***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Colorectal carcinoma ranks as the second most common cancer and the second leading cause of cancer death in the United States . Hispanics are less likely than their non‐Hispanic white counterparts to have ever received a  fecal occult blood test ( FOBT ) or sigmoidoscopy/colonoscopy . Little is known about the barriers to screening in the Hispanic population This study aim ed to identify the social , cultural and psychological characteristics influencing behaviour in a cancer mass screening campaign in a French population . The intention to take a screening test and actually doing it was studied , in particular . A self reported- question naire was mailed in December 1992 to a r and om sample of people living in Caen ( western France ) , and aged from 45 - 74 years . The sample was formed by r and om selection from electoral registers . The study was population based , in the Caen area , department of Calvados , France . The question naire comprised 26 open and close questions . Starting in February 1993 , the occult blood screening test ( haemoccult IIR ) for colorectal cancer was offered by general practitioners ( GPs ) , occupational health doctors and pharmacists in the Caen area to all those aged 45 - 74 years . From 1 February 1993 to 30 June 1994 , the data on the mass screening campaign were central ized and the study population divided into those who took the screening test and those who did not . Of the 1,129 persons contacted , 645 ( 57.1 % ) returned the question naire . After exclusions , 585 question naires were used for analysis . The results show that whether a person will actually take a screening test can not be predicted from their intention to do so . The sociodemographic and cultural characteristics influencing the intention to take the test differ from those influencing execution of the test . Among the variables tested here , the following four sociodemographic and cultural characteristics were independently predictive of actually taking the screening test for colorectal cancer : compliance with the health insurer 's advice ; low or medium sociodemographic status , living with a partner ( or widowhood ) ; and not knowing someone with cancer . The analysis of the quantitative and qualitative differences between the intention to take the test and actually doing it could eluci date the reasons underlying refusal . Poor screening compliance has multiple causes . A record of intention to take a screening test alone is not appropriate . This type of study should no longer be carried out to determine the mechanisms underlying behaviour towards secondary prevention Objective — To survey screening practice s , knowledge , and attitudes towards screening among first degree relatives of people with colon cancer . Setting — A r and om sample of people with colon cancer listed on the New South Wales ( NSW ) Cancer Registry were mailed a question naire to be passed on to an appropriate first degree relative . Methods — Two hundred and twenty five first degree relatives completed a self administered question naire . Results — Although there were high levels of awareness about colorectal cancer , and attitudes towards colorectal cancer were generally positive , screening rates were low , and only three relatives had been screened in accordance with current Australian recommendations . Factors associated with previous participation in any type of screening test  ( usually once ) included receiving a medical recommendation to screen , having more than one relative with colorectal cancer , being a sibling of the relative with colon cancer , the relative with cancer being female , and perceiving screening as messy , but not painful . Conclusions — Strategies to enhance screening awareness and participation among relatives need to be considered . This study provides some insight into factors to be considered in developing awareness programmes . Further research is required to explore these factors , and to identify ways to overcome barriers BACKGROUND Breast cancer is the most prevalent malignancy among women in Israel , and routine screening is recommended for early detection . In 1997 , a health management organization primary care centre in rural Israel established a 1-year programme wherein family physicians were encouraged to remind their patients to undergo breast cancer examinations . This study evaluates the impact of the physicians ' intervention on patient compliance . METHODS Family practitioners from two practice s were requested to discuss the importance of early breast cancer detection with all eligible patients who visited the clinic for any reason and to assist them in scheduling an appointment for screening .  The files of the patients who received the recommendation were stamped accordingly . On completion of the programme , the physicians ' files were audited , and the potential c and i date s for breast cancer screening were divided into two groups : those who had received the intervention ( n = 251 ) and those who had not ( n = 187 ) ; results were also compared with those of a third group of patients who had gone for an examination on their own initiative ( n = 100 ) prior to the study ( i.e. did not require intervention ) . A r and om sample of half the patients also completed an ad hoc question naire covering sociodemographic variables and the impact of the doctors ' intervention on their behaviour . RESULTS Patients in the intervention group showed a significantly greater change in behaviour regarding breast cancer screening than the controls ( 32 % versus 13 % , P = 0.001 ) . This change was manifested particularly in the group of women aged 50 - 74 years who received the recommendation for mammography to be performed ( according to the guidelines ) . CONCLUSION Although this is a study in only two practice s , the results suggest that primary care physicians can significantly alter the behaviour of their patients regarding regular breast examinations . The use of a special reminder can also help the individual doctor to ensure that each patient has been properly instructed BACKGROUND An explanatory framework referred to as the Preventive Health Model was used to identify factors associated with prospect i ve adherence to colorectal cancer screening . METHODS Data on sociodemographic , psychosocial , social influence , and program factors were collected via telephone survey  for 501 older adult members of an independent practice association-type health maintenance organization . Subjects were later mailed fecal occult blood tests for completion and return . Adherence was defined as the return of the tests within 90 days . RESULTS Structural analysis shows that for men ( N = 145 ) , perceived self-efficacy ( OR = 1.4 ) , salience and coherence of testing ( OR = 2.3 for a 5-point increment on a 30-point scale ) , and exposure to  health education interventions ( OR = 6.8 ) were significant independent predictors of intention to adhere and of adherence . Among women ( N = 185 ) , predictors were age ( OR = 1.8 ) and salience and coherence of testing ( OR = 1.8 for a 5-point increment on a 30-point scale ) . CONCLUSIONS These findings indicate that for both men and women , adherence is influenced strongly by the extent to which the behavior is judged to make sense in everyday life . It also appears that additional education and encouragement may persuade men and younger women to participate in screening BACKGROUND Even though colorectal cancer ( CRC ) screening tests for persons 50 years of age or over are recommended to reduce colorectal cancer mortality , screening rates remain disturbingly low . METHODS Using r and om digit dialing , 355 telephone interviews  were conducted with black and white men and women , 50 - 79 years of age , who resided in Genesee County , Michigan . The Health Belief Model provided the framework to assess attitudes and practice s regarding CRC screening . RESULTS For both endoscopic procedures , significantly higher percentages of whites than blacks were aware of the screening procedure ( P < 0.05 ) . Overall , fewer than 30 % of respondents were adherent to current CRC screening guidelines . Adherence was lowest for black females : 21 % for fecal occult blood test , 20 % for flexible sigmoidoscopy , and 12 % for colonoscopy .  Black males compared to black females were about 2.8 times more likely to have had either flexible sigmoidoscopy or colonoscopy ( P < 0.05 ) . Physician recommendation was a powerful motivator to screening . Two consistent barriers to screening were the belief that : ( a ) the test is not needed ; and ( b ) the test is embarrassing . CONCLUSIONS Interventions directed at physicians and patients are essential to enhance CRC screening rates . CRC survival rates may be improved by physician-guided promotion of screening that focuses on identified barriers 
    Output:
    
There were important inconsistencies among studies in the factors that were associated with screening .
Receiving recommendations from clinicians was the most consistent predictor identified across studies .
The review also revealed a consistent pattern of association with predictors related to familial aspects of CRC , such as strength of family history , and relationship to the affected relative .
Among the psychological constructs , " social influence " emerged as the most consistent predictor of screening participation .
This review provides evidence that clinicians , as well as use of family history and social networks , offer the most promising avenues to promoting and improving screening participation by individuals at increased risk of colorectal cancer