Colorectal Cancer Screening Invitation Research Articles

The effect of colorectal cancer screening on health status in a survey study

Background: Colorectal cancer (CRC) screening has been found to reduce mortality from CRC but it may have adverse effects on other aspects of health. Our aim was to evaluate the effect of CRC screening on overall health status among men and women within a randomized health-services study in Finland.Material and methods: A random sample of 10,648 men and women born in 1951 received a questionnaire on health and lifestyle. They were randomized for CRC screening or controls (1:1) in 2011 (N = 10,271). The current study population consisted of those who responded to the questionnaire both before and after screening (n = 4895). Self-rated health (SRH), perceived healthiness of diet and perceived physical fitness were used to determine health status, and assessed with logistic and ordered logistic models using calendar time (2010, 2012), screening randomization and demographic characteristics as covariates.Results: SRH, healthiness of diet and physical fitness improved over time (OR 1.32, CI 1.17–1.48, OR 1.23, CI 1.08–1.41 and OR 1.44, CI 1.28–1.60, respectively). Compared to non-invited controls, CRC screening invitation had no effect on these measures (OR 0.91, CI 0.74–1.12, OR 0.95, CI 0.75–1.20, and OR 1.09, CI 0.87–1.37, respectively). Women reported better health status than men. However, among those who attended screening, women reported weaker, and men better health status than the respective controls.Conclusions: CRC screening did not have any effect on health status measured using self-rated health, healthiness of diet, and physical fitness. Thus, screening for colorectal cancer can be recommended as a health policy.

Factors related to the participation and detection of lesions in colorectal cancer screening programme-based faecal immunochemical test.

The overall aim of this study was to describe trends in participation rates and detection of lesions in a colorectal cancer (CRC) screening programme, during three rounds, using faecal immunochemical test (FIT). National registers were used to collect data on invitations for CRC screening in the Basque Country (Spain) from 2009 to 2014. Information about participation, age, gender and lesions in each round were collected. A total of 961.533 individuals were included in the analysis; respectively, 584.950, 298.143 and 78.440 in the first, second and third rounds. The average participation rate was 68.4% (66.8, 70.4 and 72.3%, respectively by round; P < 0.001) and the positivity rate was 6.3% (7, 5.5 and 5.4%, respectively by round; P < 0.001). The participation rate increased significantly with age and was found to be higher in women versus men. A total of 15.144 advanced adenomas and 2.131 CRCs were diagnosed, leading to a detection rate of 23.9 and 3.4‰, respectively. Regarding gender, men had the highest rates in all periods and rounds. The detection rate of advanced neoplasia was lower in the regular when compared with irregular paricipants. In a CRC screening, this organization obtained high FIT participation rates. Older participants and women were associated with a higher participation. The detection rate of lesions was higher in men, independent on age and round.

1416P - The change in self-perceived characteristics of health and lifestyle due to colorectal cancer screening invitation and attendance

Background: Previous research implies that colorectal cancer (CRC) screening may have an effect on lifestyle. The aim of the current study was to evaluate the effect of CRC screening on self-perceived health and lifestyle among men and women within a randomized health-services study in Finland. Methods: A random sample of 31951 Finnish men and women born in 1951 were randomized 1:1 for CRC screening for the first time in 2011. A random third received a questionnaire on lifestyle before and after screening in 2010 and 2012 (n = 10271). The current study population responded to the questionnaire on both years (n = 4895). Self-rated health (SRH), perceived healthiness of diet and perceived physical fitness were assessed with logistic and ordered logistic models using calendar time (2010, 2012), screening randomization and demographic characteristics as covariates. Results: SRH, healthiness of diet and physical fitness improved over time (OR 1.32, CI 1.17–1.48, OR 1.23, CI 1.08–1.41 and OR 1.44, CI 1.28–1.60, respectively). CRC screening invitation had no effect on these measures compared to controls (OR 0.91, CI 0.74–1.12, OR 0.95, CI 0.75–1.20 and OR 1.09, CI 0.87–1.37, respectively). Women reported better health than men. However, further analysis showed that the attender women reported weaker and the attender men better health than the corresponding control groups. Conclusions: CRC screening did not have an effect on self-perceived health and lifestyle. However, the difference between men and women both in controls and in CRC screening attendees needs further research. The randomized setting enables us to generalize of the results to the whole screening target population. Legal entity responsible for the study: Nea Malila Funding: None Disclosure: All authors have declared no conflicts of interest.

