| Abstract |
Introduction: Bowel or colorectal cancer is the third most common cause of malignant neoplasia (MΝ) and the fourth most common cause of cancer death in the world. It has been observed that colorectal cancer screening plays an important role for the decline not only in the incidence rates but also in the mortality rates of the disease throughout the world. The aim of this postgraduate paper is, firstly, to look into the interference of medical recommendation and the participation in the colorectal cancer screening and to bring out the factors that influence it. Secondly, this study tends to define: a) the participation of the population (over 50 years old in the SHARE study) in the colorectal cancer screening, b) the role of medical recommendation for the study population, c) the role of a General practitioner (GP), d) the factors that probably affect the participation, e) the relationship between those factors and participation (risk factors or protective factors).
Methods: This is a cross-sectional study. It was based on data taken from wave 1 (2004-05) of the SHARE Study, a Survey on Health, Ageing and Retirement in Europe (www.share-project.org). A random sampling was used since the institutional framework varies from country to country: simple random sampling based on national archives (the case of Denmark), stratified and multistage sampling based on regional, local archives and telephone directories (the case of Greece). The basic parameters examined were co-morbidity, religiousness (faith / prayer / church attendance) and relationship with children. The analysis of the data was done with IBM SPSS 21.0.
Results: A low participation rate has been observed in the preventive screening tests for colorectal cancer such as sigmoidoscopy or colonoscopy (21.9%) and slightly higher participation rate in the Fecal Occult Blood Test (25.7%). The medical recommendation (from any health care provider) was particularly low for both sigmoidoscopy / colonoscopy (20.5%) and the FOBT (21.6%), which probably affects participation rate in the colorectal cancer screening tests, even if 90.2% of the study population mentioned that they had a General practitioner who treated their health problems. In south European countries the participation rate in the colorectal cancer screening with sigmoidoscopy / colonoscopy (13.3%) or FOBT (9.6%) was the lowest. Moreover, it is clear that the co-morbidity has positive effect on both tests with statistically significant difference (OR=1.65, 95% ΔΕ=1.49-1.83, p-value΄&λτ0.001). As for religiousness, the prayer affects
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the participation rate of the population in sigmoidoscopy or colonoscopy (95% ΔΕ=1.01-1.11, p-value 0.027) and the church attendance in the FOBT (OR=1.25, 95%CI=1.08-1.45, p-value=0.002). Lastly, the contact between parents and their children has a positive effect on the participation rate in colorectal cancer screening but without any statistically significant difference.
Discussion: This study opens the way for further research on the role of the general practitioner in different countries and on the way the medical recommendation affects the participation rates in these countries. It is also important to be explored, in each country separately, the association between insurance and participation in the colorectal cancer screening tests and the relationship between low frequency of cancers in south European countries and the factors that probably affect it – e.g. food, religiousness or lifestyle.
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