Colonoscopy later than 270 days in a fecal immunochemical test-based population screening program is associated with higher prevalence of colorectal cancer

Endoscopy ◽  
2020 ◽  
Vol 52 (10) ◽  
pp. 871-876 ◽  
Author(s):  
Manuel Zorzi ◽  
Cesare Hassan ◽  
Giulia Capodaglio ◽  
Maddalena Baracco ◽  
Giulio Antonelli ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
High Risk ◽  
Screening Program ◽  
Waiting Times ◽  
Multivariable Analysis ◽  
Latex Agglutination ◽  
Old Patients ◽  
Screening Programs ◽  
Increased Risk ◽  
Immunochemical Test

Background Colorectal cancer (CRC) screening programs based on fecal immunochemical testing (FIT) generate substantial pressure on colonoscopy capacity in Europe. Thus, a relevant proportion of FIT-positive patients undergo colonoscopy after the recommended 30-day interval, which may be associated with an excess CRC risk. Methods In a cohort of 50–69-year-old patients undergoing biennial rounds of FIT (OC-Hemodia latex agglutination test; cutoff 20 µg hemoglobin/g feces) between 2004 and 2017, we assessed the outcome at colonoscopy (low/high risk adenoma/CRC/advanced stage CRC) among FIT-positive patients, according to different time intervals. The association of each outcome with waiting time, and demographic and clinical factors, was analyzed through multivariable analysis. Results 123 138/154 213 FIT-positive patients (79.8 %) underwent post-FIT colonoscopy. Time to colonoscopy was ≤ 30 days, 31–180 days, and ≥ 181 days in 50 406 (40.9 %), 71 724 (58.3 %), and 1008 (0.8 %) patients, respectively. At colonoscopy, CRC, high risk adenoma, and low risk adenoma were diagnosed in 4813 (3.9 %), 30 500 (24.8 %), and 22 986 (18.7 %) patients, respectively. An increased CRC prevalence at colonoscopy was observed for a time to colonoscopy of ≥ 270 days (odds ratio [OR] 1.75, 95 % confidence interval [CI] 1.15–2.67), whereas it was stable for waiting times of < 180 days. The proportion of advanced CRC also increased after 270 days (OR 2.79, 95 %CI 1.03–7.57). No increase for low or high risk adenomas according to time to colonoscopy was observed. Conclusion In a European FIT-based screening program, post-FIT colonoscopy after 9 months was associated with an increased risk of CRC and CRC progression.

Overall evaluation of an immunological latex agglutination system for fecal occult blood testing in the colorectal cancer screening program of Florence

2012 ◽  
Vol 27 (3) ◽  
pp. 195-202 ◽  
Author(s):  
Tiziana Rubeca ◽  
Benedetta Peruzzi ◽  
Massimo Confortini ◽  
Stefano Rapi
Keyword(s):  
Colorectal Cancer ◽  
Screening Program ◽  
Occult Blood ◽  
Fecal Occult Blood Testing ◽  
Latex Agglutination ◽  
Fecal Occult Blood ◽  
Detection Rates ◽  
Screening Programs ◽  
Fecal Occult ◽  
Advanced Adenomas

Several immunological fecal occult blood tests (FOBT) are currently available for colorectal cancer (CRC) screening. We compared the HM Jack (Jack) (Kiowa, Japan), with the OC-Hemodia (OC) (Eiken, Japan) in use in the Florence screening program. Aims of the study were: (i) to investigate the diagnostic performance and the best cutoff value for Jack; (ii) to evaluate the handiness of sampling tubes; (iii) to compare costs. A total of 5,044 subjects were screened with both tests. Sampling tube investigation was performed running each sample on both instruments. A number of 352 subjects positive for at least one test (175 OC, 310 Jack) were selected for further investigations, while 46 subjects refused further assessments. Analysis of costs related to the assessment phase was performed on the basis of Tuscany region's fares. Amongst the 306 subjects investigated, 9 CRC and 67 advanced adenomas (AdA) were detected. Detection rates (DR) were 1.4‰ for CRC and 9.6‰ for AdA. After Jack cutoff optimization, DR for CRC+AdA resulted in 11.1‰ for OC and 13.3‰ for Jack (p=0.041). Sensitivity of the methods was 73.7 for OC and 88.2 for Jack; specificity was 97.6 for OC and 96.0 for Jack, resulting in an increase of the required assessments from 3.5% to 5.1%. No differences were observed between sampling methods. Despite the lower specificity of Jack, its greater sensitivity makes the method attractive for screening programs. An increase of the costs of 30% for every subject investigated for pathological lesion (CRC+AdA) may be thus foreseen.

