Public Awareness of Colorectal Cancer Screening: Knowledge, Attitudes, and Interventions for Increasing Screening Uptake

Colorectal cancer ranks as one of the most incidental and death malignancies worldwide. Colorectal cancer screening has proven its benefit in terms of incidence and mortality reduction in randomized controlled trials. In fact, it has been recommended by medical organizations either in average-risk or family-risk populations. Success of a screening campaign highly depends on how compliant the target population is. Several factors influence colorectal cancer screening uptake including sociodemographics, provider and healthcare system factors, and psychosocial factors. Awareness of the target population of colorectal cancer and screening is crucial in order to increase screening participation rates. Knowledge about this disease and its prevention has been used across studies as a measurement of public awareness. Some studies found a positive relationship between knowledge about colorectal cancer, risk perception, and attitudes (perceived benefits and barriers against screening) and willingness to participate in a colorectal cancer screening campaign. The mentioned factors are modifiable and therefore susceptible of intervention. In fact, interventional studies focused on average-risk population have tried to increase colorectal cancer screening uptake by improving public knowledge and modifying attitudes. In the present paper, we reviewed the factors impacting adherence to colorectal cancer screening and interventions targeting participants for increasing screening uptake.

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Colorectal Cancer Screening Programme: Algarve Preliminary data

European Journal of Public Health ◽

10.1093/eurpub/ckz186.685 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

M Correia ◽

M Cancela ◽

P Caldeira ◽

J Morera ◽

C Cardoso ◽

...

Keyword(s):

Colorectal Cancer ◽

Cancer Screening ◽

Early Diagnosis ◽

Colorectal Cancer Screening ◽

Cancer Detection ◽

Burden Of Disease ◽

Public Awareness ◽

Target Population ◽

University Hospital ◽

Invasive Treatment

Abstract Problem The burden of disease for oncological problems is significant in Portugal. Population-based screenings, such as colorectal cancer screening (CCS) with faecal occult blood tests (FIT) is a priority program to reduce the burden of disease and a cost-effectiveness measure. Description problem Algarve CCS started in 2017,to early detect colorectal cancer reducing morbidity and mortality. Screening strategy to detect and remove cancer precursors (adenomas) and early cancer detection with less invasive treatment using a non-invasive stool test was selected. A quantitative faecal immunochemical test for haemoglobin (FIT) with higher sensitivity for adenoma and cancer, specific for human globin with no dietary restriction, with a single sample screening is considered a test with higher participation. Target population all gender from 50 to 75 are invited to participate in the CCS by letter. Screening interval is 2 years and FIT cut-off- 117 (ng Hb/mL). Software was used to manage all CCS. Health units distribute the test and a flyer. All FIT-positive were invited to do a full colonoscopy at University Hospital. Results A preliminary descriptive analysis (2017/2019) was made. After exclusions 25017 of target population participate 34,4%(n = 8594),27.5%(n = 6883) submitted it for analysis, 3.9% (n = 266) had positive FIT and were invited for a full colonoscopy with 57.5% (n = 153)participation rate. Cancer detection was 0.9‰ and adenomas detection rate was 9.9%. FIT positive with colonoscopy 3.9% (n = 6) had carcinoma and 44.4% (n = 68) had adenoma. Lessons Some operational changes were made to improve participants and professionals adherence to CCS. Pathology observed in the positive cases, reinforce the need to implement strategies to increase literacy, raise public awareness, keep the screening test and improve accessibility of health facilities. Key messages The importance of a colorectal cancer early diagnosis prevent aggressive interventions in a precancerous phase. The importance of a colorectal cancer early diagnosis improves survival and population quality of life.

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Evaluating Screening Participation, Follow-up, and Outcomes for Breast, Cervical, and Colorectal Cancer in the PROSPR Consortium

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/djz137 ◽

2019 ◽

Vol 112 (3) ◽

pp. 238-246 ◽

Cited By ~ 1

Author(s):

William E Barlow ◽

Elisabeth F Beaber ◽

Berta M Geller ◽

Aruna Kamineni ◽

Yingye Zheng ◽

...

