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

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 6,807 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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To do or not to do – a survey study on factors associated with participating in the Danish screening program for colorectal cancer

BMC Health Services Research ◽

10.1186/s12913-020-06023-6 ◽

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

10.21203/rs.3.rs-49112/v2 ◽

2020 ◽

Author(s):

Jesper Bo Nielsen ◽

Gabriela 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 6,807 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. gender, 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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To do or not to do – A survey study on factors associated with participating in the Danish Screening Program for Colorectal Cancer

10.21203/rs.3.rs-49112/v1 ◽

2020 ◽

Author(s):

Jesper Bo Nielsen ◽

Gabriela Berg-Beckhoff ◽

Anja Leppin

Keyword(s):

Colorectal Cancer ◽

Screening Program ◽

Smoking Status ◽

Demographic Data ◽

Survey Study ◽

Stepwise Logistic Regression ◽

Willingness To Participate ◽

Cross Sectional Survey ◽

Crc Screening ◽

Screening Participation

Abstract BackgroundScreening 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, and to study if more people would accept the screening offer if the present fecal test was replaced by a blood test. MethodsWe used a cross-sectional survey design based on a representative group of 6,807 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. ResultsDanes 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, age, income, and moderate alcohol intake was positively associated with screening participation, whereas a negative association was observed for educational attainment, obesity, smoking status, and 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.ConclusionThe CRC screening program intents to include the entire population within a certain at-risk age group. However, individual factors (e.g. gender, 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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'Orange is the new Blue': the start of organised colorectal cancer screening in a Milan penitentiary

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.1341 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

C E Gandolfi ◽

D Iemmi ◽

C Lari ◽

R Danese ◽

A R Silvestri

Keyword(s):

Colorectal Cancer ◽

Cancer Screening ◽

Screening Program ◽

Target Population ◽

Willingness To Participate ◽

Jail Inmates ◽

Screening Service ◽

Screening Programs ◽

Crc Screening ◽

Prison Setting

Abstract Issue According to the United Nations basic principles for the treatment of prisoners, they “shall have access to the health services available in the country without discrimination on the grounds of their legal situation”. In Italy this principle is executed by national legislation allocating responsibility for inmates' health directly to the National Health Service. In the Metropolitan City of Milan this duty is fulfilled by the Agency for Health Protection (ATS) that guarantees medical assistance in its penitentiaries. Description of the problem In Italy, cancer screening activities are considered essential levels of assistance i.e. guaranteed to all citizens. In fact, organised colorectal cancer (CRC) screening is offered by ATS, free of charge, to males and females, aged 50 to 74, in the form of a fecal immunochemical test every 2 years. Unfortunately, CRC screening uptake remains low among fragile patients, such as jail inmates, who are hard-to-reach by standard organised screening efforts. In 2019 the ATS Preventive Medicine Screening Unit began a small pilot organised CRC screening program, specific for inmates, starting in one of the city's main penitentiaries: Casa di Reclusione Milano Bollate, comprising 1200 inmates, and recently appointed nationwide referral center for elderly inmates. Results Inmates represent a large scarcely screened population that, following implementation of an organised tailored CRC screening program, showed high willingness to participate. Organised cancer screening programs may thus be necessary to guarantee maximum uptake among prisoners. Lessons Tailoring the organised CRC screening program to the prison-setting may increase adherence and ensure standardised coverage of the target population, eliminating disparity in the CRC screening service, and hopefully others in the future. Key messages Tailoring an organised CRC screening program to the prison-setting may increase adherence and ensure standardised coverage of the target population, eliminating disparity in the CRC screening service Organised screening programs could achieve extensive coverage and enhance equity of access in this hard-to-reach fragile population.

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Prevalence of self-reported abdominal symptoms among 50–74-years-old men and women eligible for colorectal cancer screening –a cross-sectional study

BMC Cancer ◽

10.1186/s12885-021-08657-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Mette Bach Larsen ◽

Heidi Heinsen Bachmann ◽

Bo Søborg ◽

Tinne Laurberg ◽

Katrine J. Emmertsen ◽

...

Keyword(s):

