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Ola I, Cardoso R, Hoffmeister M, Brenner H. Utilization of colorectal cancer screening tests across European countries: a cross-sectional analysis of the European health interview survey 2018-2020. THE LANCET REGIONAL HEALTH. EUROPE 2024; 41:100920. [PMID: 38707865 PMCID: PMC11067466 DOI: 10.1016/j.lanepe.2024.100920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/10/2024] [Accepted: 04/15/2024] [Indexed: 05/07/2024]
Abstract
Background Colorectal cancer (CRC) screening has been shown to reduce CRC incidence and mortality, and most European countries have started to implement CRC screening programs in the past 20 years. Consequently, this study aimed to estimate the utilization of fecal tests and colonoscopy, as well as investigate factors associated with their utilization based on specific screening program characteristics in European countries. Methods We analyzed data from the European Health Interview Survey 2018-2020 to determine the utilization of fecal tests [guaiac-based fecal occult blood test (gFOBT) or fecal immunochemical test (FIT)] within the preceding 2 years or colonoscopy within the preceding 10 years among people aged 50-74 years, based on the type of screening offered in each country. Using multivariable logistic regression and sub-group meta-analysis, factors associated with screening use were determined. Findings The analyses included data from 129,750 respondents across 29 European countries, with participant counts ranging from 1511 individuals in Iceland to 11,755 individuals in Germany. Unit response rates ranged from 22% to 88%. The use of either test was highest among countries with fully rolled-out programs with fecal tests [from 37.7% (867/2379) in Croatia to 74.9% (2321/3085) in Denmark] and in countries offering colonoscopy as an alternative screening method [from 26.2% (854/3329) in Greece to 75.4% (1192/1760) in Luxembourg]. We observed the lowest utilization of either test in countries with no program or small-scale programs [6.3% (195/3179) in Bulgaria to 34.2% (722/2144) in Latvia]. Across all types of screening offers, younger age, being without a partner, low education, rural residence, and living in large households were associated with lower utilization, as were poor lifestyle scores and prolonged periods without physician consultation. Interpretation Our findings point to large disparities and much room for improvement in CRC screening offers and utilization across Europe. Funding There was no funding source for this study.
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Affiliation(s)
- Idris Ola
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg 69120, Germany
- Medical Faculty Heidelberg, University of Heidelberg, Heidelberg 69120, Germany
| | - Rafael Cardoso
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg 69120, Germany
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg 69120, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg 69120, Germany
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg 69120, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg 69120, Germany
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Romanová A, Lustigová M, Urbanová J, Keil R, Krollová P, Šťovíček J, Wasserbauer M, Hlava Š, Malinovská J, Drábek J, Brož J. Factors affecting participation in the colorectal cancer screening program: a cross-sectional population study. J Cancer Res Clin Oncol 2023; 149:11135-11143. [PMID: 37347259 DOI: 10.1007/s00432-023-04972-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 06/04/2023] [Indexed: 06/23/2023]
Abstract
PURPOSE Fecal immunochemical test (FIT) once a year or colonoscopy once in 10 years is the option approved for colorectal cancer (CRC) screening for asymptomatic individuals aged ≥ 50 years in the Czech Republic. We analyzed participation in the screening program to determine possible improvements. METHODS In this observational cross-sectional study, data were collected from 4044 randomly chosen individuals from the Czech population (1866 men, 2178 women) aged ≥ 50 years by questionnaires. Individuals who underwent colonoscopy within the last 10 years or/and FIT within the last 2 years were classified as participants in the screening. RESULTS 1050 individuals underwent FIT, 464 colonoscopy, and 558 underwent both. Adjusted for age, gender, and education, a higher chance of participation in the screening was observed in groups of non-smokers (OR = 1.25; CI 1.05-1.48), ex-smokers (OR = 1.51; CI 1.26-1.83), consuming smoked meat products less than once a week (OR = 1.26; CI 1.09-1.45), practicing physical activity at least once a week (OR = 1.25; CI 1.03-1.51), hospitalized in the past 12 months (OR = 1.73; CI 1.47-2.05), or consulting a general practitioner (GP) in the past 12 months (OR = 2.26; CI 1.87-2.74). The chance of participation of individuals having a risk factor for CRC (obesity, smoking, diabetes, low physical activity, alcohol drinking) was not higher compared to those without the risk factors. CONCLUSION Individuals with a tendency to a healthy lifestyle or being in recent contact with the healthcare system by various means, mainly visiting a GP, had a higher participation in the screening for CRC. Among groups with an increased risk for CRC, higher participation was not shown.
