Obesity and overweight associated with lower rates of colorectal cancer screening in Switzerland

Abstract

Screening for colorectal cancer (CRC) is associated with reduced CRC mortality, but low screening rates have been reported in several settings. The aim of the study was to assess predictors of low CRC screening in Switzerland. A retrospective cohort of a random sample of 940 patients aged 50-80 years followed for 2 years from four Swiss University primary care settings was used. Patients with illegal residency status and a history of CRC or colorectal polyps were excluded. We abstracted sociodemographic data of patients and physicians, patient health status, and indicators derived from RAND's Quality Assessment Tools from medical charts. We defined CRC screening as colonoscopy in the last 10 years, flexible sigmoidoscopy in the last 5 years, or fecal occult blood testing in the last 2 years. We used bivariate and multivariate logistic regression analyses. Of 940 patients (mean age 63.9 years, 42.7% women), 316 (33.6%) had undergone CRC screening. In multivariate analysis, birthplace in a country outside of Western Europe and North America [odds ratio (OR) 0.65, 95% confidence interval (CI) 0.45-0.97], male sex of the physician in charge (OR 0.67, 95% CI 0.50-0.91), BMI 25.0-29.9 kg/m2 (OR 0.66, CI 0.46-0.96) and at least 30.0 kg/m2 (OR 0.61, CI 0.40-0.90) were associated with lower CRC screening rates. Obesity, overweight, birthplace outside of Western Europe and North America, and male sex of the physician in charge were associated with lower CRC screening rates in Swiss University primary care settings. Physician perception of obesity and its impact on their recommendation for CRC screening might be a target for further research.

Offering patients a choice for colorectal cancer screening: a quality improvement pilot study in a quality circle of primary care physicians

“…The short observation time could explain the only moderate increase in screening rates at baseline between data collections. Finally, although the overall baseline testing rates and test proportions we found seem consistent with the literature,5 8 34 generalisation to practices in Switzerland is difficult due to the local context and the limited number of patients assessed in this pilot study.…”

Patterns of Colorectal Cancer Screening Uptake in Newly Eligible Men and Women

“…The majority of research suggests that being overweight and obese is associated with reduced participation in colorectal cancer screening compared with normal weight individuals ( 27, 28 ), particularly in women ( 29, 30 ). In the Reducing Barriers to Colorectal Cancer Screening study, Messina et al ( 31 ) determined that women who were overweight or obese were 40% less likely to have had recent screening compared to normal weight women, while for men, there were no differences in recent screening by BMI category.…”

Colorectal Cancer Screening in Switzerland: Cross-Sectional Trends (2007-2012) in Socioeconomic Disparities

“…We considered only tests performed within 2 years for the hemoccult and 10 years for endoscopy because sigmoidoscopy is rarely performed (<4% of all CRC screenings) in Switzerland. [ 10 ] Three separate outcomes were considered: hemoccult in the past 2 years, endoscopy in the past 10 years, and any CRC screening (hemoccult in the past 2 years or endoscopy in the past 10 years).…”