scholarly journals Performance of the Fecal Immunochemical Test in Patients With a Family History of Colorectal Cancer

2019 ◽  
Author(s):  
Sarvee Moosavi ◽  
Laura Gentile ◽  
Lovedeep Gondara ◽  
Colleen Mcgahan ◽  
Robert Alan Enns ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Logistic Regression ◽  
Family History ◽  
High Risk ◽  
Screening Program ◽  
Fecal Immunochemical Test ◽  
Study Cohort ◽  
Predictive Values ◽  
Two Samples ◽  
Immunochemical Test

Abstract Objective To assess the performance of a fecal immunochemical test (FIT) among participants of a population-based colorectal cancer (CRC) screening program with one or more first-degree relatives (FDR) with CRC. Methods Asymptomatic 50 to 74 years olds with a FDR diagnosed with CRC, enrolled in a colon screening program completed FIT (two samples, cut-off 20 µg Hemoglobin/gram feces) and underwent colonoscopy. FIT-interval CRCs were identified from the British Columbia cancer registry. Logistic regression analysis was used to identify variables associated with the detection of CRC and high-risk polyps (nonmalignant findings that required a 3-year surveillance colonoscopy) in those patients undergoing FIT and colonoscopy. Results Of the 1387 participants with a FDR with CRC, 1244 completed FIT with a positivity rate of 10.8%, 52 declined FIT but underwent colonoscopy and 90 declined screening. Seven CRCs were identified: six in patients with a positive FIT, one in a patient who only had colonoscopy. No CRCs were found in patients with a negative FIT. The positive and negative predictive values of FIT in the detection of CRC were 4.8% and 100%, respectively. On multivariate logistic regression, positive FIT, and not type of family history, was the only variable associated with detection of CRC or high-risk polyps. At 2-year follow-up, there was no FIT interval cancer detected in the study cohort. Conclusion FIT is more strongly associated with high-risk findings on colonoscopy than type of family history. FIT may be an alternative screening strategy to colonoscopy in individuals with a single FDR with CRC.

scholarly journals Overtreatment in nonmalignant lesions detected in a colorectal cancer screening program: a retrospective cohort study

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Joaquín Cubiella ◽  
Antía González ◽  
Raquel Almazán ◽  
Elena Rodríguez-Camacho ◽  
Raquel Zubizarreta ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Screening Program ◽  
Multivariable Analysis ◽  
Low Risk ◽  
Benign Lesions ◽  
Screening Programs ◽  
Crc Screening ◽  
European Guidelines ◽  
Adenoma Detection ◽  
Incidence And Mortality

Abstract Background Although colorectal cancer (CRC) screening programs reduce CRC incidence and mortality, they are associated with risks in healthy subjects. However, the risk of overtreatment and overdiagnosis has not been determined yet. The aim of this study was to report the surgery rates in patients with nonmalignant lesions detected within the first round of a fecal immunochemical test (FIT) based CRC screening program and the factors associated with it. Methods We included in this analysis all patients with nonmalignant lesions detected between May 2013 and June 2019 in the Galician (Spain) CRC screening program. We calculated surgery rate according to demographic variables, the risk classification according to the colonoscopy findings (European guidelines for quality assurance), the endoscopist’s adenoma detection rate (ADR) classified into quartiles and the hospital’s complexity level. We determined which variables were independently associated with surgery rate and expressed the association as Odds Ratio and its 95% confidence interval (CI). Results We included 15,707 patients in the analysis with high (19.9%), intermediate (26.9%) low risk (23.3%) adenomas and normal colonoscopy (29.9%) detected in the analyzed period. Colorectal surgery was performed in 162 patients (1.03, 95% CI 0.87–1.19), due to colonoscopy complications (0.02, 95% CI 0.00–0.05) and resection of colorectal benign lesions (1.00, 95% CI 0.85–1.16). Median hospital stay was 6 days with 17.3% patients developing minor complications, 7.4% major complications and one death. After discharge, complications developed in 18.4% patients. In benign lesions, an endoscopic resection was performed in 25.4% and a residual premalignant lesion was detected in 89.9%. The variables independently associated with surgery in the multivariable analysis were age (≥60 years = 1.57, 95% CI 1.11–2.23), sex (female = 2.10, 95% CI 1.52–2.91), the European guidelines classification (high risk = 67.94, 95% CI 24.87–185.59; intermediate risk = 5.63, 95% CI 1.89–16.80; low risk = 1.43; 95% CI 0.36–5.75), the endoscopist’s ADR (Q4 = 0.44, 95% CI 0.28–0.68; Q3 = 0.44, 95% CI 0.27–0.71; Q2 = 0.71, 95% CI 0.44–1.14) and the hospital (tertiary = 0.54, 95% CI 0.38–0.79). Conclusions In a CRC screening program, the surgery rate and the associated complications in patients with nonmalignant lesions are low, and related to age, sex, endoscopic findings, endoscopist’s ADR and the hospital’s complexity.