Respondent selection in a repeated survey on lifestyle within the randomized colorectal cancer screening programme.

Screening for colorectal cancer (CRC) has been shown to decrease colorectal cancer mortality in randomized-controlled trials. However, screening may have an adverse impact on an individual's lifestyle. We describe here the design of a repeated survey study on lifestyle and assess response in the survey target population by randomization to CRC screening and demographic factors. The survey study population (n=10271) included Finnish men and women born in 1951 who were randomized for the CRC screening programme in 2011 and received a questionnaire on lifestyle in 2010 and 2012. We assessed responding by randomization to CRC screening, calendar time and demographic factors using the population-averaged Poisson model. Responding to survey was overall similar in 2010 and 2012. Those invited for CRC screening increased responding in time [incidence rate ratio (IRR) 1.06, confidence interval (CI) 1.03-1.09], whereas controls decreased their responding (IRR 0.97, CI 0.94-1.00). Women were more likely to respond than men (IRR 1.17, CI 1.12-1.23). Also, secondary (IRR 1.20, CI 1.13-1.27) and tertiary (IRR 1.31, CI 1.23-1.40) level education increased the response proportion compared with primary-level education. We could reliably assess the effect of CRC screening invitation and demographic factors on survey response. Although invitation to CRC screening increased responding, the self-selection was similar on both survey rounds. Self-selection should be taken into account when generalizing results from survey studies to their target population.

Sociodemographic predictors of participation in colorectal cancer screening.

Colorectal cancer screening by inviting citizens to complete a test for blood in faeces was initiated in Denmark in 2014. We have examined sociodemographic predictors that influence participation to identify factors that could be targeted to increase compliance. National registers were used to link data on invitations for colorectal cancer screening in Denmark from 2014 to 2015. Region of residence, age, gender, immigration status, income, educational level and marital status were identified. Logistic regression analysis was used to estimate the risk of non-participation for invited citizens while adjusting for all other sociodemographic variables. A total of 854,237 individuals were included in the analysis. The national participation proportion was 65.33%, with significant differences between sociodemographic groups. Participation proportions were the lowest in non-Western immigrants (53.00%), individuals without a partner (54.05%) and those in the lowest income quartile (54.65%), with subgroup participation as low as 40.56%. The highest participation proportion was seen in individuals in the highest income quartile (71.56%). Region of residence, age, gender, educational level, income quartile, marital status and immigration status all had statistically significant independent differences in risk of non-participation after full model adjustment. Participation in colorectal cancer screening was high in Denmark in 2014 and 2015. Large differences in participation were seen between sociodemographic subgroups, potentially resulting in social inequality in the benefits from screening. Future efforts to increase participation should focus on the low compliance subgroups, such as singles, non-Western immigrants and people from the lowest socioeconomic groups.

Decomposing socio-economic inequality in colorectal cancer screening uptake in England

Colorectal cancer (CRC) is the second largest cause of cancer death in the UK. Since 2010, CRC screening based on Faecal Occult Blood testing has been offered by the NHS in England biennially to all persons age 60–69 years. Several studies have demonstrated a gradient in uptake using area-level markers of socio-economic status (SES), but few have examined the individual-level contributors to the gradient. We aimed to quantify the extent of SES inequality in CRC screening uptake in England using individual-level data, and to identify individual factors associated with this inequality.We used data from 1833 participants (aged 61–69) in Wave 5 (collected in years 2010/11) of the English Longitudinal Study of Ageing (ELSA) eligible for having been sent at least one CRC screening invitation. Uptake was defined by self-report of ever having been screened as part of the National Screening Programme. We assessed socio-economic inequality using the corrected concentration index of uptake against SES rank, which was derived by regressing a range of SES markers against net non-pension household wealth. Other demographic and health-related variables were included in the analysis. Factors associated with inequality were measured using concentration index decomposition.There was a significant pro-rich gradient in screening uptake (concentration index: 0.16, 95% CI:0.11–0.22), mostly explained within our model by differences in non-pension wealth (38.7%), partner screening status (15.9%), sickness/disability (13.5%), and health literacy (8.5%).Interventions aimed at reducing inequalities in CRC screening uptake should focus on improving acceptability of screening in populations with low levels of education and literacy barriers.