Colorectal Cancer ◽

Prevalence Ratio ◽

Survey Study ◽

Healthy Population ◽

Cross Sectional Survey ◽

Low Anterior Resection Syndrome ◽

Cross Sectional ◽

Men And Women ◽

Crc Screening ◽

Abdominal Symptoms

Abstract Background Screening is defined as the identification of unrecognized disease in an apparently healthy population. Symptomatic individuals are recommended to contact a physician instead of participating in screening. However, in colorectal cancer (CRC) screening this approach may be problematic as abdominal symptoms are nonspecific. This study aimed at identifying the prevalence of self-reported abdominal symptoms among screening-eligible men and women aged 50–74 years. Methods This cross-sectional survey study included 11,537 individuals aged 50–74 years invited for CRC screening from 9 to 23 September 2019. Descriptive statistics of responders experiencing alarm symptoms of CRC, Low Anterior Resection Syndrome Score (LARS) and the Patient Assessment of Constipation-Symptoms (PAC-SYM) were derived. The association between abdominal symptoms and demographic and socioeconomic variables were estimated by prevalence ratio (PR) using a Poisson regression model with robust variance. Results A total of 5488 respondents were included. The respondents were more likely women, of older age, Danish, cohabiting and had higher education and income level compared to non-respondents. Abdominal pain more than once a week was experienced by 12.0% of the respondents. Of these, 70.8% had been experiencing this symptom for >1 month. Fresh blood in the stool was experienced by 0.7% and of these 82.1% for >1 month. About one third of those experiencing alarm symptoms more than once a week for >1 month had not consulted a doctor. A total of 64.1% of the respondents had no LARS, 21.7% had minor LARS and 14.2% had major LARS. The median PAC-SYM score was 0.33 (Interquartile range (IQR): 0.17;0.75), the median abdominal score was 0.50 (IQR: 0.00;1.00), median rectal score 0.00 (IQR:0.00;0.33) and median stool score 0.40 (IQR: 0.00;0.80). Men and those aged 65–74 reported less symptoms than women and those aged 50–64 years, respectively. Conclusions This study illustrated that abdominal symptoms were frequent among screening-eligible men and women. This should be taken into account when implementing and improving CRC screening strategies. A concerning high number of the respondents experiencing alarm symptoms had not consulted a doctor. This calls for attention to abdominal symptoms in general and how those with abdominal symptoms should participate in CRC screening.

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

BMC Cancer ◽

10.1186/s12885-021-08606-w ◽

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.

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Evidence-Based Selection on the Appropriate FIT Cut-Off Point in CRC Screening Programs in the COVID Pandemic

Frontiers in Medicine ◽

10.3389/fmed.2021.712040 ◽

2021 ◽

Vol 8 ◽

Author(s):

Rocío Aznar-Gimeno ◽

Patricia Carrera-Lasfuentes ◽

Rafael del-Hoyo-Alonso ◽

Manuel Doblaré ◽

Ángel Lanas

Keyword(s):

Colorectal Cancer ◽

Screening Program ◽

Selection Process ◽

Optimal Number ◽

Evidence Based ◽

Program Outcomes ◽

Screening Programs ◽

Crc Screening ◽

Immunological Test ◽

Number Of Individuals

Background: The COVID pandemic has forced the closure of many colorectal cancer (CRC) screening programs. Resuming these programs is a priority, but fewer colonoscopies may be available. We developed an evidence-based tool for decision-making in CRC screening programs, based on a fecal hemoglobin immunological test (FIT), to optimize the strategy for screening a population for CRC.Methods: We retrospectively analyzed data collected at a regional CRC screening program between February/2014 and November/2018. We investigated two different scenarios: not modifying vs. modifying the FIT cut-off value. We estimated program outcomes in the two scenarios by evaluating the numbers of cancers and adenomas missed or not diagnosed in due time (delayed).Results: The current FIT cut-off (20-μg hemoglobin/g feces) led to 6,606 colonoscopies per 100,000 people invited annually. Without modifying this FIT cut-off value, when the optimal number of individuals invited for colonoscopies was reduced by 10–40%, a high number of CRCs and high-risk adenomas (34–135 and 73–288/100.000-people invited, respectively) will be undetected every year. When the FIT cut-off value was increased to where the colonoscopy demand matched the colonoscopy availability, the number of missed lesions per year was remarkably reduced (9–36 and 29–145/100.000 people, respectively). Moreover, the unmodified FIT scenario outcome was improved by prioritizing the selection process based on sex (males) and age, rather than randomly reducing the number invited.Conclusions: Assuming a mismatch between the availability and demand for annual colonoscopies, increasing the FIT cut-off point was more effective than randomly reducing the number of people invited. Using specific risk factors to prioritize access to colonoscopies should be also considered.

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Patients’ participation in the colorectal cancer screening program and their health beliefs

European Journal of Public Health ◽

10.1093/eurpub/ckz187.064 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

S Kaseliene ◽

O Mesceriakova-Veliuliene

Keyword(s):