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Affiliation(s)
- Alexandra Romanová
- Department of Internal Medicine, Second Faculty of Medicine, Charles University, V Úvalu 84, 150 06, Prague, Czech Republic
| | - Michala Lustigová
- National Institute of Public Health, Šrobárova 49/48, 100 00, Prague, Czech Republic.
- Department of Social Geography and Regional Development, Faculty of Science, Charles University, Albertov 6, 128 43, Prague, Czech Republic.
| | - Jana Urbanová
- Third Faculty of Medicine of Faculty Hospital Královské Vinohrady, Charles University, Ruská 87, 100 00, Prague, Czech Republic
| | - Radan Keil
- Department of Internal Medicine, Second Faculty of Medicine, Charles University, V Úvalu 84, 150 06, Prague, Czech Republic
| | - Pavlína Krollová
- Department of Internal Medicine, Second Faculty of Medicine, Charles University, V Úvalu 84, 150 06, Prague, Czech Republic
| | - Jan Šťovíček
- Department of Internal Medicine, Second Faculty of Medicine, Charles University, V Úvalu 84, 150 06, Prague, Czech Republic
| | - Martin Wasserbauer
- Department of Internal Medicine, Second Faculty of Medicine, Charles University, V Úvalu 84, 150 06, Prague, Czech Republic
| | - Štěpán Hlava
- Department of Internal Medicine, Second Faculty of Medicine, Charles University, V Úvalu 84, 150 06, Prague, Czech Republic
| | - Jana Malinovská
- Department of Internal Medicine, Second Faculty of Medicine, Charles University, V Úvalu 84, 150 06, Prague, Czech Republic
| | - Jiří Drábek
- Department of Internal Medicine, Second Faculty of Medicine, Charles University, V Úvalu 84, 150 06, Prague, Czech Republic
| | - Jan Brož
- Department of Internal Medicine, Second Faculty of Medicine, Charles University, V Úvalu 84, 150 06, Prague, Czech Republic
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Bhargava S, Botteri E, Berthelsen M, Iqbal N, Randel KR, Holme Ø, Berstad P. Lower participation among immigrants in colorectal cancer screening in Norway. Front Public Health 2023; 11:1254905. [PMID: 37822535 PMCID: PMC10562536 DOI: 10.3389/fpubh.2023.1254905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/12/2023] [Indexed: 10/13/2023] Open
Abstract
Introduction Organized cancer screening programs should be equally accessible for all groups in society. We assessed differences in participation in colorectal cancer (CRC) screening among different immigrant groups. Methods Between 2012 and 2019, 140,000 individuals aged 50 to 74 years were randomly invited to sigmoidoscopy or repeated faecal immunochemical test (FIT) in a CRC screening trial. In this study, we included 46,919 individuals invited to sigmoidoscopy and 70,018 invited to the first round of FIT between 2012 and 2017. We examined difference in participation between non-immigrants and immigrants, and within different immigrant groups by geographic area of origin, using logistic regression models, adjusted for several sociodemographic factors and health factors. Results In total, we included 106,695 non-immigrants and 10,242 immigrants. The participation rate for FIT was 60% among non-immigrants, 58% among immigrants from Western countries and 37% among immigrants from non-Western countries. The participation rate for sigmoidoscopy was 53% among non-immigrants, 48% among immigrants from Western countries and 23% among immigrants from non-Western countries. Compared to non-immigrants, multivariate adjusted odds ratio for non-participation in FIT screening was 1.13 (95% confidence interval 1.04-1.23) and 1.82 (1.69-1.96) for immigrants from Western and non-Western countries. The corresponding numbers in sigmoidoscopy screening were 1.34 (1.21-1.48) and 2.83 (2.55-3.14). The lowest participation was observed in immigrants from Eastern Europe, Northern Africa and Western Asia, and South-Central Asia. Conclusion Participation in CRC screening in Norway was particularly low among non-Western immigrants, which could put them at increased risk for late stage diagnosis of CRC. Participation was lower in sigmoidoscopy screening than in FIT screening, especially among immigrants from non-Western countries.
