Mass screening programs for PCa attract large numbers of men who are concerned about their health,39
thereby providing an opportunity to address adherence to other cancer-related behaviors. In the present study, ½ of the PCa screening participants were nonadherent to CRC screening, and 45% had never been screened for CRC, despite a large portion having access to care. This represents a missed opportunity for capitalizing on men’s cancer-related health concerns, at a time when they may be primed to undergo CRC screening if presented with the opportunity and/or encouragement to do so. At the very least, they may be willing to participate in an intervention designed to address knowledge-based as well as psychological barriers to CRC screening.12
Psychosocial and behavioral interventions have been shown to increase rates of CRC screening,40-45
and it has been suggested that such interventions, in conjunction with risk-factor modification and treatment interventions, can reduce mortality.46
This study confirmed prior findings regarding the underutilization of CRC screening, and extended these findings to a subgroup of men who were aware of the potential benefit of the early detection of cancer. Also consistent with previous research, we found that having a regular physician,12,16,19-26
having health insurance,12,16,19,22-28,46
and PCa screening adherence12,21,23,25,31
were significant predictors of CRC screening adherence. Race was not significant in the multivariate models, which confirmed prior research suggesting that CRC screening and race are not related,16,25,27
although it contradicted other studies that have found this relationship.20,32
Importantly, race was significant in the multivariate model predicting adherence when we removed the SES-related variables from the analysis (ie, screening site, education, regular physician, and health insurance [data not shown]). These findings underscore the importance of including both race and SES within a given model, and may partially explain the contradictory findings regarding the association between race and CRC screening in the literature.
Several limitations should be considered in the interpretation of these results. As in many other cancer screening studies,12,23
men were not asked to distinguish between tests given for screening purposes versus diagnostic purposes, and self-report data are not always reliable. Furthermore, a lack of generalizability would be a usual limitation of a study conducted with men who had attended a free PCa screening program and who had participated in a randomized trial. However, these limitations are a strength in this case, as we have identified that men who attend free PCa screening are in fact a population of interest for future studies of CRC screening interventions. Furthermore, the screening rates and the correlates of prior CRC screening were almost identical to several studies that used nationally representative samples,12-15,21,23,24
suggesting that given the prevalence of PCa screening in the United States, men who undergo PCa screening are quite comparable to the general population.
The finding that the majority of the men who were nonadherent to CRC screening actually had access to screening (ie, health insurance and/or a regular physician), along with the finding that these same variables were highly significant correlates of CRC screening, is a potentially very important set of findings. These results indicate that CRC screening adherence was not limited by the usual systemic barriers, which opens the door for testing already proven CRC screening behavioral and psychosocial interventions in this population. As the number of US men who participate in free PCa screening programs exceeds 100,000 men annually,35
they are a large and easily accessible group of men who could benefit from such programs.
Utilization of free PCa screening programs as a teachable moment to increase awareness and encourage CRC screening among men attending free PCa screening programs has not been explored to date. However, it is worth pursuing given the large number of men who are eligible and who could benefit from such an intervention. For example, free PCa screening programs provide the opportunity for men to receive 1 of the simplest yet most effective screening interventions for CRC screening, a physician recommendation to be screened.17,26,47,48
Thus, utilization of the teachable moment should include the distribution of CRC screening educational materials at PCa screening programs, which would include addressing commonly reported barriers to receiving CRC screening, such as a lack of knowledge and awareness about the proven usefulness of the test49
and embarrassment about the test.47
Finally, the most practical use of the PCa screening setting as a teachable moment would be to provide information about local facilities that provide CRC screening, including phone numbers, websites, and information about insurance requirements as well as sites for low-cost screening. As has been suggested for breast and cervical cancer screening settings,12,50,51
using the PCa screening setting to provide such interventions could significantly improve CRC screening rates among this group and could provide a model for providing such interventions in other settings.