Lower Rate of Colorectal Cancer Screening May Be Linked to Higher Cancer Fatalism

Anne Miles, PhD

Higher cancer fatalism may be associated with a lower rate of colorectal cancer (CRC) screening, a recent study suggests. The term cancer fatalism refers to the belief that a cancer diagnosis leads inevitably to death.

The results show that even in the United Kingdom, where medical care is offered free of charge by the National Health Service (NHS), only slightly more than half of eligible patients opt for CRC testing. And individuals with a lower socioeconomic status (SES) present less often for testing than those with a higher SES.

Anne Miles, PhD, of the University of London, and colleagues examined responses to postal surveys that that looked at SES, self-rated health, and cancer fatalism in 529 men and women aged 60 to 69 years. The researchers also gathered data on fecal occult blood test (FOBT) uptake.

Colorectal cancer is the second major cause of cancer death in both the United Kingdom and worldwide, Miles and associates pointed out. The FOBT can decrease the relative risk of CRC mortality by up to 25% in patients who complete at least 1 FOBT. While free CRC screening programs are available in several countries, typically fewer than 60% of eligible individuals participate. Notably, lower uptake has been routinely linked to lower SES status, they said.

However, although a lack of health insurance may contribute to low screening rates in some countries, low screening rates are also seen in countries where healthcare is free. A better grasp of the determinants of SES differences in screening uptake is important for devising ways to decrease SES gaps in CRC mortality, the researchers added.

Although a lack of health insurance may contribute to low screening rates in some countries, low screening rates are also seen in countries where healthcare is free.

Results showed that screening uptake was 56% and was higher in people with higher SES, better self-rated health, and lower cancer fatalism. Thus, individuals who perceived that they were less healthy were more likely to be fatalistic about cancer and had lower screening rates. Unlike earlier reports, screening uptake did not appear to be influenced by gender, age, or ethnicity.

Miles and associates noted that cancer fatalism has also been linked with lower levels of other cancer-prevention behaviors besides CRC screening, including exercise and fruit and vegetable consumption, and is increasingly becoming a major target for intervention in cancer control. “There are beliefs about cancer that could be addressed in the years before a screening invitation that may enhance uptake among people with lower socioeconomic status,” the authors wrote.

They emphasized, however, that cancer fatalism is not well understood and “has been measured differently across different studies.”

Miles A, Rainbow S, von Wagner C. Cancer fatalism and poor self-rated health mediate the association between socioeconomic status and uptake of colorectal cancer screening in England [published online ahead of print September 27, 2011]. Cancer Epidemiol Biomarkers Prev. 2011;20(10);2132-2140.