Perceived life expectancy and colorectal cancer screening intentions and behaviour: A population-based UK study.

Rachael H Dodd,Christian Von Wagner,Lindsay C Kobayashi

doi:10.1016/j.pmedr.2019.101002

Abstract

The relationships between perceived life expectancy (PLE), cancer screening intentions and behaviour are not well understood, despite the importance of remaining life expectancy for the early diagnosis benefits of screening. This study investigates the relationships between PLE and each of: the intention to complete faecal occult blood test (FOBt) screening, ‘ever’ uptake of FOBt screening, and repeat uptake of FOBt screening for colorectal cancer. Data were from the population-representative Attitudes, Behaviour and Cancer UK Survey II (ABACUS II) in England in 2015. Eligible respondents for the present analysis were aged 60–70 years (FOBt eligible age range), who completed the survey question on perceived life expectancy (N = 824). We used logistic regression models to estimate the associations between PLE and the intention to complete screening, ‘ever’ uptake of screening, and repeat uptake of screening, with adjustment for age, gender, occupation-based social grade, marital status, ethnicity, and smoking status. PLE was positively associated with repeated uptake of FOBt (adjusted OR = 2.55; 95% CI: 1.04–6.30 for expecting to live to ≥90 years versus <80 years). Older adults may base decisions to continually participate in cancer screening on their expectations of remaining life expectancy. Future research should investigate the feasibility and acceptability of individualised cancer screening recommendations that take life expectancy into account.

Highlights

Colorectal cancer (CRC) is the fourth most common cancer and third leading cause of cancer death in the United Kingdom (UK) (Cancer Research UK, 2015; Siegel et al, 2014), but is highly treatable if detected early (Scholefield, 2002; Libby et al, 2012)
The American College of Physicians recommends that individuals who have less than 10 years of remaining life expectancy should not participate in CRC screening, as the harms they may experience outweigh any benefit from early diagnosis (Levin et al, 2008)
Two existing studies have observed that perceived life expectancy (PLE; referred to as selfrated life expectancy) (Roberto and Kawachi, 2015) is associated with the uptake of mammography screening for breast cancer in 14 European countries and in Israel (Wuebker, 2012), and the uptake of colorectal cancer screening in England (Kobayashi et al, 2017)

Summary

Introduction

Colorectal cancer (CRC) is the fourth most common cancer and third leading cause of cancer death in the United Kingdom (UK) (Cancer Research UK, 2015; Siegel et al, 2014), but is highly treatable if detected early (Scholefield, 2002; Libby et al, 2012). Annual uptake of FOBt screening among the eligible population has consistently been below the national target of 60% and there are wide variations in uptake according to age, sex, ethnicity, and geographic location, ranging from 35 to 61% of the eligible population (von Wagner et al, 2011) The reasons for these low and variable rates of uptake in the population are unknown, and there is interest in optimising uptake rates to ensure that the benefits are maximised and harms minimised among the screening-eligible population. Both of these studies indicated that PLE has a strong relationship with actual mortality risk factors, and is concordant with a validated 10-year mortality risk score in England (Kobayashi et al, 2017)

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Conclusion