Colonoscopy-related adverse events and mortality in an Italian organized colorectal cancer screening program

Endoscopy ◽  
2020 ◽  
Author(s):  
Luca Benazzato ◽  
Manuel Zorzi ◽  
Giulio Antonelli ◽  
Stefano Guzzinati ◽  
Cesare Hassan ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cancer Screening ◽  
Adverse Events ◽  
Colorectal Cancer Screening ◽  
Screening Program ◽  
Multivariable Analysis ◽  
Screening Colonoscopy ◽  
Polyp Size ◽  
Screening Programs ◽  
Frequent Event

Abstract Background Post-colonoscopy adverse events are a key quality indicator in population-based colorectal cancer screening programs, and affect safety and costs. This study aimed to assess colonoscopy-related adverse events and mortality in a screening setting. Methods We retrieved data from patients undergoing colonoscopy within a screening program (fecal immunochemical test every 2 years, 50–69-year-olds, or post-polypectomy surveillance) in Italy between 2002 and 2014, to assess the rate of post-colonoscopy adverse events and mortality. Any admission within 30 days of screening colonoscopy was reviewed to capture possible events. Mortality registries were also matched with endoscopy databases to investigate 30-day post-colonoscopy mortality. Association of each outcome with patient-/procedure-related variables was assessed using multivariable analysis. Results Overall, 117 881 screening colonoscopies (66 584, 56.5 %, with polypectomy) were included. Overall, 497 (0.42 %) post-colonoscopy adverse events occurred: 281 (0.24 %) bleedings (3.69‰/0.68‰, operative/diagnostic procedures) and 65 (0.06 %) perforations (0.75‰/0.29‰, respectively). At multivariable analysis, bleeding was associated with polyp size (≥ 20 mm: odds ratio [OR] 16.29, 95 % confidence interval [CI] 9.38–28.29), proximal location (OR 1.46, 95 %CI 1.14–1.87), and histology severity (high risk adenoma: OR 5.6, 95 %CI 2.43–12.91), while perforation was associated with endoscopic resection (OR 2.91, 95 %CI 1.62–5.22), polyp size (OR 4.34, 95 %CI 1.46–12.92), and proximal location (OR 1.94, 95 %CI 1.12–3.37). Post-colonoscopy mortality occurred in 15 /117 881 cases (1.27/10 000 colonoscopies). Conclusions In an organized screening program, post-colonoscopy adverse events were rare but not negligible. The most frequent event was post-polypectomy bleeding, especially after resection of large (≥ 20 mm) and proximal lesions.

scholarly journals NF1 Patients Receiving Breast Cancer Screening: Insights from The Ontario High Risk Breast Screening Program

Cancers ◽  
2019 ◽  
Vol 11 (5) ◽  
pp. 707 ◽  
Author(s):  
Nika Maani ◽  
Shelley Westergard ◽  
Joanna Yang ◽  
Anabel M. Scaranelo ◽  
Stephanie Telesca ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Screening ◽  
High Risk ◽  
Breast Cancer Screening ◽  
Breast Screening ◽  
Screening Program ◽  
Type I ◽  
Screening Programs ◽  
Increased Risk ◽  
High Risk Breast

