摘要：Objectives. We examined the prevalence of endoscopy (sigmoidoscopy or colonoscopy) by indication and by demographic and lifestyle factors. Methods. We analyzed cross-sectional data collected in 1997 from participants aged 50 years and older in the Cancer Prevention Study (CPS) II Nutrition Cohort. Results. Fifty-eight percent of men and 51% of women reported ever having undergone endoscopy; only 42% of men and 31% of women reported endoscopy for screening rather than for disease diagnosis or follow-up. Prevalence varied by demographic and lifestyle factors. Conclusions . Efforts to increase colorectal cancer screening need to target women, all persons aged 50–64 years, and those with colorectal cancer risk factors. Future studies should distinguish endoscopy for screening from procedures for disease diagnosis and follow-up to avoid overestimating screening compliance. Flexible sigmoidoscopy 1– 4 and colonoscopy 5– 9 have been shown to be effective in reducing colorectal cancer mortality by allowing for the early detection and removal of colorectal cancers and preneoplastic lesions. Despite the known efficacy of colorectal cancer screening and widely publicized screening guidelines issued by national organizations since the late 1970s, 10– 16 the use of endoscopic screening in the general population remains low. 17– 22 According to the 1998 National Health Interview Survey (NHIS), only 37% of adults aged 50 and older reported having ever undergone sigmoidoscopy. 21 The 2001 Behavioral Risk Factor Surveillance System (BRFSS) found that 47% of adults aged 50 years and older reported ever receiving lower endoscopy; 22 this national survey 17, 22 does not separate procedures for colorectal cancer screening from tests for disease diagnosis or follow-up. Population-based prevalence estimates of endoscopy use also do not distinguish procedures performed in high-risk persons from those performed in average-risk persons, even though screening guidelines now specify earlier and more frequent screening in persons at high risk, based on personal and family history of colorectal diseases. 13– 16 Furthermore, little is known about demographic and lifestyle factors associated with screening endoscopy beyond health insurance coverage and access to health care. 19, 20, 23 One of the Healthy People 2010 objectives is to increase to 50% the proportion of adults aged 50 years and older who have ever undergone a sigmoidoscopy. 21 The corresponding American Cancer Society 2015 objective is to increase the usage of endoscopic screening, fecal occult blood testing (FOBT), or both to 75% in adults aged 50 years and older. 24 We analyzed cross-sectional data collected in 1997 from participants in the Cancer Prevention Study (CPS) II Nutrition Cohort to examine the prevalence of endoscopy use for colorectal cancer screening (as distinguished from disease diagnosis and surveillance) and to identify demographic and lifestyle factors associated with use of screening endoscopy.