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Affiliation(s)
- Sameer Bhargava
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
- Department of Oncology, Akershus University Hospital, Lørenskog, Norway
| | - Edoardo Botteri
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Mona Berthelsen
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | - Nadia Iqbal
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | | | - Øyvind Holme
- Department of Research, Sorlandet Hospital, Kristiansand, Norway
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Paula Berstad
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
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López Salas M, De Haro Gázquez D, Fernández Sánchez B, Amador Muñoz ML. Knowledge, Compliance, and Inequities in Colon Cancer Screening in Spain: An Exploratory Study. Healthcare (Basel) 2023; 11:2475. [PMID: 37761672 PMCID: PMC10530971 DOI: 10.3390/healthcare11182475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 07/28/2023] [Accepted: 08/29/2023] [Indexed: 09/29/2023] Open
Abstract
In Spain, inequities exist in implementing colorectal cancer (CRC) tests with the target population-adults aged 50 to 69-as part of population-based CRC screening programs. This research aims to further our understanding of the target population's awareness, attitudes, and perceptions of these test-based screening programs. A survey was carried out using an online panel representative of the target population, with a sample collected from 5313 individuals. Data collection took place in June 2022. Descriptive and bivariate analyses were carried out using contingency tables, the Chi-square test, and Cramer's V statistics. The sample was also segmented based on key variables. Finally, the results were analyzed using logistic regression. In the sample population, 62.5% had taken the fecal occult blood test (FOBT), 72.5% reported receiving the invitation letter to participate in the screening program, and 86.8% had prior knowledge of the FOBT. Noncompliance was mainly due to lack of symptoms (40%), non-receipt of invitation letters (39.7%), and forgetfulness or neglect (28.5%). On the contrary, receipt of the letter of invitation (OR 7.35, p < 0.01) and prior knowledge of FOBT (OR 6.32, p < 0.01) were the main variables that increased the probability of test uptake. Other significant variables included frequency of primary care visits (OR 1.71, p < 0.01) and being older (65-69 years old) (OR 1.52, p < 0.01) There is still a pressing need for greater awareness of both CRC risk factors and the benefits of early detection, as well as for overcoming the common misconception that detection should only be sought when symptoms are present.
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Affiliation(s)
- Mario López Salas
- Asociación Española Contra el Cáncer, Teniente Coronel Noreña, 30, 28045 Madrid, Spain; (D.D.H.G.); (B.F.S.); (M.L.A.M.)
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van de Schootbrugge-Vandermeer HJ, Lansdorp-Vogelaar I, de Jonge L, van Vuuren AJ, Dekker E, Spaander MCW, Ramakers CRB, Nagtegaal ID, van Kemenade FJ, van Leerdam ME, Toes-Zoutendijk E. Socio-demographic and cultural factors related to non-participation in the Dutch colorectal cancer screening programme. Eur J Cancer 2023; 190:112942. [PMID: 37406529 DOI: 10.1016/j.ejca.2023.112942] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/24/2023] [Accepted: 06/08/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND High participation rates are essential for a screening programme to be beneficial. To reach non-participants in a targeted manner, insight in characteristics of non-participants is needed. We investigated demographic differences between participants and non-participants in the Dutch faecal immunochemical test-based colorectal cancer (CRC) screening programme. METHODS In this population-based cohort study, we included all invitees for CRC screening in 2018 and 2019. Participation status, birth year, and sex were extracted from the Dutch national screening information system and linked to demographic characteristics from Statistics Netherlands, including migration background, level of education, socioeconomic category, household composition, and household income. A multivariable logistic regression was used to assess the association between demographic factors and participation. RESULTS A total of 4,383,861 individuals were invited for CRC screening in 2018 and 2019, of which 3,170,349 (72.3%) participated. Individuals were less likely to participate when they were single and/or living with others (single with other residents versus couple: odds ratio [OR] 0.34, 95% confidence interval [CI]: 0.31-0.38), had a migration background (e.g. Moroccan migrant versus Dutch background: OR 0.43, 95% CI: 0.42-0.44), or had a low income (lowest versus highest quintile: OR 0.45, 95% CI: 0.44-0.45). Although to a lesser extent, non-participation was also significantly associated with being male, being younger, receiving social welfare benefits and having a low level of education. CONCLUSION We found that individuals who were single and/or living with others, immigrants from Morocco or individuals with low income were the least likely to participate in the Dutch CRC screening programme. Targeted interventions are needed to minimise inequities in CRC screening.