Keyword(s):

Colorectal Cancer ◽

Cancer Screening ◽

Colorectal Cancer Screening ◽

Target Population ◽

Population Based ◽

Diagnostic Evaluation ◽

Cancer Type ◽

Screening Process ◽

Screening Participation ◽

Cancer Types

Abstract Background Cancer screening is a complex process encompassing risk assessment, the initial screening examination, diagnostic evaluation, and treatment of cancer precursors or early cancers. Metrics that enable comparisons across different screening targets are needed. We present population-based screening metrics for breast, cervical, and colorectal cancers for nine sites participating in the Population-based Research Optimizing Screening through Personalized Regimens consortium. Methods We describe how selected metrics map to a trans-organ conceptual model of the screening process. For each cancer type, we calculated calendar year 2013 metrics for the screen-eligible target population (breast: ages 40–74 years; cervical: ages 21–64 years; colorectal: ages 50–75 years). Metrics for screening participation, timely diagnostic evaluation, and diagnosed cancers in the screened and total populations are presented for the total eligible population and stratified by age group and cancer type. Results The overall screening-eligible populations in 2013 were 305 568 participants for breast, 3 160 128 for cervical, and 2 363 922 for colorectal cancer screening. Being up-to-date for testing was common for all three cancer types: breast (63.5%), cervical (84.6%), and colorectal (77.5%). The percentage of abnormal screens ranged from 10.7% for breast, 4.4% for cervical, and 4.5% for colorectal cancer screening. Abnormal breast screens were followed up diagnostically in almost all (96.8%) cases, and cervical and colorectal were similar (76.2% and 76.3%, respectively). Cancer rates per 1000 screens were 5.66, 0.17, and 1.46 for breast, cervical, and colorectal cancer, respectively. Conclusions Comprehensive assessment of metrics by the Population-based Research Optimizing Screening through Personalized Regimens consortium enabled systematic identification of screening process steps in need of improvement. We encourage widespread use of common metrics to allow interventions to be tested across cancer types and health-care settings.

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Registered Nurse-Performed Flexible Sigmoidoscopy in Ontario: Development and Implementation of the Curriculum and Program

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2014/561749 ◽

2014 ◽

Vol 28 (1) ◽

pp. 13-18 ◽

Cited By ~ 5

Author(s):

Mary Anne Cooper ◽

Jill Margaret Tinmouth ◽

Linda Rabeneck

Keyword(s):

Colorectal Cancer ◽

Cancer Screening ◽

Registered Nurses ◽

Colorectal Cancer Screening ◽

Cancer Detection ◽

Simulation Training ◽

Flexible Sigmoidoscopy ◽

Average Risk ◽

Incidence And Mortality ◽

Proper Training

Although colorectal cancer is a leading cause of death in Canada, it is curable if detected in the early stages. Flexible sigmoidoscopy has been shown to reduce the incidence and mortality of colorectal cancer in patients who are at average risk for this disease and, therefore, is an appropriate screening intervention. Moreover, it may be performed by nonphysicians. A program to enable registered nurses to perform flexible sigmoidoscopy to increase colorectal cancer screening capacity in Ontario was developed. This program incorporated practical elements learned from other jurisdictions as well as specific regional considerations to fit within the health care system of Ontario. The nurses received structured didactic and simulation training before performing sigmoidoscopies on patients under physician supervision. After training, nurses were evaluated by two assessors for their ability to perform complete sigmoidoscopies safely and independently. To date, 17 nurses have achieved independence in performing flexible sigmoidoscopy at 14 sites. In total, nurses have screened >7000 Ontarians, with a cancer detection rate of 5.1 per 1000 screened, which is comparable with rates in other jurisdictions and with sigmoidoscopy performed by gastroenterologists, surgeons and other trained nonphysicians. We have shown, therefore, that with proper training and program structure, registered nurses are able to perform flexible sigmoidoscopy in a safe and thorough manner resulting in a significant increase in access to colorectal cancer screening.

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A Comparison of Colorectal Cancer Screening Uptake Among Average-Risk Insured American Indian/Alaska Native and White Women

Journal of Health Care for the Poor and Underserved ◽

10.1353/hpu.2013.0139 ◽

2013 ◽

Vol 24 (3) ◽

pp. 1125-1135 ◽

Cited By ~ 4

Author(s):

David G. Perdue ◽

Jessica Chubak ◽

Andy Bogart ◽

Denise A. Dillard ◽

Eva Marie Garroutte ◽

...

Keyword(s):

Colorectal Cancer ◽

Cancer Screening ◽

American Indian ◽

Colorectal Cancer Screening ◽

Alaska Native ◽

White Women ◽

Average Risk ◽

Screening Uptake

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Invitation of non-attenders to colorectal cancer screening: impact on coverage by examination

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.1344 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

O Majek ◽

O Ngo ◽

B Seifert ◽

S Suchanek ◽

M Zavoral ◽

...