Neurofibromatosis Type I (NF1) is caused by variants in neurofibromin (NF1). NF1 predisposes to a variety of benign and malignant tumor types, including breast cancer. Women with NF1 <50 years of age possess an up to five-fold increased risk of developing breast cancer compared with the general population. Impaired emotional functioning is reported as a comorbidity that may influence the participation of NF1 patients in regular clinical surveillance despite their increased risk of breast and other cancers. Despite emphasis on breast cancer surveillance in women with NF1, the uptake and feasibility of high-risk screening programs in this population remains unclear. A retrospective chart review between 2014–2018 of female NF1 patients seen at the Elizabeth Raab Neurofibromatosis Clinic (ERNC) in Ontario was conducted to examine the uptake of high-risk breast cancer screening, radiologic findings, and breast cancer characteristics. 61 women with pathogenic variants in NF1 enrolled in the high-risk Ontario breast screening program (HR-OBSP); 95% completed at least one high-risk breast screening modality, and four were diagnosed with invasive breast cancer. Our findings support the integration of a formal breast screening programs in clinical management of NF1 patients.

scholarly journals Faecal immunochemical test after negative colonoscopy may reduce the risk of incident colorectal cancer in a population-based screening programme

Gut ◽  
2020 ◽  
pp. gutjnl-2020-320761
Author(s):  
Szu-Min Peng ◽  
Wen-Feng Hsu ◽  
Ying-Wei Wang ◽  
Li-Ju Lin ◽  
Amy Ming-Fang Yen ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Screening Programme ◽  
Multivariable Analysis ◽  
Study Cohort ◽  
Diagnostic Colonoscopy ◽  
Cox Regression Analysis ◽  
Faecal Immunochemical Test ◽  
Adenoma Detection ◽  
Increased Risk ◽  
Immunochemical Test

ObjectiveSubjects with a positive faecal immunochemical test (FIT) have a much higher likelihood of advanced neoplasms than the general population. Whether FIT-positive subjects with negative colonoscopy should receive subsequent FIT screening remain unclear.DesignSubjects with a negative colonoscopy after positive FIT in the first screening in the Taiwanese Colorectal Cancer (CRC) Screening Program 2004–2009 were followed until the end of 2014. CRC incidence was compared between those who did and did not receive subsequent FIT screening. Cox regression analysis was conducted, adjusting for major confounders to investigate whether subsequent FIT was associated with lower risk of incident CRC.ResultsThe study cohort was comprised of 9179 subjects who had negative diagnostic colonoscopy after positive FIT in 2004–2009, of whom 6195 received subsequent FIT during the study period. The CRC incidence (per 1000 person years) was 1.34 in those who received subsequent FIT and 2.69 in those who did not, with corresponding adjusted HR (aHR) of 0.47 (95% CI 0.31 to 0.71). Lower adenoma detection rate of diagnostic colonoscopy was associated with higher risk of incident CRC but became non-significant in multivariable analysis after adjustment for subsequent FIT. Higher baseline faecal haemoglobin concentration (FHbC, μg haemoglobin/g faeces) was associated with increased risk of incident CRC (reference: FHbC=20–39; aHR=1.93 (1.04–3.56), 0.95 (0.45–2.00), 2.26 (1.16–4.43) and 2.44 (1.44–4.12) for FHbC=40–59, 60–99, 100–149 and ≥150, respectively).ConclusionSubsequent FIT should be scheduled after negative colonoscopy to detect missed neoplasms and reduce the risk of incident CRC in a national FIT screening programme.

scholarly journals Overtreatment in Nonmalignant Lesions Detected in a Colorectal Cancer Screening Program: A Cross-Sectional Analysis.