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Affiliation(s)
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Lucie de Jonge
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Anneke J van Vuuren
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, AMC, Amsterdam, the Netherlands
| | - Manon C W Spaander
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Christian R B Ramakers
- Department of Clinical Chemistry, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Iris D Nagtegaal
- Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Folkert J van Kemenade
- Department of Pathology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Monique E van Leerdam
- Department of Gastrointestinal Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Esther Toes-Zoutendijk
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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Engdahl J, Gudmundsdottir KK, Rosenqvist M. Screening for atrial fibrillation: all invitees are equal, but some are more equal than others? Europace 2023:7163937. [PMID: 37191126 DOI: 10.1093/europace/euad133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Affiliation(s)
- Johan Engdahl
- Karolinska Institutet, Department of Clinical Sciences, Danderyd University Hospital, Entrévägen, SE-18288 Stockholm, Sweden
| | - Katrin Kemp Gudmundsdottir
- Karolinska Institutet, Department of Clinical Sciences, Danderyd University Hospital, Entrévägen, SE-18288 Stockholm, Sweden
| | - Mårten Rosenqvist
- Karolinska Institutet, Department of Clinical Sciences, Danderyd University Hospital, Entrévägen, SE-18288 Stockholm, Sweden
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Bülow Therkildsen S, Larsen PT, Njor S. Subsequent participation in organized FIT based screening following screen-derived colonoscopy - A Danish nationwide cohort study. Prev Med Rep 2023; 32:102125. [PMID: 36816764 PMCID: PMC9929440 DOI: 10.1016/j.pmedr.2023.102125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 01/24/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
Introduction In the Danish National Colorectal Cancer (CRC) screening program, participants with screen-detected low-risk adenomas are invited to a new faecal immunochemical test (FIT) screening after two years. However, participation rate in next FIT screening is unknown. We aimed to investigate this subsequent participation rate within the Danish CRC screening program. Methods This nationwide register-based study included participants aged 50-72 years registered with FIT screening in the Danish CRC screening program between January 1, 2016, and June 30, 2017. Participants were included if their index FIT was negative or if it was positive and the subsequent colonoscopy detected low-risk adenomas. Invitees were categorized as subsequent participants if they returned a FIT within 135 days following the invitation to screening. We estimated the relative risk for participation depending on screening outcome, age, and sex. Result 415,107 with a negative result and 5,550 with low-risk adenomas were included. 86.0% (85.9;86.1) of the invitees with a negative result participated in the subsequent screening, while 71.8% (70.6;73.0) of the invitees with low-risk adenomas participated subsequently. The risk of participation in the subsequent screening was significantly lower among all age groups of men and women with low-risk adenomas compared to similar groups with negative results. Conclusion Invitees with low-risk adenomas detected at their initial colonoscopy are less likely to participate in the subsequent screening than invitees with negative results. This association was found in all age groups and for both sexes. Further studies are necessary to assess whether non-attendance is more pronounced in specific subgroups.
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Key Words
- Adenomas
- Adherence
- CI, Confidence Interval
- CRC, Colorectal cancer
- CRN, Civil register number
- Colonoscopy
- Colorectal cancer screening
- Colorectal neoplasm
- DCCG, The Danish Colorectal Cancer register
- DCCSD, Database for Colorectal cancer screening
- DCR, The Danish Cancer Registry
- DNPR, The National Patient Register
- FAP, Familial adenomatous polyposis
- FIT, Fecal Immunochemical Test
- IBD, Inflammatory bowel database
- ICD, International Classification of Diseases
- Mass screening
- Participation
- RR, Relative risk
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Affiliation(s)
- Signe Bülow Therkildsen
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, 8930 Randers NØ, Denmark,Corresponding authors.
