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BMC Public Health. 2018 Jan 25;18(1):177. doi: 10.1186/s12889-018-5095-4.

Patterns and predictors of adherence to colorectal cancer screening recommendations in Alberta's Tomorrow Project participants stratified by risk.

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Cancer Measurement, Outcomes, Research and Evaluation, CancerControl Alberta, Alberta Health Services, Calgary, AB, Canada.
Alberta's Tomorrow Project, CancerControl Alberta, Alberta Health Services, 1820 Richmond Road SW, Calgary, AB, T2T 5C7, Canada.
Cancer Measurement, Outcomes, Research and Evaluation, CancerControl Alberta, Alberta Health Services, Calgary, AB, Canada.
Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
Department of Health and Physical Education, Faculty of Health, Community and Education, Mount Royal University, Calgary, AB, Canada.
Population, Public and Indigenous Health, Alberta Health Services, Calgary, AB, Canada.



Colorectal cancer (CRC) screening is an important modifiable behaviour for cancer control. Regular screening, following recommendations for the type, timing and frequency based on personal CRC risk, contributes to earlier detection and increases likelihood of successful treatment.


To determine adherence to screening recommendations in a large provincial cohort of adults, participants in Alberta's Tomorrow Project (n = 9641) were stratified based on increasing level of CRC risk: age (Age-only), family history of CRC (FamilyHx), personal history of bowel conditions (PersonalHx), or both (Family/PersonalHx) using self-reported information from questionnaires. Provincial and national guidelines for timing and frequency of screening tests were used to determine if participants were up-to-date based on their CRC risk. Screening status was compared between enrollment (2000-2006) and follow-up (2008) to determine screening pattern over time.


The majority of participants (77%) fell into the average risk Age-only strata. Only a third of this strata were up-to-date for screening at baseline, but the proportion increased across the higher risk strata, with > 90% of the highest risk Family/PersonalHx strata up-to-date at baseline. There was also a lower proportion (< 25%) of the Age-only group who were regular screeners over time compared to the higher risk strata, though age, higher income and uptake of other screening tests (e.g. mammography) were associated with a greater likelihood of regular screening in multinomial logistic regression.


The low (< 50%) adherence to regular CRC screening in average and moderate risk strata highlights the need to further explore barriers to uptake of screening across different risk profiles.


Cohort; Colonoscopy; Colorectal cancer; Early diagnosis; Screening

[Indexed for MEDLINE]
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