2020 ◽  
Author(s):  
Joaquin Cubiella ◽  
Antía González ◽  
Raquel Almazán ◽  
Elena Rodríguez-Camacho ◽  
Raquel Zubizarreta ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Screening Program ◽  
Multivariable Analysis ◽  
Low Risk ◽  
Benign Lesions ◽  
Screening Programs ◽  
Crc Screening ◽  
European Guidelines ◽  
Adenoma Detection ◽  
Incidence And Mortality

Abstract Background: Although colorectal cancer (CRC) screening programs reduce CRC incidence and mortality, they are associated with risks in healthy subjects. However, the risk of overtreatment and overdiagnosis has not been determined yet. The aim of this study is to report the surgery rates in patients with nonmalignant lesions detected within the first round of a fecal immunochemical test (FIT) based CRC screening program and the factors associated with it. Methods: We included in this analysis all patients with nonmalignant lesions detected between May 2013 and June 2019. We calculated surgery rate according to demographic variables, the risk classification according to the colonoscopy findings (European guidelines for quality assurance), the endoscopist’s adenoma detection rate (ADR) classified into quartiles and the hospital’s complexity level. We determined which variables were independently associated with surgery rate and expressed the association as Odds Ratio and its 95% confidence interval (CI).Results: We included 15,707 patients in the analysis with high (19.3%), intermediate (25.1%) low risk (21.7%) adenomas and normal colonoscopy (27.8%) detected in the analyzed period. Colorectal surgery was performed in 162 (10.3‰, 95% CI 8.7-11.9), due to colonoscopy complications (0.2‰, 95% CI 0.005-0.5) and resection of colorectal benign lesions (10.0‰, 95% CI 8.5-11.6). Median hospital stay was 6 days with 17.3% patients developing minor complications, 7.4% major complications, one death. After discharge, complications developed in 18.4% patients. In benign lesions, an endoscopic resection was performed in 25.4% and a residual premalignant lesion was detected in 89.9%. The variables independently associated with surgery in the multivariable analysis were age (≥60 years= 1.57, 95% CI 1.11-2.23), sex (female= 2.10, 95% CI 1.52-2.91), the European guidelines classification (high risk= 67.94, 95% CI 24.87-185.59; intermediate risk= 5.63, 95% CI 1.89-16.80; low risk= 1.43; 95% CI 0.36-5.75), the endoscopist’s ADR (Q4= 0.44, 95% CI 0.28-0.68; Q3= 0.44, 95% CI 0.27-0.71; Q2= 0.71, 95% CI 0.44-1.14) and the hospital (third level= 0.54, 95% CI 0.38-0.79). Conclusions: In a CRC screening program, the surgery rate and the associated complications in patients with nonmalignant lesions are acceptable and related to age, sex, endoscopic findings, endoscopist’s ADR and the hospital’s complexity.

Risk factors of colorectal cancer after screening colonoscopy

2021 ◽  
Vol 8 ◽  
pp. 25-29
Author(s):  
Paulina Wieszczy ◽  
Michał F. Kamiński ◽  
Jarosław Reguła
Keyword(s):  
Colorectal Cancer ◽  
High Risk ◽  
Screening Program ◽  
Risk Group ◽  
High Risk Group ◽  
High Grade Dysplasia ◽  
Screening Colonoscopy ◽  
High Grade ◽  
Screening Programs

In the era of populational screening programs for colorectal cancer, evaluation of their quality and efficacy becomes an important issue. One of the main criteria taken into account when assessing the quality of a screening program is related to the risk of colorectal cancer developing in the period between the screening colonoscopy and the control examination. The objective of this article consists in presenting the results of the doctoral research carried out by dr. Paulina Wieszcza, a beneficient of the Polpharma Scientific Foundation scholarship. The objective of the doctoral dissertation was to investigate and discuss the relationship between the definition of risk groups as well as the quality of the study and the risk of colorectal cancer developing after the screening colonoscopy. The risk of colorectal cancer developing following adenomas being removed during the screening colonoscopy procedure was assessed using data obtained from the Colorectal Cancer Screening Program and the National Cancer Registry databases. The quality of the study was assessed on the basis of literature evidence regarding the adenoma detection rates (ADR). A total of 236.089 patients were included in colorectal cancer risk analyses, with at least one adenoma being detected in a screening study in 17.7% of cases. Over the follow-up period (median of 7 years, maximum duration of 14 years), colorectal cancer was detected in 439 patients. It was demonstrated that when the high-risk group was defined as patients presenting with adenomas ≥ 20 mm in diameter or high grade dysplasia rather than patients with ≥ 3 adenomas or adenomas ≥10 mm in diameter with high grade dysplasia or villous component (current definition), the number of patients requiring intensive surveillance can be reduced by 74% without any impact on the risk in the low-risk group. The literature review revealed a total of three studies which clearly showed that the risk of colorectal cancer significantly decreased with the increase in the endoscopist’s ADR. Restricting the high-risk group to patients with adenomas ≥ 20 mm in diameter or high-grade dysplasia facilitates optimized care being delivered to patients with a significantly increased risk of colorectal cancer. Scientific evidence is available for the important role of endoscopist’s ADR as the key parameter of the quality of colonoscopic examination.

