Additional outreach effort of providing an opportunity to obtain a kit for fecal immunochemical test during the general health check-up to improve colorectal cancer screening rate in Japan: A longitudinal study.

Misuzu Fujita,Takehiko Fujisawa,Akira Hata,Toshiyuki Ojima

doi:10.1371/journal.pone.0238474

Abstract

A sufficient screening rate is indispensable to optimize the positive impact of colorectal cancer (CRC) screening. This study aimed to evaluate the effect of an additional outreach of providing an opportunity to obtain a kit for fecal immunochemical test (FIT) during the general health check-up to increase CRC screening rate. This was a longitudinal study using pre-existing data in Kujukuri Town, Japan. The town provided CRC screening in the fiscal year (FY) 2017 using an existing procedure for all beneficiaries of the National Health Insurance, whereas in FY 2018, an additional outreach effort was made to only those with an even number of age (exposed group), who were offered an opportunity to obtain a kit for FIT at the time of general health check-ups but not to those with an odd number of age (control group). To estimate the effectiveness, generalized estimating equation (GEE) with individuals as clusters was performed. In total, 3,530 individuals were included (1,708 in the control group and 1,822 in the exposed group). GEE showed significant interaction between the groups (control and exposed) and FYs (2017 and 2018) (p<0.001), indicating that the change in CRC screening rate from 2017 to 2018 was significantly different between the two groups. Although an achieved actual rate of 17.1% in the exposed group in FY 2018 was low, the additional outreach increased the rate by 5.8 percentage point (95% confidence interval, 3.5-8.1) compared with an existing rate. Additional outreach of providing an opportunity to obtain a kit for FIT at the time of the general health check-up improved the CRC screening rate. However, screening rate achieved by this strategy remained low, indicating further efforts is required.

Highlights

The incidence of colorectal cancer (CRC) globally increased by 38% between 2007 and 2017 from 1.3 million to 1.8 million, and an estimated 896,000 died from the disease in 2017 [1]
An achieved actual rate of 17.1% in the exposed group in fiscal year (FY) 2018 was low, the additional outreach increased the rate by 5.8 percentage point (95% confidence interval, 3.5–8.1) compared with an existing rate
Additional outreach of providing an opportunity to obtain a kit for fecal immunochemical test (FIT) at the time of the general health check-up improved the CRC screening rate

Summary

Introduction

The incidence of colorectal cancer (CRC) globally increased by 38% between 2007 and 2017 from 1.3 million to 1.8 million, and an estimated 896,000 died from the disease in 2017 [1]. In Japan, CRC is the most common malignancy and the second leading cause of cancer-related death, with 158,127 incident cases [2] and 50,681 deaths [3] in 2017. In Japan, even though an accurate CRC screening rate is unavailable owing to the lack of registration system, some statistics have been published. According to a Report on Regional Public Health Services and Health Promotion Services, the CRC screening rate in the population aged 40–69 years was only 8.4% in 2017 [9]. According to Comprehensive Survey of Living Conditions, based on a self-reported questionnaire, the CRC screening rate in 2016 was 41.4% [10]. Effective strategies to improve CRC screening rate are keenly anticipated

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Conclusion