Preferences and acceptance of colorectal cancer screening in Thailand.

Udomsak Saengow,Alan Geater,Stephen Birch,Virasakdi Chongsuwiwatvong

doi:10.7314/apjcp.2015.16.6.2269

Udomsak Saengow, Alan Geater + Show 2 more

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https://doi.org/10.7314/apjcp.2015.16.6.2269

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Abstract

Colorectal cancer (CRC) is now common in Thailand with an increase in incidence over time. Health authorities are planning to implement a nationwide CRC screening program using fecal immunochemical test (FIT) as a primary screening tool. This study aimed to estimate preferences and acceptance of FIT and colonoscopy, explore factors influencing the acceptance, and investigate reasons behind choosing and rejecting to screen before the program was implemented. Patients aged 50-69, visiting the primary care unit during the study period, were invited to join this study. Patients with a history of cancer or past CRC screening were excluded. Face-to-face interviews were conducted. Subjects were informed about CRC and the screening tests: FIT and colonoscopy. Then, they were asked for their opinions regarding the screening. The total number of subjects was 437 (86.7% response rate). Fifty-eight percent were females. The median age was 58 years. FIT was accepted by 74.1% of subjects compared to 55.6% for colonoscopy. The acceptance of colonoscopy was associated with perceived susceptibility to CRC and family history of cancer. No symptoms, unwilling to screen, healthy, too busy and anxious about diagnosis were reasons for refusing to screen. FIT was preferred for its simplicity and non-invasiveness compared with colonoscopy. Those rejecting FIT expressed a strong preference for colonoscopy. Subjects chose colonoscopy because of its accuracy; it was refused for the process and complications. If the screening program is implemented for the entire target population in Thailand, we estimate that 106,546 will have a positive FIT, between 8,618 and 12,749 identified with advanced adenoma and between 2,645 and 3,912 identified with CRC in the first round of the program.

Highlights

In Thailand, colorectal cancer (CRC) is the third and fifth most common cancer in men and women respectively
fecal immunochemical test (FIT) was preferred for its simplicity and non-invasiveness compared with colonoscopy
If the screening program is implemented for the entire target population in Thailand, we estimate that 106,546 will have a positive FIT, between 8,618 and 12,749 identified with advanced adenoma and between 2,645 and 3,912 identified with Colorectal cancer (CRC) in the first round of the program

Summary

Introduction

In Thailand, colorectal cancer (CRC) is the third and fifth most common cancer in men and women respectively. From 1990 to 2005, age-standardized incidence rates (per 100 000 persons per year) increased 54% in men (from 8.4 to 12.9) and 61% in women (from 5.7 to 9.2) (National Cancer Institute, 2012). The screening aims to detect advanced adenoma (precancerous stage) and early cancer of which treatments could reduce the cancer incidence and mortality respectively Incidence rates of CRC have decreased in US and reached a plateau in Canada and New Zealand as a result of the screening (Jemal et al, 2010). The United States Preventive Services Task Force (USPSTF) recommends these screening modalities: stool test, sigmoidoscopy and colonoscopy. The target population for screening includes those aged 50-75 years without other risk factors (the ‘average risk’ population)

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