Abstract
BackgroundCancer screening is a behavior that represents investment in future health. Such investment may depend on how much ‘future’ a person expects.PurposeThe purpose of this study was to investigate the prospective association between perceived personal life expectancy and participation in fecal occult blood test screening for colorectal cancer (CRC) in a national program.MethodsData were from interviews with 3975 men and women in the English Longitudinal Study of Ageing (ELSA) within the eligible age range for the national screening program (60 to 74 years). Perceived life expectancy was indexed as the individual’s estimate of their chance of living another 10–15 years (exact time varied by age), assessed in 2008/2009. Participation in CRC screening from 2010 to 2012/2013 was assessed in 2012/2013. Logistic regression was used to estimate the association between perceived life expectancy and screening participation, adjusted for numeracy and known mortality risk factors.ResultsOverall, 71% of respondents (2817/3975) reported completing at least one fecal occult blood test (FOBt) during the follow-up. Screening uptake was 76% (1272/1683) among those who estimated their 10–15-year life expectancy as 75–100%, compared with 52% (126/243) among those who estimated theirs as 0–25% (adjusted OR 1.74, 95% CI 1.29–2.34).ConclusionsA longer perceived life expectancy is associated with greater likelihood of participating in CRC screening in England. However, half of people with a low perceived life expectancy still participated in screening. Given that CRC screening is recommended for adults with a remaining life expectancy of ≥10 years, future research should investigate how to communicate the aims of screening more effectively.
Highlights
Colorectal cancer (CRC) is the third most common cancer in men and the second most common cancer in women worldwide, with an estimated 1.4 million cases and 693,300 deaths in 2012 [1]
Scores ranged from 1 to 18 points, but are collapsed at 11 points. In this population-based cohort study of English men and women who were age-eligible for nationally organized fecal occult blood test (FOBt)-based colorectal cancer (CRC) screening, perceived life expectancy at baseline was a strong positive predictor of FOBt uptake over the 4-year study follow-up
Our finding has particular salience for two issues in CRC screening: the fact that CRC screening is not recommended for adults with an actual life expectancy of less than 10 years, and persistent socioeconomic inequalities in CRC screening uptake
Summary
Colorectal cancer (CRC) is the third most common cancer in men and the second most common cancer in women worldwide, with an estimated 1.4 million cases and 693,300 deaths in 2012 [1]. In the UK, the National Health Service (NHS) provides CRC screening without charge using the fecal occult blood test (FOBt), which is mailed biennially to the home addresses of all men and women aged 60–74 years. Because routine screening improves CRC outcomes and reduces mortality in the population [4, 5], a better understanding of the causes of low uptake is needed to inform system-level interventions to increase participation. Cancer screening is a behavior that represents investment in future health Such investment may depend on how much ‘future’ a person expects. Purpose The purpose of this study was to investigate the prospective association between perceived personal life expectancy and participation in fecal occult blood test screening for colorectal cancer (CRC) in a national program
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