Repeated screening for colorectal cancer with fecal occult blood test in Catalonia, Spain

Abstract

The objective of this study was to explore the variables associated with repeated screening for colorectal cancer (CRC) among individuals aged 50-69 years in Catalonia, Spain. We selected for the study all individuals (n=11 969) screened by a population-based CRC screening program in 2004 and who were eligible for rescreening in two years. A multilevel logistic regression model was derived. The contextual variables were the percentage of people with less than primary studies and the percentage of CRC screening participation. The individual variables used were: sex, age, CRC screening (prior to 2004), guaiac fecal occult blood test result, ease of recruitment, and number of tests used. The rescreening rate was 87%. No differences according to sex and age were found. The strongest barrier for CRC rescreening was an inconclusive fecal occult blood test result at baseline screening [odds ratio (OR): 0.24; 95% confidence intervals (CI): 0.20-0.29]. Individuals who agreed to participate just after receiving the screening invitation were more likely to accept a second screen compared with those who received a reminder letter six weeks later (OR: 1.53; 95% CI: 1.36-1.73). Those individuals who lived in a neighborhood with a higher educational level were more willing to rescreen (OR: 1.22; 95% CI: 1.03-1.45) than those who lived in more deprived areas. Rescreening was highly adequate in our program, reflecting satisfaction with the service received at screening. Strategies to enhance initial screening participation for CRC and to improve quality throughout the screening process should be prioritized.