People who have problems with numbers may be more likely to feel negative about colorectal cancer screening, including fearing an abnormal result, while some think the test is disgusting or embarrassing, according to a study published in the Journal of Health Psychology (2014; doi:10.1177/1359105314560919).

The researchers, from Cancer Research UK in the United Kingdom, sent information about colorectal cancer screening to patients ages 45 to 59 years along with a questionnaire that assessed their numerical skills and attitudes to the screening test, which looks for blood in stool samples.

Almost 965 people from four general practitioner practices in the north of England returned the questionnaire. It asked: Which of the following numbers represents the biggest risk of getting a disease: 1 in 100, 1 in 1,000, 1 in 10? Nearly half (46%) answered the question incorrectly.

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These people, considered to have low numeracy skills, were also more negative about the colorectal cancer screening test, and these attitudes made them less inclined to take part in screening than those who answered the question correctly.

They were more likely to think taking the test was disgusting, embarrassing, or tempting fate, and to be more afraid of an abnormal result. They also tended to know less about colorectal cancer and were more likely to avoid or ignore cancer information, even when other factors such as education and ethnicity were taken into account.

“People’s comprehension of numbers may have links with how well they understand and use information about bowel [colorectal] cancer screening,” said lead study author Samuel Smith, PhD, based at Queen Mary University of London. “Our findings could help to improve how we discuss screening with the public. That might be through targeted campaigns in deprived areas where low numeracy and literacy skills are more common, or through health workers discussing screening with people who might be inclined to ignore written information or think they don’t need to take a screening test.

“More research is needed but changes to the test itself that make it quicker and easier to use, might also help to increase the number of people with low numeracy skills who take part in screening, by reducing barriers such as disgust or embarrassment.”

Those with low numeracy skills were more likely to have a defensive attitude to cancer information, such as saying they did not need screening because their colorectal movements were regular, they ate healthily, or their physician had not told them that the test was important.

The study was part of a project that aims to find ways of getting more people, whoever and wherever they are, to consider undergoing colorectal cancer screening when it’s offered to them. Researchers say that using results from the study to specifically target those with low numeracy skills could help to achieve this.