824 Tailored Versus Non-Tailored Invitations for Colorectal Cancer Screening in Ontario's Coloncancercheck Program: Two Randomized Controlled Trials

824 Tailored Versus Non-Tailored Invitations for Colorectal Cancer Screening in Ontario's Coloncancercheck Program: Two Randomized Controlled Trials

Increasing participation in colorectal cancer screening: results from a cluster randomized trial of directly mailed gFOBT kits to previous nonresponders.

Regular screening using guaiac fecal occult blood test (gFOBT) reduces mortality from colorectal cancer (CRC). The objective of this study was to determine whether the addition of a gFOBT kit to a second mailed invitation compared to a second mailed invitation alone increases CRC screening among eligible persons who did not respond to an initial mailed invitation. We conducted a cluster randomized controlled trial, with the physician as the unit of randomization. Participants were persons who had been invited but who had not responded to an invitation for CRC screening in an earlier pilot project. The intervention group received a mailed gFOBT kit and second mailed CRC screening invitation (n = 2,008) while the control group received a second mailed CRC screening invitation alone (n = 1,586). The primary outcome was the uptake of gFOBT within 6 months of the second mailing. We found that the uptake of gFOBT was more than twice as high in the intervention group (20.1%) compared to the control group (9.6%). The absolute difference between the two groups was 10.5% (95% CI: 7.5-13.4%, p ≤ 0.0001). In a subsequent adjusted analysis, participants in the intervention group were twice as likely to complete the test as those in the control group (OR = 2.1; 95% CI: 1.6-2.6). These findings suggest that directly mailed gFOBT kits increase CRC screening participation among previous nonresponders to a mailed invitation and that approximately 10 gFOBT kits would have to be sent by mail in order to screen 1 additional person. (ClinicalTrials.gov: NCT01629004).

Using physician-linked mailed invitations in an organised colorectal cancer screening programme: effectiveness and factors associated with response

ObjectivesA central tenet of organised cancer screening is that all persons in a target population are invited. The aims of this study were to identify participant and physician factors associated...

888 Mailed Invitations to Be Screened for Colorectal Cancer Improve Uptake in Population Based Screening Program

Introduction: A central tenet of organized cancer screening programs is that all members of the target population be invited to be screened. While mailed invitations for colorectal cancer (CRC) screening have been shown to be effective in randomized controlled trials, to date, their effectiveness has not been reported in population-based studies. The aim of this study is to evaluate the effectiveness of mailed invitations for CRC screening in a populationbased CRC screening program. Methods: In 2008, Ontario launched its organized provincewide CRC screening program, ColonCancerCheck (CCC). In November 2009, CCC conducted a technical evaluation (“the Pilot”) of large scale mailed invitations asking patients to visit their family physician to arrange CRC screening. The Pilot comprised 102 family physicians and all their associated eligible patients (i.e., aged 50-74 years, due for screening, no prior CRC). In the current study, we linked the records of the Pilot patients to provincial health administrative records. Patient and physician factors associated with response to the mailed invitation were identified using logistic regression adjusting for clustering of patients within physicians. Using propensity scores to match in a 1:1 fashion, we then selected a control group of eligible patients from family physicians who did not participate in the Pilot. CRC screening uptake was compared between Pilot patients and matched controls using McNemar's test. Results: There were 11,302 eligible patients in the Pilot cohort. Median age (interquartile range) was 58 years (53-64), 5,853 (52%) were female and 1,548 (14%) completed an FOBT previously (from 2 to 5 years prior). 2503 (22%) completed an FOBT within 6 months of the mailed invitation. Factors significantly associated with uptake of FOBT included older patient age (70-74 vs. 50-59 years old: OR 1.6, 95% CI: 1.3 2.0), greater patient co-morbidity (greatest vs. no co-morbidity: OR 1.6, 95% CI: 1.3 2.0), having a female physician (OR 1.3, 95% CI: 1.04 1. 6), lack of intercurrent hospital admission (OR 3.5, 95% CI: 2.2 5.6) and prior FOBT(OR 2.8, 95% CI: 2.5 3.3). In the matched analysis, Pilot patients were more likely to complete an FOBT within 6 months of mailed invitation than matched controls (22% vs. 7%, p<0.0001). Benefit was maintained when the definition of uptake of CRC screening included FOBT or colonoscopy within 6 months of invitation (25% vs. 10%, p <0.0001). Seven invitations were mailed for each additional person participating in screening. Conclusion: Mailed invitations improved the uptake of CRC screening in this provincial population-based CRC screening program. Organized CRC screening programsmay wish to use mailed invitations to improve patient participation.

