Adherence to screening colonoscopy and its influencing factors in China: a multicentre population-based cross-sectional study

Abstract

BackgroundScreening for colorectal cancer is effective in reducing the burden of this disease. The measure of adherence is crucial in determining the magnitude of the health impact of screening for colorectal cancer at a population level. We aimed to assess adherence of screening colonoscopy and its influencing factors in a population-based programme of colorectal cancer screening in China. MethodsThis study was done under the framework of Screening Program in Urban China supported by the central government of China. Urban permanent residents of aged 40–69 years were defined as the eligible population for the cancer screening programme. Eligible participants were invited to fill an epidemiological questionnaire survey for assessment of cancer risk based on Harvard Cancer Risk Index, and those who were assessed to be at high risk of colorectal cancer were recommended to take a screening colonoscopy. We collected detailed questionnaires and colonoscopy reports. For this analysis, we used research data for 2012–14. We applied logistic regression to identify potential factors associated with the adherence to screening colonoscopy. This study was approved by the Institutional Review Board of the Cancer Hospital of Chinese Academy of Medical Sciences. Written informed consent was obtained from each participant in the study. FindingsOverall, 97 445 participants were assessed to be potentially at high risk of colorectal cancer in 2012–14. 14 949 (15·3%) of the high-risk population followed the recommendation of undertaking screening colonoscopy. Adherence rates varied greatly across the 12 participating provinces, ranging from 7·9% to 26·2%. We noted a significantly higher adherence rate in 2013–14 (17·0%, 9766 of 57 280 participants) than in 2012–13 (12·9%, 5183 of 40 165 participants). After adjusting potential confounding factors, past positive result of fecal occult blood test (odd ratio 1·40, 95% CI 1·31–1·49), previous polyp detection (1·44, 1·38–1·50), inflammatory bowel disease (1·63, 1·56–1·69), and family history of colorectal cancer (1·59, 1·53–1·66) were found to be associated with the adherence to screening colonoscopy. InterpretationThe adherence rate of screening colonoscopy is low in a population-based screening programme in China. Adoption of effective primary screening modalities to precisely identify high-risk population and carrying out health promotion campaigns would be necessary to improve the adherence to screening colonoscopy in China. FundingThe National Health and Family Plan Committee of China.