Prevalence and predictors of colon cancer screening among an Afro-Caribbean cohort: Insights from the Living in Full Health project

Objective: Colorectal cancer (CRC) is the third leading cause of cancer death in Jamaica, preventable through screening for pre-malignant lesions. We assessed the prevalence and predictors of CRC screening and up-to-date screening among average risk Jamaicans 50-years and older. We also compared the frequency of CRC screening with that for other cancers (breast, cervical and prostate cancer) in this population. Design and Methods: We analyzed data on self-reported CRC and other cancer screening practices from the baseline visit of 50-70 years old Jamaicans enrolled in the Living In Full Health (LIFE) cohort study. Socio-demographic information and medical history were obtained from an interviewer-administered questionnaire. Multivariable logistic regression was used to identify factors associated with undergoing any form of CRC screening. Chi square statistics were used to compare CRC screening practices with other sex-specific cancers. Results: Of 2,496 participants eligible for CRC screening, 239 (9.6%) had undergone screening. Those screened were significantly older (mean age 61.1±7.1 versus 59.7±6.6 years; p= 0.002), completed secondary education (75.3% versus 67.1%; p=0.010), retired (23.8% versus 9.9%; p<0.001), report higher monthly income of ≥JMD$120,000 (34.5% versus 16.5%; p <0.001), have health insurance (40.6% versus 16.8%; p<0.001), have at least one non-communicable disease (NCD) (75.3% versus 55.5%; p<0.001), and history of colon polyps (5.1% versus 0.4%; p <0.001). Less than a quarter (24.3% ) were up-to-date for CRC screening. In multivariate analysis having health insurance (OR 1.9; p=0.021), and a NCD (OR 1.9; p=0.026) were significant predictors for CRC screening. Those with low monthly income (JMD $<28,000 [OR=0.2; p=0.004]) were significantly less likely to be screened. Not having a personal healthcare provider (unadjusted OR=0.4; p=0.044) was the only significant predictor of not being up-to-date with CRC screening. Among women while only 9.5% (95% CI 8.0, 11.0) had undergone at least one method of CRC screening, 30.5% (95% CI 28.8, 32.1) had previously screened for cervical cancer and 85.9% (95% CI 84.6, 87.2) had been screened at least once for breast cancer. Among men 9.7% (95% CI 7.8, 11.5) had CRC screening compared to 17.9% (95% CI 15.9, 19.9) who reported prostate cancer screening. Lack of physician recommendation was the most common reason for not undergoing cancer screening among eligible participants. Conclusions: Approximately 10% of eligible Jamaicans were screened for CRC. Access to affordable CRC screening service and having a regular healthcare provider who recommends cancer screening may help to improve CRC screening uptake in Jamaica.