Abstract
BackgroundThere is controversy regarding how comorbidity impacts on colorectal cancer screening, especially in the context of organised programmes. The aim of this study is to assess the effect of comorbidities on participation in the Barcelona population-based colorectal cancer screening programme (BCCSP).MethodsCross-sectional study carried out in ten primary care centres involved in the BCCSP. Individuals aged 50 to 69, at average risk of colorectal cancer, who were invited to participate in the first round of the faecal immunochemical test-based BCCSP were included (2011–2012). The main variable was participation in the BCCSP. Comorbidity was assessed by clinical risk group status. Other adjusting variables were age, sex, socioeconomic deprivation, visits to primary care, smoking, alcohol consumption and body mass index. Logistic regression models were used to test the association between participation in the programme and potential explanatory variables. The results were given as incidence rate ratios (IRR) and their 95% confidence intervals (CI).ResultsOf the 36,208 individuals included, 17,404 (48%) participated in the BCCSP. Participation was statistically significantly higher in women, individuals aged 60 to 64, patients with intermediate socioeconomic deprivation, and patients with more medical visits. There was a higher rate of current smoking, high-risk alcohol intake, obesity and individuals in the highest comorbidity categories in the non-participation group. In the adjusted analysis, only individuals with multiple minor chronic diseases were more likely to participate in the BCCSP (IRR 1.14; 95% CI [1.06 to 1.22]; p < 0.001). In contrast, having three or more dominant chronic diseases was associated with lower participation in the screening programme (IRR 0.76; 95% CI [0.65 to 0.89]; p = 0.001).ConclusionsHaving three or more dominant chronic diseases, was associated with lower participation in a faecal immunochemical test-based colorectal cancer screening programme, whereas individuals with multiple minor chronic diseases were more likely to participate. Further research is needed to explore comorbidity as a cause of non-participation in colorectal cancer screening programmes and which individuals could benefit most from colorectal cancer screening.
Highlights
There is controversy regarding how comorbidity impacts on colorectal cancer screening, especially in the context of organised programmes
Of the initial population, 3100 subjects were excluded as they met the exclusion criteria for participation in the based colorectal cancer screening programme (BCCSP) and 1734 were excluded as there was no comorbidity information available for them
In comparison with the group of patients included in the study, in the group of patients with no information on the variable clinical risk group (CRG) status we observed a greater proportion of men (54% vs. 46%), of individuals in the fifth deprivation quintile (25% vs. 19%), of individuals who did not attend their health centre in the last year (55% vs. 23%) and of smokers (34% vs. 24%)
Summary
There is controversy regarding how comorbidity impacts on colorectal cancer screening, especially in the context of organised programmes. Recommended colorectal cancer screening strategies fall into two categories: stool tests that primarily detect cancer, which involve the detection of occult blood or exfoliated DNA; and structural exams, which are effective in detecting both cancer and premalignant lesions and include flexible sigmoidoscopy, colonoscopy, and computed tomography colonography [3]. Following European Union recommendations [5], colorectal cancer screening programmes have been implemented progressively in Spain in recent years and have involved men and women aged 50 to 69 at average risk of developing colorectal cancer Participation in these programmes, with the exception of some regions, has not reached the desired rate [6]. The latter include social, cultural and psychological issues (e.g. knowledge about a specific disease, the benefits of screening, and the perceived risk, benefits, barriers) which may, in turn, interact with one other in a complex way [8]
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