This study aims to examine lifestyle predictors of the utilization of colorectal cancer screening. Using modified Poisson regression, we studied self-reported colorectal cancer screening utilization (colonoscopy or fecal occult blood test) with various dietary and lifestyle characteristics among 33,922 subjects aged 51 + years in the Adventist Health Study-2, a large population-based prospective cohort study. According to the multivariable-adjusted models, vegetarians were less likely to report screening: vegans, prevalence ratio (PR) = 0.80 (95% confidence interval 0.77–0.83); lacto-ovo-vegetarians (0.95 [0.93–0.97]); and semi-vegetarians (0.97 [0.94–0.99]) compared to non-vegetarians. Blacks were more likely than non-Blacks to be screened (1.04 [1.02–1.06]) and males were less likely (0.93 [0.92–0.95]) to utilize the screening tests. Older subjects were more likely to be screened, and unmarried and divorced/widowed subjects were less likely to screen. Education, personal income, and BMI were positively associated with screening, with p-value for trend < 0.001 for all three variables. A family history of colorectal cancer was associated with higher screening prevalence (1.15 [1.12–1.17]). Our stratified analyses on race and gender with dietary patterns showed non-Hispanic White vegans (PR = 0.77 [0.74–0.81]) and male vegans (PR = 0.76 [0.72–0.81]) were least likely compliant with colorectal cancer screening (p = 0.009 and p = 0.04, respectively). Vegans may believe that their personal risk for colorectal cancer is low due to their healthy lifestyle, resulting in lack of compliance to colorectal cancer screening. It remains to be seen whether vegans in AHS-2 also experience higher incidence of colorectal cancer or are diagnosed at a later stage.

本研究旨在检验结直肠癌筛查利用的生活方式预测因素。使用改良的泊松回归，我们研究了 Adventist Health Study-2 中 33,922 名年龄在 51 岁以上的受试者的自我报告的结直肠癌筛查利用情况（结肠镜检查或粪便隐血试验）以及各种饮食和生活方式特征，这是一个基于人群的大型前瞻性队列学习。根据多变量调整模型，素食者不太可能报告筛查：素食者，患病率 (PR) = 0.80（95% 置信区间 0.77–0.83）；乳蛋素食者 (0.95 [0.93–0.97])；与非素食者相比，半素食者 (0.97 [0.94–0.99])。黑人比非黑人更有可能接受筛查 (1.04 [1.02–1.06])，男性不太可能 (0.93 [0.92–0.95]) 利用筛查测试。年龄较大的受试者更有可能接受筛查，未婚和离婚/丧偶的受试者不太可能接受筛查。教育、个人收入和 BMI 与筛查呈正相关，所有三个变量的趋势 p 值 < 0.001。结直肠癌家族史与较高的筛查患病率相关 (1.15 [1.12–1.17])。我们对种族和性别以及饮食模式的分层分析显示，非西班牙裔白人纯素食者 (PR = 0.77 [0.74–0.81]) 和男性纯素食者 (PR = 0.76 [0.72–0.81]) 最不可能符合结直肠癌筛查 ( 结直肠癌家族史与较高的筛查患病率相关 (1.15 [1.12–1.17])。我们对种族和性别以及饮食模式的分层分析显示，非西班牙裔白人纯素食者 (PR = 0.77 [0.74–0.81]) 和男性纯素食者 (PR = 0.76 [0.72–0.81]) 最不可能符合结直肠癌筛查 ( 结直肠癌家族史与较高的筛查患病率相关 (1.15 [1.12–1.17])。我们对种族和性别以及饮食模式的分层分析显示，非西班牙裔白人纯素食者 (PR = 0.77 [0.74–0.81]) 和男性纯素食者 (PR = 0.76 [0.72–0.81]) 最不可能符合结直肠癌筛查 (p  = 0.009 和 p = 0.04）。纯素食者可能认为，由于他们健康的生活方式，他们患结直肠癌的个人风险很低，导致对结直肠癌筛查缺乏依从性。AHS-2 中的纯素食者是否也会经历更高的结直肠癌发病率或在后期被诊断出来还有待观察。