Su1224 Participation in the First Four Rounds of the Colorectal Cancer Screening Program With Guaiac Fecal Occult Blood Test Conducted in the Haut-Rhin (Alsace, France)

Abstract

Organized screening programs depend on high participation rates to be effective and efficient. Whether uptake rates obtained in randomized controlled trials on colorectal cancer (CRC) screening with guaiac fecal occult blood test (gFOBT) are transposable in the real world is questionable. gFOBT has several drawbacks, one is the requirement for frequent testing, which may limit compliance. Aim: To assess participation in the first 4 rounds of an organized CRC screening program using gFOBT. Methods: Comparison of the determinants of participation in the first 4 rounds (R1 to R4) of the CRC screening programwith Hemoccult II implemented since 2003 in the Haut-Rhin, a French administrative area. We performed a population-based open cohort study of all average risk residents aged 50 74 years. They were invited to participate every other year. A first letter invited them to visit their general practitioner (GP) for CRC screening. Three recall letters were mailed to all those who had not complied, the second with a gFOBT kit. Results: Main results are presented in the table. The decrease in uptake was similar in men and women and was observed in all age groups except the 70 74 year age group. Overall, after 4 rounds, 242,292 persons had been invited and 34545 (14.3%) had completed 4 tests, 26675 (11.0%) 3 tests, 37193 (15.4%) 2 tests and 50070 (20.7%) 1 test. Overall, 148,483 (61.3%) persons had been screened at least once. Of 86,694 people who were eligible in all rounds, 34,545 (39.8%) had completed all the 4 tests, 8679 (10.0%) 3 tests, 8099 (9.3%) 2 tests, 6552 (7.6%) 1 test, and 28,819 (33.2%) 0 test. The uptake following the 2nd, 3rd and 4th invitation in people who never complied before was 17.0%, 8.8% and 5.5%, respectively. 16% of people who had participated in Rn did not participate in Rn+1. The proportion of people screened by GPs increased significantly from 76.9% in the 1st round to 84.0% in the 4th (p<0.01) while that of people screened by direct mailing of the gFOBT kit decreased significantly from 15.6% to 12.1% (p<0.01). The proportion of uptake following the first 2 invitation letters increased from R1 to R4 from 78.4% to 86.9%, while that following the mailing of the gFOBT kit decreased from 15.3% to 7.8%. The uptake decreased between years 2008 2009 and 2011 2012 from 34.3% to 31.7% in France and from 51.3% to 47.1% in our region. The latter uptake was among the highest achieved in France, where it varied from 7.1% to 51.4% depending on regions. Conclusion: The uptake and adherence to repeat testing are modest and deteriorate with time in the French organized population-based gFOBT CRC screening program, so that the reduction in CRC mortality will be significantly lower than in the trials. Effort is needed to enhance uptake and to reduce inequalities in participation related to sex, age, place of residence and deprivation.