The common practice of universally recommending colonoscopy may reduce adherence to screening for colorectal cancer (CRC). Clinicians might increase a patient’s compliance with CRC screening recommendations if fecal occult blood testing (FOBT) is recommended as an alternative.

This finding came from a study of 997 persons at average risk for CRC in a racially and ethnically diverse urban setting. The participants were randomly assigned to screening with FOBT, colonoscopy, or their choice of one method or the other. One year after randomization, 58% of the group had completed CRC screening.

Patients assigned to colonoscopy completed screening at a significantly lower rate (38%) than those screened with FOBT (67%; P<0.001) or those who were given a choice between colonoscopy and FOBT (69%; P<0.001). Hispanics and Asians (primarily Chinese) completed screening more often than did blacks. Nonwhite participants adhered more often to FOBT, whereas white participants adhered more often to colonoscopy. 

“[Our] results suggest that patient preferences should be considered when making CRC screening recommendations,” the researchers wrote (Inadomi JM et al. Arch Intern Med. 2012;172:575-582).

The results from a seperate study showed that differences in screening may be responsible for more than 40% of the disparity in CRC incidence and nearly 20% of CRC mortality between blacks and whites (Lansdorp-Vogelaar I et al. Cancer Epidemiol BiomarkersPrev. 2012;21:728-736).