Abstract
BackgroundScreening is defined as the identification of unrecognized disease in an apparently healthy population. Symptomatic individuals are recommended to contact a physician instead of participating in screening. However, in colorectal cancer (CRC) screening this approach may be problematic as abdominal symptoms are nonspecific. This study aimed at identifying the prevalence of self-reported abdominal symptoms among screening-eligible men and women aged 50–74 years.MethodsThis cross-sectional survey study included 11,537 individuals aged 50–74 years invited for CRC screening from 9 to 23 September 2019. Descriptive statistics of responders experiencing alarm symptoms of CRC, Low Anterior Resection Syndrome Score (LARS) and the Patient Assessment of Constipation-Symptoms (PAC-SYM) were derived. The association between abdominal symptoms and demographic and socioeconomic variables were estimated by prevalence ratio (PR) using a Poisson regression model with robust variance.ResultsA total of 5488 respondents were included. The respondents were more likely women, of older age, Danish, cohabiting and had higher education and income level compared to non-respondents.Abdominal pain more than once a week was experienced by 12.0% of the respondents. Of these, 70.8% had been experiencing this symptom for >1 month. Fresh blood in the stool was experienced by 0.7% and of these 82.1% for >1 month. About one third of those experiencing alarm symptoms more than once a week for >1 month had not consulted a doctor. A total of 64.1% of the respondents had no LARS, 21.7% had minor LARS and 14.2% had major LARS. The median PAC-SYM score was 0.33 (Interquartile range (IQR): 0.17;0.75), the median abdominal score was 0.50 (IQR: 0.00;1.00), median rectal score 0.00 (IQR:0.00;0.33) and median stool score 0.40 (IQR: 0.00;0.80). Men and those aged 65–74 reported less symptoms than women and those aged 50–64 years, respectively.ConclusionsThis study illustrated that abdominal symptoms were frequent among screening-eligible men and women. This should be taken into account when implementing and improving CRC screening strategies. A concerning high number of the respondents experiencing alarm symptoms had not consulted a doctor. This calls for attention to abdominal symptoms in general and how those with abdominal symptoms should participate in CRC screening.
Highlights
Screening is defined as the identification of unrecognized disease in an apparently healthy population
This should be taken into account when implementing and improving colorectal cancer (CRC) screening strategies
A concerning high number of the respondents experiencing alarm symptoms had not consulted a doctor. This calls for attention to abdominal symptoms in general and how those with abdominal symptoms should participate in CRC screening
Summary
Screening is defined as the identification of unrecognized disease in an apparently healthy population. Screening is defined as the presumptive identification of unrecognized disease in an apparently healthy and asymptomatic population according to the World Health Organization. Information material in CRC screening often recommends symptomatic individuals to contact a physician instead of participating in screening. This approach may not be optimal for several reasons. In Europe, as many as 10% of consultations in general health care are due to abdominal symptoms but only 0.3% of these result in patients being diagnosed with an incident abdominal cancer within 6 months [6]. Many organized CRC screening programs suffer from suboptimal participation rates [10]
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