Gender differences in attitudes impeding colorectal cancer screening

Abstract

BackgroundColorectal cancer screening (CRCS) is the only type of cancer screening where both genders reduce risks by similar proportions with identical procedures. It is an important context for examining gender differences in disease-prevention, as CRCS significantly reduces mortality via early detection and prevention. In efforts to increase screening adherence, there is increasing acknowledgment that obstructive attitudes prevent CRCS uptake. Precise identification of the gender differences in obstructive attitudes is necessary to improve uptake promotion. This study randomly sampled unscreened, screening - eligible individuals in Ontario, employing semi-structured interviews to elicit key differences in attitudinal obstructions towards colorectal cancer screening with the aim of deriving informative differences useful in planning promotions of screening uptake.MethodsN = 81 participants (49 females, 32 males), 50 years and above, with no prior CRCS, were contacted via random-digit telephone dialing, and consented via phone-mail contact. Altogether, N = 4,459 calls were made to yield N = 85 participants (1.9% response rate) of which N = 4 participants did not complete interviews. All subjects were eligible for free-of-charge CRCS in Ontario, and each was classified, via standard interview by CRCS screening decision-stage. Telephone-based, semi-structured interviews (SSIs) were employed to investigate gender differences in CRCS attitudes, using questions focused on 5 attitudinal domains: 1) Screening experience at the time of interview; 2) Barriers to adherence; 3) Predictors of Adherence; 4) Pain-anxiety experiences related to CRCS; 5) Gender-specific experiences re: CRCS, addressing all three modalities accessible through Ontario’s program: a) fecal occult blood testing; b) flexible sigmoidoscopy; c) colonoscopy.ResultsInterview transcript analyses indicated divergent themes related to CRCS for each gender: 1) bodily intrusion, 2) perforation anxiety, and 3) embarrassment for females and; 1) avoidant procrastination with underlying fatalism, 2) unnecessary health care and 3) uncomfortable vulnerability for males. Respondents adopted similar attitudes towards fecal occult blood testing, flexible sigmoidoscopy and colonoscopy, and were comparable in decision stage across tests. Gender differences were neither closely tied to screening stage nor modality. Women had more consistent physician relationships, were more screening-knowledgeable and better able to articulate views on screening. Men reported less consistent physician relationships, were less knowledgeable and kept decision-making processes vague and emotionally distanced (i.e. at ‘arm’s length’).ConclusionsMarked differences were observed in obstructive CRCS attitudes per gender. Females articulated reservations about CRCS-associated distress and males suppressed negative views while ambiguously procrastinating about the task of completing screening. Future interventions could seek to reduce CRCS-related stress (females) and address the need to overcome...

Comparison of Uptake of Colorectal Cancer Screening Based on Fecal Immunochemical Testing (FIT) in Males and Females: A Systematic Review and Meta-analysis

“…The evidence base for reasons underlying gender-based differences in colorectal cancer screening uptake is very limited, and even less is known about uptake in FIT based screening specifically. Recently Ritvo and colleagues (45) suggested that males may procrastinate about colorectal cancer screening, but that, underlying this, is a deeper fatalism about cancer disease and a disbelief in the preventative-protective elements of screening. It has also been reported that males use primary care services less frequently than women (46) perhaps making them less inclined to be screened when offered the opportunity.…”

Antenatal Care and Couples’ HIV Testing in Rural Northern Uganda: A Gender Relations Analysis

“…Longstanding commentaries about Western men suggest that their collective reticence to access health care in general is fueled by men's desire to be seen as invincible and their disregard for screening in the absence of symptoms (Courtenay, 2000;Ritvo et al, 2013). However, in the context of HIV testing for Amuru men, much was at stake for a man who was known to harbor the HIV virus.…”

Análisis de la satisfacción de los participantes en el Programa de detección precoz de cáncer colorrectal de Barcelona: valoración positiva de la farmacia comunitaria

“…Los autores de este estudio no han encontrado ninguna publicación referente a la encuesta de satisfacción de un programa poblacional de detección precoz de cáncer de colon y recto. No obstante, existen algunos estudios que hacen referencia a algunos de los aspectos considerados en la encuesta, como los motivos de participación y no participación [13][14][15][16][17][18][19][20] , los conocimientos y la percepciones sobre el CCR [14][15][16][17]21 , las preferencias sobre diferentes estrategias de cribado 17,22-24 y la satisfacción con la colonoscopia 25,26 .…”

“…Asimismo, los hombres aluden la falta de preocupación como motivo de no participación más que las mujeres, en concordancia también con otros autores 14 y a pesar de que el porcentaje de hombres y mujeres NoP que consideraban el CCR como un problema relevante antes de ser invitados al Programa es similar. La menor tendencia de los hombres a realizar prácticas preventivas se ha relacionado con aspectos psicosociales, un menor conocimiento e interés por el cáncer y la prevención, y un menor contacto con la atención primaria 15 . Por ello, y porque en nuestro programa, al igual que en otros programas que utilizan PDSOH, los hombres participan menos que las mujeres 7 , parece razonable adecuar las estrategias de comunicación del Programa en función del género.…”