Abstract
BackgroundDespite strong recommendations for colorectal cancer (CRC) screening, participation rates are low. Understanding factors that affect screening choices is essential to developing future screening strategies. Therefore, this study assessed patient willingness to use non-invasive stool or blood based screening tests after refusing colonoscopy.MethodsParticipants were recruited during regular consultations. Demographic, health, psychological and socioeconomic factors were recorded. All subjects were advised to undergo screening by colonoscopy. Subjects who refused colonoscopy were offered a choice of non-invasive tests. Subjects who selected stool testing received a collection kit and instructions; subjects who selected plasma testing had a blood draw during the office visit. Stool samples were tested with the Hb/Hp Complex Elisa test, and blood samples were tested with the Epi proColon® 2.0 test. Patients who were positive for either were advised to have a diagnostic colonoscopy.Results63 of 172 subjects were compliant to screening colonoscopy (37%). 106 of the 109 subjects who refused colonoscopy accepted an alternative non-invasive method (97%). 90 selected the Septin9 blood test (83%), 16 selected a stool test (15%) and 3 refused any test (3%). Reasons for blood test preference included convenience of an office draw, overall convenience and less time consuming procedure.Conclusions97% of subjects refusing colonoscopy accepted a non-invasive screening test of which 83% chose the Septin9 blood test. The observation that participation can be increased by offering non-invasive tests, and that a blood test is the preferred option should be validated in a prospective trial in the screening setting.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-230X-14-183) contains supplementary material, which is available to authorized users.
Highlights
Despite strong recommendations for colorectal cancer (CRC) screening, participation rates are low
In Germany, screening by annual guaiac fecal occult blood tests has been recommended since the mid 1970’s, and screening by colonoscopy was introduced as a covered option in 2002 [8,9]
Though not the focus of this study, the two subjects who were positive for the Septin9 test and the two who were positive for FIT went on to colonoscopy. In this observational study, we report the impact of providing a choice of non-invasive screening tests on participation in colorectal cancer screening in Berlin, Germany and surrounding areas
Summary
Despite strong recommendations for colorectal cancer (CRC) screening, participation rates are low. It is well established that the five-year survival rate for CRC, which is greater than 90% for early localized cancer, In Germany, screening by annual guaiac fecal occult blood tests (gFOBT) has been recommended since the mid 1970’s, and screening by colonoscopy was introduced as a covered option in 2002 [8,9]. While screening is encouraged, organized nationwide screening activities are limited. Both methods are available without additional cost as part of health care coverage. In Germany, nationwide data on screening colonoscopy, including adenoma detection, cecal intubation and complication rates amongst others are tracked through a central registry [10]. In the city of Berlin, the quality and performance of screening colonoscopy has been tracked through the Berlin colonoscopy projects - BECOP 1&3 [9,11]
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