| | - Pernille Thordal Larsen
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, 8930 Randers NØ, Denmark,Department of Clinical Medicine, Aarhus University, Palle Juul-Jensen Boulevard 82, 8200 Aarhus N, Denmark,Corresponding authors.
| | - Sisse Njor
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, 8930 Randers NØ, Denmark,Department of Clinical Medicine, Aarhus University, Palle Juul-Jensen Boulevard 82, 8200 Aarhus N, Denmark
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Bhargava S, Czapka E, Hofvind S, Kristiansen M, Diaz E, Berstad P. Polish immigrants’ access to colorectal cancer screening in Norway – a qualitative study. BMC Health Serv Res 2022; 22:1332. [DOI: 10.1186/s12913-022-08719-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 10/21/2022] [Indexed: 11/11/2022] Open
Abstract
Abstract
Background
The Norwegian colorectal cancer (CRC) screening programme started in May 2022. Inequities in uptake of CRC screening is a concern, and we expect that immigrants are at risk of non-uptake. Immigrants from Poland are the most populous immigrant group in Norway. The purpose of this study was to identify and explore factors that may facilitate Polish immigrants’ access to the Norwegian CRC screening programme.
Material and methods
This study was based on qualitative interviews with ten Polish immigrants in Norway. The participants represented a convenience sample that varied in terms of gender, education, employment, time in Norway, place of residence, Norwegian language skills and ties to the Norwegian-Polish community. We performed thematic content analysis to understand CRC screening from the perspective of Polish immigrants, using transnationalism and Levesque’s conceptualization of accessibility as theoretical frameworks.
Results
We grouped our findings into three themes; “understanding of CRC development and the need to access health care”, “binationalism” and “improving accessibility through information”. Within these themes, various factors influenced the participants’ accessibility to CRC screening, namely knowledge about the screening and about causes, development and prevention of the disease, language, choice of screening country, trust in health personnel’s competence, information needs, methods and sources, as well as participants’ perception of the faecal immunochemical test screening user manual. These factors were further influenced by communication between the Polish community in Norway and Poland, as well as travel between the countries.
Conclusion
We identified several factors that can be targeted with an aim to increase Polish immigrants’ access to the Norwegian CRC screening programme. Effective measures could include increasing cultural competence among health care providers and providing information in Polish through Polish-speaking health care professionals, general practitioners and internet portals used by the Polish-speaking community. Focusing on accessibility in a transnational setting, our findings may be of interest for policy makers and service providers planning preventive health measures for immigrants.
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Gudmundsdottir KK, Bonander C, Hygrell T, Svennberg E, Frykman V, Strömberg U, Engdahl J. Factors predicting participation and potential yield of screening-detected disease among non-participants in a Swedish population-based atrial fibrillation screening study. Prev Med 2022; 164:107284. [PMID: 36183797 DOI: 10.1016/j.ypmed.2022.107284] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 09/18/2022] [Accepted: 09/24/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND The success of any screening program is dependent on participation. The characteristics of participants vs. non-participants have been studied and non-participants usually have a higher risk of disease. The potential yield of screening-detected disease in non-participants could be of interest to several screening programs. AIMS This is a sub-study to STROKESTOP II, a Swedish atrial fibrillation screening study. The aim was to study factors predicting participation and to estimate the potential yield of screening-detected disease in non-participants. METHODS Individual, anonymized data for participants and non-participants with respect to socioeconomic factors, medical history and drugs dispensed were obtained from Swedish registries. A random forest model was trained to predict propensity scores for participation. The propensity scores were used to estimate potential screening-detected disease among non-participants. RESULTS Non-participants (n = 7086) had lower income, were more likely to have been hospitalized and had higher CHA2DS2-VASc scores compared to participants (n = 6868). The strongest factor predicting non-attendance was low income. The weighted estimates suggested that the yield of new atrial fibrillation was 2.4% in non-participants compared to 2.3% in the participants, which was not significant. CONCLUSIONS Non-participants had higher CHA2DS2-VASc scores, indicating a higher stroke-risk and presumable benefit from attending screening, although estimated new atrial fibrillation detected was not significantly more common when compared to participants. Low income was the strongest factor for predicting non-attendance and should be a focus area when planning future screening scenarios.
