Purpose: Despite the proven effectiveness of colorectal cancer screening (CRCS), nearly 50% of Americans are not up-to-date. While repeat screening maximizes effectiveness, this behavior has not been well-studied. Staging models have been used to understand readiness to adopt and/or maintain preventive behaviors. Accordingly, we staged CRCS behavior at two time points to monitor changes in CRCS intention and behavior.

Methods: From the VA Pittsburgh primary care clinic, 158 males (aged 50-74 years) were staged at baseline and 15 months for completion of acceptable CRCS tests: fecal occult blood testing (FOBT) and flexible sigmoidoscopy (FS). Stages included: Pre-Contemplation (never completed a test and not intending to); Contemplation (never completed a test but intending to); Action (current with screening and intending to repeat); Relapse Risk (current with screening but not intending to repeat); and, Relapse (prior completion but not current with screening). Summary statistics describe the cohort at baseline and 15-months. Tests of marginal homogeneity assessed changes in staging between baseline and follow-up.

Results: For FOBT: Pre-Contemplation (n= 10 at baseline) 50% were unchanged at follow-up, 40% advanced to Contemplation, 10% advanced to Action; Contemplation (n=14) 71% unchanged, 14% regressed to Pre-Contemplation, 14% advanced to Action; Action (n=89) 62% unchanged, 1% regressed to Relapse Risk, 37% regressed to Relapse; Relapse Risk (n=5) 80% regressed to Relapse, 20% advanced to Action; and Relapse (n=38) 66% unchanged, 3% advanced to Relapse Risk, 32% advanced to Action. For FS: Pre-Contemplation (n=59) 44% unchanged, 56% advanced to Contemplation; Contemplation (n=20) 60% unchanged, 20% regressed to Pre-Contemplation, 20% advanced to Action; Action (n=45) 82% unchanged, 18% regressed to Relapse Risk; Relapse Risk (n=10) 50% unchanged, 50% advanced to Action; and Relapse (n=16) 100% unchanged. There were significant differences in staging from baseline to follow-up for FOBT (p < .05) and FS (p < .001).

Conclusions: Staging over time was not static. For both FOBT and FS, there is a high degree of movement from Pre-Contemplation to Contemplation while those in Contemplation are not likely to advance to Action. Movement, from Relapse Risk and Relapse, to Action appears different for FOBT compared to FS. When addressing CRCS, it would be worthwhile to reassess an individual's stage over time to accommodate changes in the intent and performance of this lifesaving behavior.