Abstract
Despite the recognized benefits of colorectal cancer (CRC) screening, uptake is still suboptimal in many countries. In addressing this issue, one important element that has not received sufficient attention is population preference. Our review provides a comprehensive summary of the up-to-date evidence relative to this topic. Four OVID databases were searched: Ovid MEDLINE® ALL, Biological Abstracts, CAB Abstracts, and Global Health. Among the 742 articles generated, 154 full texts were selected for a more thorough evaluation based on predefined inclusion criteria. Finally, 83 studies were included in our review. The general population preferred either colonoscopy as the most accurate test, or fecal occult blood test (FOBT) as the least invasive for CRC screening. The emerging blood test (SEPT9) and capsule colonoscopy (nanopill), with the potential to overcome the pitfalls of the available techniques, were also favored. Gender, age, race, screening experience, education and beliefs, the perceived risk of CRC, insurance, and health status influence one’s test preference. To improve uptake, CRC screening programs should consider offering test alternatives and tailoring the content and delivery of screening information to the public’s preferences. Other logistical measures in terms of the types of bowel preparation, gender of endoscopist, stool collection device, and reward for participants can also be useful.
Highlights
There are two prominent trends in population preference for colorectal cancer (CRC) screening tests reported in previous studies: people preferred either the most accurate test [29,31,41,42,43,44,45,46,47,48,49,50,51] or the least invasive one (stool-based test: fecal occult blood test (FOBT) or stool DNA test) [26,28,52,53,54,55,56,57,58]
While both tests are highly recommended by international guidelines [5,6,7,8], with colonoscopy recommended as the gold standard test and stool-based test as the standard firstline test for population-based CRC screening, population preference for colonoscopy and stool-based tests, as well as the other available screening techniques, has not been systematically reviewed
With regards to the amount that people would be willing to pay for CRC testing, studies included in this review reveal fluctuating trends [45,58,61,88,104,109,113,153,154], with the mean values ranging around $100–200 for both structural and stool-based testing (e.g., FOBT and stool DNA test (sDNA))
Summary
CRC-related deaths in 2020 [1]. Screening is an excellent preventive intervention to detect pre-cancerous polyps and tumors at an early stage and reduce the mortality and morbidity of CRC [2,3,4]. Current international guidelines recommend two main screening methods for CRC: colonoscopy as the gold standard test and fecal occult blood tests (guaiac fecal occult blood test—gFOBT or fecal immunochemical test—iFOBT/FIT) as the standard first-line test for population-based CRC screening [5,6,7,8]. Other less common screening modalities include stool DNA test (sDNA), sigmoidoscopy, computed tomography colonography (CTC), barium enema, and capsule colonoscopy [6,9,10]
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