Colorectal Cancer Screening Behavior Among Older Koreans: Directions Toward Reducing Cancer Health Disparity

Purpose: Screening for colorectal cancer is underutilized in Korea, although colorectal cancer is one of most commonly diagnosed cancers in Korea (Choi et al, 2010). The underutilization of cancer screening has led Korean older adults to have high mortality rates of colorectal cancer (National Cancer Center, 2008). Although there is a urgent need to promote colorectal cancer screening in this population, there is a dearth of empirical study that investigates barriers and facilitators associated with colorectal cancer screening behaviors. This study seeks to close the critical gap by examining factors related to colorectal cancer screening among older Korean adults.

Methods: A sample of 290 community-dwelling Korean men and women aged 50 and over residing in Seoul and Kwangju in Korea was collected using a quota sampling. Participants age 50 to 59 completed self-administered questionnaires and participants age 60 or older had face-to-face interviews. Colorectal cancer screening including a fecal occult blood test (FOBT) and Colonoscopy/Sigmoidoscopy was the dependent variable in this study. Andersen’s health behavior model theoretically guided this study and hierarchical logistic regression was used to investigate the research aim.

Findings: Results showed that only 21.4% of the sample had undergone a FOBT within the past year, and a mere 37.2% of the respondents had received a sigmoidoscopy and/or a colonoscopy within the past five years. The significant predictors receiving a FOBT are marital status as a predisposing factor, having a primary hospital and a primary physician, family support, the level of cancer literacy as enabling factors, and depression as a need factor. The significant predictors receiving a sigmoidoscopy and/or a colonoscopy are gender and marital status as predisposing factors and having a primary physician as an enabling factor.

Implications: The findings reinforce a need for educating Korean older adults on the topic of cancer literacy and colorectal cancer screening guideline. Enhancing health care accessibility is another strategy to promote colorectal cancer screening in Korea. Establishing a health care policy that enables each patient to have his/her own primary care physician and usual source of care is urgent to promote colorectal cancer screening behaviors. Furthermore, a community education program aimed to increase older Koreans’ knowledge and benefit of colorectal cancer screening should be implemented as a part of the colorectal cancer screening intervention program.