Colorectal Cancer ◽

Health Beliefs ◽

Screening Program ◽

Family Doctor ◽

Cross Sectional Study ◽

Categorical Variables ◽

Cross Sectional ◽

Family Doctors ◽

Screening Programs ◽

Crc Screening

Abstract Background Both morbidity and mortality rates from colorectal cancer (CRC) have been increasing in Lithuania. However, only about 50% of the target Lithuanian population was involved in CRC screening in 2018. The aim of this study was to evaluate associations between the involvement of 50- to 74-year-old primary care patients in CRC screening and their health beliefs as well as awareness about this screening. Methods A cross-sectional study was conducted in September-November 2016. A total of 390 patients aged 50-74 years were anonymously surveyed at 10 primary health care institutions of Šakiai region, Lithuania. The response rate was 86.7%. Chi-square and z tests were used to determine a relationship between two nominal (categorical) variables (α = 0.05). Results 43.1% of the respondents noted about their participation in the CRC screening program. Those who had participated in the program more often (p < 0.05) than nonparticipants reported to be worried about getting CRC (60.6% vs 43%) and thought that this could happen already in the next year (16.8% vs 6.5%), more frequently believed that the possibility of getting CRC for them was very high (74.8% vs 60.9%), that they had predisposition to CRC (44.9% vs 27.6%) and that CRC screening will prevent them from problems in the future (97.4% vs 90.9%). The participants of the CRC screening program also more frequently (p < 0.05) than nonparticipants noted that they had heard about this program before their involvement in it (98.8% vs 70.9%) and got this information from their family doctor 2.1 times more frequently (88.1% vs 41.4%). Nearly half (47.3%) of the program participants and 30.6% of the nonparticipants mentioned that the responsibility for participation in the CRC screening program should be taken by patients themselves (p < 0.05). Conclusions Participation of patients in the CRC screening program is related to their health beliefs, awareness and active engagement of family doctors in CRC screening programs. Key messages The patients who had participated in the CRC screening program had more negative health beliefs regarding CRC and were better informed on the program by their family doctor than nonparticipants. Family doctors should pay more attention to informing patients about CRC and its prevention.

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Faecal immunochemical test-based colorectal cancer screening in Mexico: an initial experience

Family Practice ◽

10.1093/fampra/cmz078 ◽

2020 ◽

Vol 37 (3) ◽

pp. 321-324 ◽

Cited By ~ 1

Author(s):

José María Remes-Troche ◽

Gabriela Hinojosa-Garza ◽

Priscilla Espinosa-Tamez ◽

Arturo Meixueiro-Daza ◽

Peter Grube-Pagola ◽

...

Keyword(s):

Colorectal Cancer ◽

Potential Benefit ◽

Large Scale ◽

Screening Program ◽

Preliminary Evidence ◽

Premalignant Lesions ◽

Middle Income ◽

Screening Programs ◽

Crc Screening ◽

Middle Income Countries

Abstract Background In middle-income countries, the burden of colorectal cancer (CRC) is increasing in parallel with resources for diagnosis and treatment. There is a potential benefit of CRC screening programs in Mexico. Objective Since there are no organized screening programs in the country, we explored the willingness of individuals to complete a faecal immunochemical testing (FIT) based CRC screening program and its potential benefit in Mexico. Methods We conducted a CRC screening program pilot in Veracruz, Mexico, during 2015–16 using FIT. Individuals with FIT results >100 ng of haemoglobin/ml buffer were referred for diagnostic colonoscopy. Results Of 473 FIT kits distributed to adults aged 50–75, 85.8% (406) were completed by participants and analysed in the laboratory. Of these, 5.9% (24/406) of test results showed >100 ng haemoglobin/ml. Twenty-one participants completed colonoscopy. The positive predictive value of FIT >100 ng haemoglobin/ml for premalignant lesions was 33%. Conclusion These results provide preliminary evidence of the willingness of individuals to complete FIT-based CRC screening program in Mexico. However, further evaluation of health systems resources will be needed prior to large-scale implementation of CRC screening programs.

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Short-term impact of the COVID-19 pandemic on a population-based screening program for colorectal cancer in Catalonia (Spain)

10.21203/rs.3.rs-562834/v1 ◽

2021 ◽

Author(s):

Vives Nuria ◽

Binefa Gemma ◽

Vidal Carmen ◽

Milà Núria ◽

Muñoz Rafael ◽

...

Keyword(s):

Colorectal Cancer ◽

Perceived Risk ◽

Screening Program ◽

Waiting Times ◽

Population Based ◽

Emotional Wellbeing ◽

Short Term ◽

Crc Screening ◽

Screening Participation ◽

Mean Time

Abstract Background By mid-March 2020, colorectal cancer (CRC) screening program in Catalonia was suspended at all levels. Our goal was to assess the short-term impact of the COVID-19 pandemic at a FIT-based CRC screening hub in the metropolitan area of Barcelona. Methods Short-term impact was measured in individuals invited between 1 January and 12 March 2020: screening participation, colonoscopy adherence, interval from positive test result to colonoscopy and psychological distress. Results Lockdown with the first wave of COVID-19 caused 111,000 individuals to defer their screening invitations. Participation among invitees between January - March 2020 was 39.3% (95% CI: 38.9–39.7), a decrease of 5% in comparison with the 41.4% (95% CI: 41.2–41.6) participation in 2019. Adherence to colonoscopy decreased from 89.3% (95% CI: 88.4–90.2) in 2019 to 81.4% (95% CI: 78.9–83.7) in the first quarter of 2020. The mean time to colonoscopy after resumption was 128.7 days (CI 95%: 125.3–132.2). Irrespective of test results, factors associated with higher levels of distress were a greater perceived risk of CRC and greater impairment of emotional wellbeing due to COVID-19. Conclusions The short-term impact of COVID-19 on CRC screening seems to have been modest, with a slight decrease in participation, a moderate decrease in colonoscopy adherence, and lengthened waiting times. However, a marked impact on future CRC incidence and deaths could be expected. Thus, it is critical to revert participation and colonoscopy adherence rates to that previously achieved while reducing the 5-month delay in screening invitations.

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