Patterns and determinants of adherence to primary and secondary colorectal cancer prevention recommendations in the BC Generations Project

Introduction. Adherence to cancer prevention recommendations can greatly reduce the risk of colorectal cancer. This study investigates the patterns and determinants of adherence to these recommendations by participants (n = 26 074) at baseline in a cohort study in British Columbia, Canada. Methodology. We measured adherence to five primary colorectal cancer prevention behaviors from recommendations issued by the Canadian Cancer Society and the World Cancer Research Fund (smoking cessation, body mass index (BMI), physical activity, alcohol consumption, and fruit and vegetable consumption) and developed a composite score based on the sum of the measures. The definition of adherence to secondary prevention behaviors was based on the recommendations of the Canadian Task Force on Preventive Health Care for colorectal cancer screening. Results. Adherence to primary prevention guidelines ranged from 94.8% (no smoking) to 44.2% (healthy BMI). The median composite score was 4. Higher composite scores were associated with being female, being married, and having higher education. The colorectal cancer screening adherence rate was 62.4%. Older age, the presence of chronic disease, having had a recent medical examination, and being in a high-income household were associated with an increased likelihood of screening adherence. Conclusion. Adherence to some colorectal cancer prevention behaviors was found to be high, consistent with findings that British Columbia has low rates for many health risk behaviors. However, there was a clustering of lower adherence to prevention behaviors with each other and in the presence of other risk factors. Adherence to screening was found to be high, but varied with certain sociodemographic and health factors. Future work should focus on targeted interventions to improve adherence among individuals in groups with the most precarious socioeconomic and health status. There is also a need to better understand the barriers to access and participation in colorectal cancer screening that persist even within the Canadian public health system.