Keyword(s):

Colorectal Cancer ◽

Cancer Screening ◽

Early Detection ◽

Colorectal Cancer Screening ◽

Colorectal Neoplasia ◽

Target Population ◽

Screening Colonoscopy ◽

Complete Coverage ◽

Crc Screening ◽

Incidence And Mortality

Abstract Issue Colorectal cancer (CRC) has been among the most important cancer causes of death globally. CRC screening and early detection can decrease CRC incidence and mortality through timely removal of colorectal neoplasia or early CRC treatment. CRC screening has been initiated in the Czech Republic in 2000 for individuals over 50, with GPs having a key role in recruiting individuals to screening, offering faecal occult blood test (FOBT). Screening colonoscopy (CS) was added for individuals over 55 since 2009. Description of the problem To increase uptake of CRC screening, personal invitation of non-attenders under 70 was implemented in 2014, along with temporary mass-media campaign. Health insurance companies have been sending invitations to those individuals without record of recent FOBT, CS or CRC treatment. The aim of our study was to evaluate impact of this policy on complete coverage by examination over 2013-2018. We defined the complete coverage by examination as the proportion of individuals aged 50-69 undergoing examination with CRC early detection potential (FOBT or CS for any indication) during past 3 years. We used newly established National Registry of Reimbursed Health Services as the source of data. Results Complete coverage of the target population (2.7 million individuals aged 50-69) was 44.8 % in 2013. By 2016, the coverage increased to 54.6%. Therefore, almost 300,000 individuals were newly covered by the relevant examinations. By 2018, the coverage decreased to 51.2%. When we consider only screening FOBT examinations, the coverage was 36.9 % in 2013, 45.2% in 2016, and 42.0% in 2018. Lessons In the health system with accessible CS facilities, the policy of non-attenders' invitation for CRC screening resulted not only in increase in coverage by screening examinations; complete coverage also increased. Unfortunately, the positive effect has been fading out, and further actions to sustain high coverage are therefore warranted. Key messages Invitation of non-attenders to colorectal cancer screening increased complete coverage of the target population by examination. Initial increase was followed by a slow decrease in coverage by examination, underlying the need for other actions to increase participation.

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Fecal DNA Versus Fecal Occult Blood for Colorectal-Cancer Screening in an Average-Risk Population

Yearbook of Medicine ◽

10.1016/s0084-3873(08)70569-8 ◽

2006 ◽

Vol 2006 ◽

pp. 413-414

Author(s):

J.S. Barkin

Keyword(s):

Colorectal Cancer ◽

Cancer Screening ◽

Colorectal Cancer Screening ◽

Occult Blood ◽

Fecal Occult Blood ◽

Average Risk ◽

Fecal Dna ◽

Risk Population ◽

Fecal Occult

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Effects of cancer screening restart strategies after COVID-19 disruption

British Journal of Cancer ◽

10.1038/s41416-021-01261-9 ◽

2021 ◽

Vol 124 (9) ◽

pp. 1516-1523

Author(s):

Lindy M. Kregting ◽

Sylvia Kaljouw ◽

Lucie de Jonge ◽

Erik E. L. Jansen ◽

Elleke F. P. Peterse ◽

...

Keyword(s):

Colorectal Cancer ◽

Cancer Screening ◽

Colorectal Cancer Screening ◽

Catching Up ◽

Incidence And Mortality ◽

Specific Mortality ◽

Cancer Specific Mortality ◽

Catch Up ◽

Microsimulation Models ◽

The Impact

Abstract Background Many breast, cervical, and colorectal cancer screening programmes were disrupted due to the COVID-19 pandemic. This study aimed to estimate the effects of five restart strategies after the disruption on required screening capacity and cancer burden. Methods Microsimulation models simulated five restart strategies for breast, cervical, and colorectal cancer screening. The models estimated required screening capacity, cancer incidence, and cancer-specific mortality after a disruption of 6 months. The restart strategies varied in whether screens were caught up or not and, if so, immediately or delayed, and whether the upper age limit was increased. Results The disruption in screening programmes without catch-up of missed screens led to an increase of 2.0, 0.3, and 2.5 cancer deaths per 100 000 individuals in 10 years in breast, cervical, and colorectal cancer, respectively. Immediately catching-up missed screens minimised the impact of the disruption but required a surge in screening capacity. Delaying screening, but still offering all screening rounds gave the best balance between required capacity, incidence, and mortality. Conclusions Strategies with the smallest loss in health effects were also the most burdensome for the screening organisations. Which strategy is preferred depends on the organisation and available capacity in a country.

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