Adverse Experiences Do Not Decrease Frequency of Screening in CRC

Cicely K. Johnson, PhD

Adverse experiences, such as smoking and experiencing physical abuse, do not necessarily decrease the frequency of colorectal cancer (CRC) screening, according to findings from a pilot study presented during the 5th Annual Regional Synergistic Partnership for Enhancing Equity in Cancer Health (SPEECH) Conference and Retreat in Philadelphia, Pennsylvania.¹

Findings from the study showed that patients who smoke are more likely to get screened for CRC compared with those who do not smoke (OR, 1.997; 95% CI, 1.026-3.886; P = .042). Additionally, patients who had experienced physical abuse during childhood were significantly more likely to get screened for CRC compared with those who did not (OR, 0.156; 95% CI, 0.43-0.573).

“Individuals who smoke normally don’t adopt other healthy behaviors or health-seeking behaviors, but the results of our study [showed] that individuals who smoked were more likely to screen for cancer,” Cicely K. Johnson, PhD, a research associate at the Hunter College Center for Cancer Health Disparities Research in New York, New York, said in an interview with Oncology Nursing News®. “[Moreover], those who had had physical abuse as a childhood experience were significantly more likely to screen for CRC.”

To conduct their study, investigators used a self-report questionnaire that included modified versions of questions on the Motivators of and Barrier to Health-Smart Behaviors Inventory to gather data concerning adverse childhood experiences. Additionally, they collected demographic data, such as age, ethnicity, and zip code. They aimed to use these data to discern differences by ethnicity and intent of patients who were not yet eligible to be screened for CRC. Study authors used a binary logistic regression to evaluate the relationship between variables and the likelihood that an individual will eventually be screened for CRC.

Additional findings from the study showed that patients who were single were approximately 3-times more likely to perceive cancer screening as important compared with those who were in relationships (OR, 3.695; 95% CI, 1.083-12.613; P = .037).

Study authors noted that their findings are notable because patients who smoke are historically less likely to seek out cancer screening in general, according to currently available literature. These results highlight the importance of creating community programs linked to demographic and health behaviors of individuals, rather than programs that provide generic screening information, they wrote. They also observed that, in their opinion, many health care professionals receive minimal training in terms of traumatic stress and trauma-informed approaches, and more culturally tailored approaches need to be developed.

In the future, investigators plan to collect data pertaining to all adverse childhood experiences and cancer screening intent as it relates to a variety of cancer types. Additional qualitative data on the relationships between these factors and cancer screening habits will also be gathered.

“I believe that there is not enough trauma work being done [by clinicians],” Johnson said. “It’s hard because of the time that you have to spend with patients in the rooms [to collect this data]. But [a start could be] at least collecting the data on traumatic experiences, and [using it to] link some of those patients to different programs or different opportunities that specifically work with individuals who have experienced trauma to get them on the right track to adopt healthy behaviors, whether that's diet, cancer screening, exercise, mental health, etc. There’s a lot of room for collective work there.”

Reference

Johnson CK, Leung MM, Ma GX, et al. Adverse experiences are not always associated with decreased cancer screening. Presented at: 5th Annual Regional Synergistic Partnership for Enhancing Equity in Cancer Health (SPEECH) Conference and Retreat; May 17-18, 2023; Philadelphia, PA. Poster 6.