results of an interventional study at an American
Gastroenterological Association research forum held during the
Digestive Disease Week conference.
Our aim was to design, implement, and evaluate a brief,
telephone-based educational and counseling intervention to promote
cancer screening for this group, he said.
Physicians from more than 30 hospitals across the United States gave
permission for the researchers to contact their patients with
colorectal cancer. After the patient gave informed consent, a
telephone interview was conducted to obtain a list of eligible
first-degree relativesmen and women 50 years and older who were
English speaking, aware of the cancer diagnosis of the family member,
and had no personal history of cancer.
Families with more than one eligible first-degree relative were
randomized to intervention or control groups. Consenting first-degree
relatives were sent an introductory letter, a brochure, and a core
baseline computer-assisted telephone interview that measured colon
cancer attitudes, beliefs, risk perceptions, and screening practices.
The intervention group, Dr. Ahnen said, also received a brief,
tailored, motivational telephone barriers counseling module designed
to encourage colorectal cancer screening, as well as a tailored,
reinforcement mail-out. We followed up with both groups after 3
and 12 months, he said.
The researchers conducted 860 co-lorectal cancer patient interviews,
which yielded 2,069 first-degree relatives. Of those, 1,266 completed
the baseline interview (38% men and 62% women). So far, Dr. Ahnen
reported, 969 first-degree relatives have completed the 3-month
interview and 599 the 12-month interview.
The study population is predominately white (84%), well educated (67%
with some college or more), and affluent (63% earn $40,000 a year or more).
At baseline, Dr. Ahnen said, 45% of the participants reported
colorectal screening within the recommended guidelines (fecal occult
blood tests within 1 year or endoscopic screening within the past 5
years). At the most recent analysis, the rate of adherence to the
guidelines had increased to 72% in the intervention group and 57% in
the control group.
The preliminary results indicate that phone-based education and
counseling can significantly improve screening rates in first-degree
relatives of colorectal cancer patients, Dr. Ahnen concluded.