Why Should I Get Screened? Addressing Common Misconceptions About Colorectal Cancer Screening

Background:  Of cancers affecting both men and women, colorectal cancer (CRC) is the second leading cancer killer in the United States. CRC is largely preventable. Screening, beginning at age 50, helps prevent CRC or find it early, when treatment works best.  Still, approximately 40% of Americans have not been screened as recommended.   

Program background:  The Centers for Disease Control and Prevention’s (CDC) Screen for Life: National Colorectal Cancer Action Campaign (SFL) educates men and women about the importance of CRC screening.  SFL creates and disseminates PSAs and patient education materials, and works with health departments to promote CRC screening. Creation of SFL materials is informed by substantial audience research.  In 2010, SFL conducted focus groups in English and Spanish in Philadelphia, PA, Los Angeles, CA, Chicago, IL, Miami, FL, and Charleston, SC, to assess knowledge, attitudes, and behaviors of the target audience about CRC and screening, and to test PSA creative concepts.  While most participants expressed awareness about CRC and colonoscopy as a screening test, they were less knowledgeable about other screening test options and who should be screened.  Common reasons expressed for avoiding screening included:  an absence of symptoms, lack of family history, and belief that they were not in the age group for which screening is recommended—all misconceptions.  Many also expressed reluctance to undergo colonoscopy because of perceived discomfort associated with it.     Concepts that clearly communicated facts about screening and directly addressed misconceptions resonated most with focus groups participants, who also expressed appreciation for including racial and ethnic diversity in the creative concepts. These findings led SFL to produce TV and print PSAs titled “No Excuses” (“No Hay Excusas” in Spanish).  They feature diverse men and women stating misconceptions and excuses for why they have not been screened, along with the facts correcting these misconceptions. PSAs were distributed in March 2012.  Postcards and posters were adapted from the PSAs and made available through the SFL website.  In December 2012, “No Excuses” and “No Hay Excusas” display PSAs were distributed to airports, shopping malls, and transit systems in targeted U.S. cities. 

Evaluation Methods and Results:  TV PSAs are tracked electronically to provide information on the number and times of airplays, media outlets, audience impressions (number of times PSAs are seen or heard) and donated ad value. Print PSAs are tracked using a clipping service, providing publication names, markets, impressions, and equivalent ad value.  To-date, “No Excuses” and “No Hay Excusas” PSAs in all media have generated more than 787 million impressions worth $15.7 million in donated ad value.  (Up-to-date PSA tracking results will be shared at the conference.)

Conclusions:  Since the campaign’s launch in 1999, consumer knowledge and attitudes about CRC screening have shifted.  While screening rates have increased significantly (from 54% in 2002 to approximately 65% in 2010), misconceptions about screening still exist.  Addressing misconceptions in educational materials may encourage more people to be screened as recommended.

Implications for research and/or practice:  Acknowledging common misconceptions about CRC screening in a direct way can help to effectively promote appropriate screening for this highly preventable cancer.