scholarly journals Quality Monitoring of a FIT-Based Colorectal Cancer Screening Program

2019 ◽  
Vol 65 (3) ◽  
pp. 419-426 ◽  
Author(s):  
Esther Toes-Zoutendijk ◽  
Johannes M G Bonfrer ◽  
Christian Ramakers ◽  
Marc Thelen ◽  
Manon C W Spaander ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Screening Program ◽  
Small Difference ◽  
Regression Analyses ◽  
Detection Rates ◽  
Screening Programs ◽  
Crc Screening ◽  
Specimen Collection ◽  
Cancer Screening Program ◽  
Immunochemical Test

Abstract BACKGROUND Quality assessment is crucial for consistent program performance of colorectal cancer (CRC) screening programs using fecal immunochemical test for hemoglobin (FIT). However, literature on the consistency of FIT performance in laboratory medicine was lacking. This study examined the consistency of FIT in testing positive or detecting advanced neoplasia (AN) for different specimen collection devices, lot reagents, and laboratories. METHODS All participants with a FIT sample with a cutoff concentration of 47 μg Hb/g feces in the Dutch CRC screening program in 2014 and 2015 were included in the analyses. Multivariable logistic regression analyses were performed to estimate the odds ratios of collection devices, reagents, and laboratories on testing positive or detecting AN and positive predictive value (PPV). RESULTS In total, 87519 (6.4%) of the 1371169 participants tested positive. Positivity rates and detection rates of AN differed between collection devices and reagents (all P &lt; 0.01). In contrast, PPVs were not found to vary between collection devices, reagents, or laboratories (all P &gt; 0.05). Positivity rates showed a small difference for laboratories (P = 0.004) but not for detection rates of AN. Size of the population affected by the deviating positivity rates was small (0.1% of the total tested population). CONCLUSIONS Variations were observed in positivity and detection rates between collection devices and reagents, but there was no detected variation in PPV. Although the overall population effect of these variations on the screened population is expected to be modest, there is room for improvement.

scholarly journals To do or not to do – a survey study on factors associated with participating in the Danish screening program for colorectal cancer

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jesper Bo Nielsen ◽  
Gabriele Berg-Beckhoff ◽  
Anja Leppin
Keyword(s):  
Colorectal Cancer ◽  
Screening Program ◽  
Demographic Data ◽  
Survey Study ◽  
Stepwise Logistic Regression ◽  
Willingness To Participate ◽  
Cross Sectional Survey ◽  
Screening Programs ◽  
Crc Screening ◽  
Screening Participation

Abstract Background Screening programs for colorectal cancer (CRC) exist in many countries, and with varying participation rates. The present study aimed at identifying socio-demographic factors for accepting a cost-free screening offer for CRC in Denmark, and to study if more people would accept the screening offer if the present fecal test was replaced by a blood test. Methods We used a cross-sectional survey design based on a representative group of 6807 Danish citizens aged 50–80 years returning a fully answered web-based questionnaire with socio-demographic data added from national registries. Data were analyzed in STATA and based on bivariate analyses followed by regression models. Results Danes in general have a high level of lifetime participation (+ 80%) in the national CRC screening program. The results of the stepwise logistic regression model to predict CRC screening participation demonstrated that female gender, higher age, higher income, and moderate alcohol intake were positively associated with screening participation, whereas a negative association was observed for higher educational attainment, obesity, being a smoker, and higher willingness to take health risks. Of the 1026 respondents not accepting the screening offer, 61% were willing to reconsider their initial negative response if the fecal sampling procedure were replaced by blood sampling. Conclusion The CRC screening program intends to include the entire population within a certain at-risk age group. However, individual factors (e.g. sex, age obesity, smoking, risk aversity) appear to significantly affect willingness to participate in the screening program. From a preventive perspective, our findings indicate the need for a more targeted approach trying to reach these groups.

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