Adherence to colorectal cancer screening guidelines in Canada.

BackgroundTo identify correlates of adherence to colorectal cancer (CRC) screening guidelines in average-risk Canadians.Methods2003 Canadian Community Health Survey Cycle 2.1 respondents who were at least 50 years old, without past or present CRC and living in Ontario, Newfoundland, Saskatchewan, and British Columbia were included. Outcomes, defined according to current CRC screening guidelines, included adherence to: i) fecal occult blood test (FOBT) (in prior 2 years), ii) endoscopy (colonoscopy/sigmoidoscopy) (prior 10 years), and iii) adherence to CRC screening guidelines, defined as either (i) or (ii). Generalized estimating equations regression was employed to identify correlates of the study outcomes.ResultsOf the 17,498 respondents, 70% were non-adherent CRC screening to guidelines. Specifically, 85% and 79% were non-adherent to FOBT and endoscopy, respectively. Correlates for all outcomes were: having a regular physician (OR = (i) 2.68; (ii) 1.91; (iii) 2.39), getting a flu shot (OR = (i) 1.59; (ii) 1.51; (iii) 1.55), and having a chronic condition (OR = (i) 1.32; (ii) 1.48; (iii) 1.43). Greater physical activity, higher consumption of fruits and vegetables and smoking cessation were each associated with at least 1 outcome. Self-perceived stress was modestly associated with increased odds of adherence to endoscopy and to CRC screening guidelines (OR = (ii) 1.07; (iii) 1.06, respectively).ConclusionHealthy lifestyle behaviors and factors that motivate people to seek health care were associated with adherence, implying that invitations for CRC screening should come from sources that are independent of physicians, such as the government, in order to reduce disparities in CRC screening.

An advance notification letter increases participation in colorectal cancer screening

To determine the impact of novel invitation strategies on population participation in faecal immunochemical test (FIT)-based colorectal cancer (CRC) screening. A community screening programme in Adelaide, South Australia. In total, 2400 people aged 50-74 years were randomly allocated to one of four CRC screening invitation strategies: (a) standard invitation-to-screen letter explaining risk of CRC and the concept, value and method of screening; (b) Risk: invitation with additional messages related to CRC risk; (c) Advocacy: invitation with additional messages related to advocacy for screening from previous screening programme participants and (d) Advance Notification: first, a letter introducing CONTROL letter messages followed by the standard invitation-to-screen. Invitations included an FIT kit. Programme participation rates were determined for each strategy relative to control. Associations between participation and sociodemographic variables were explored. At 12 weeks after invitation, participation was: 237/600 (39.5%); Risk: 242/600 (40.3%); Advocacy: 216/600 (36.0%) and Advance Notification: 290/600 (48.3%). Participation was significantly greater than CONTROL only in the Advance Notification group (Relative risk [RR] 1.23, 95% confidence interval [CI] 1.06-1.43). This effect was apparent as early as two weeks from date of offer; Advance Notification: 151/600 (25.2%) versus 109/600 (18.2%, RR 1.38, 95% CI 1.11-1.73). Advance notification significantly increased screening participation. The effect may be due to a population shift in readiness to undertake screening, and is consistent with the Transtheoretical Model of behaviour change. Risk or lay advocacy strategies did not improve screening participation. Organized screening programmes should consider using advance notification letters to improve programme participation.