Intervention Increases Screening in Close Relatives of Colon Cancer Patients

SAN DIEGO—First-degree relatives of colorectal cancer patients are at increased risk of getting the disease themselves, and it is generally recommended that they have colorectal cancer screening beginning at age 40. A new study suggests that educational interventions by phone and mail may increase screening rates in this high-risk population.

“Surprisingly, first-degree relatives of colon cancer patients often underestimate the risks, particularly lower-income patients and those whose affected relatives are older,” said Dennis J. Ahnen, MD, professor of gastroenterology, University of Colorado.

Dr. Ahnen presented results of an interventional study at an American Gastroenterological Association research forum held during the Digestive Disease Week conference.

“Our aim was to design, implement, and evaluate a brief, telephone-based educational and counseling intervention to promote cancer screening for this group,” he said.

Physicians from more than 30 hospitals across the United States gave permission for the researchers to contact their patients with colorectal cancer. After the patient gave informed consent, a telephone interview was conducted to obtain a list of eligible first-degree relatives—men and women 50 years and older who were English speaking, aware of the cancer diagnosis of the family member, and had no personal history of cancer.

Families with more than one eligible first-degree relative were randomized to intervention or control groups. Consenting first-degree relatives were sent an introductory letter, a brochure, and a core baseline computer-assisted telephone interview that measured colon cancer attitudes, beliefs, risk perceptions, and screening practices.

The intervention group, Dr. Ahnen said, also received a brief, tailored, motivational telephone barriers counseling module designed to encourage colorectal cancer screening, as well as a tailored, reinforcement mail-out. “We followed up with both groups after 3 and 12 months,” he said.

The researchers conducted 860 co-lorectal cancer patient interviews, which yielded 2,069 first-degree relatives. Of those, 1,266 completed the baseline interview (38% men and 62% women). So far, Dr. Ahnen reported, 969 first-degree relatives have completed the 3-month interview and 599 the 12-month interview.

The study population is predominately white (84%), well educated (67% with some college or more), and affluent (63% earn $40,000 a year or more).

At baseline, Dr. Ahnen said, 45% of the participants reported colorectal screening within the recommended guidelines (fecal occult blood tests within 1 year or endoscopic screening within the past 5 years). At the most recent analysis, the rate of adherence to the guidelines had increased to 72% in the intervention group and 57% in the control group.

“The preliminary results indicate that phone-based education and counseling can significantly improve screening rates in first-degree relatives of colorectal cancer patients,” Dr. Ahnen concluded.