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Affiliation(s)
| | - Carl Bonander
- School of Public Health & Community Medicine, Sahlgrenska Academy at University of Gothenburg, Sweden
| | - Tove Hygrell
- Karolinska Institute, Department of Clinical Sciences, Danderyd University Hospital, Stockholm, Sweden
| | - Emma Svennberg
- Karolinska Institute, Department of medicine, Huddinge, Karolinska University Hospital, Stockholm, Sweden
| | - Viveka Frykman
- Karolinska Institute, Department of Clinical Sciences, Danderyd University Hospital, Stockholm, Sweden
| | - Ulf Strömberg
- School of Public Health & Community Medicine, Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Research and Development, Region Halland, Halmstad, Sweden
| | - Johan Engdahl
- Karolinska Institute, Department of Clinical Sciences, Danderyd University Hospital, Stockholm, Sweden
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de Klerk CM, van der Vlugt M, Smagge BA, Toes-Zoutendijk E, Lansdorp-Vogelaar I, Dekker E, Bossuyt PM. Urban density differences in colorectal cancer screening participation and screening yield in The Netherlands. Prev Med Rep 2022; 27:101791. [PMID: 35656204 PMCID: PMC9152774 DOI: 10.1016/j.pmedr.2022.101791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 03/29/2022] [Accepted: 04/02/2022] [Indexed: 11/24/2022] Open
Abstract
Low socioeconomic status has been associated with lower CRC screening participation. Effective strategies to target these differences have not been proven effective. Sparse data exists on the influence of urban density on screening participation. Participation in the Dutch CRC screening programme is lower in urban areas. Differences in participation by urban density exceed those by socioeconomic status. Strategies to increase uptake should focus on regional hot spots of low participation.
Lower socioeconomic status has been associated with higher colorectal cancer incidence and lower participation in population-based screening with faecal immunochemical testing (FIT) but regional variations in participation may also exist. We analysed differences in participation and yield in colorectal cancer screening by urban density level. Data of all invitees to the Dutch colorectal cancer screening programme in 2014–2015 were included. Primary outcomes were participation (returning FIT), FIT positive predictive value, and screening yield (advanced neoplasia detected in invitees). Differences were explored across five levels of urban density. In total 1,873,639 screening invitees were included. FIT participation was 77.3% in the lowest versus 62.8% in the highest urban areas (RR 1.23; 95%CI 1.23–1.24). FIT positive predictive value was 58.6% in the lowest versus 55.2% in the highest urban areas (RR 1.06; 95% CI 1.04–1.09). Screening yield was also higher in the lowest (2.1%-2.3%) compared to the highest urban areas (1.8%). Compared to socioeconomic status, differences in urban density were associated with larger differences in screening participation. In conclusion, participation is lower and fewer cases of advanced neoplasia are detected in areas with a high urban density in the Dutch colorectal cancer screening programme. Differences in urban density could be used in tailoring regional strategies to target barriers in colorectal cancer screening.
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Botteri E, Hoff G, Randel KR, Holme Ø, de Lange T, Bernklev T, Aas E, Berthelsen M, Natvig E, Kirkøen B, Knudsen MD, Kvaerner AS, Schult AL, Ursin G, Jørgensen A, Berstad P. Characteristics of non-participants in a randomized colorectal cancer screening trial comparing sigmoidoscopy and faecal immunochemical testing. Int J Cancer 2022; 151:361-371. [PMID: 35411554 PMCID: PMC9324830 DOI: 10.1002/ijc.34025] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/23/2022] [Accepted: 04/01/2022] [Indexed: 11/11/2022]
Abstract
Public health systems should guarantee universal access to health care services, including cancer screening. We assessed whether certain population subgroups were underrepresented among participants in colorectal cancer screening with sigmoidoscopy and faecal immunochemical testing (FIT). Between 2012 and 2019, about 140 000 individuals aged 50 to 74 years were randomly invited to once‐only sigmoidoscopy or first round of FIT screening. Our study included 46 919 individuals invited to sigmoidoscopy and 70 019 to FIT between 2012 and 2017. We used logistic regression models to evaluate if demographic and socioeconomic factors and use of certain drugs were associated with participation. Twenty‐four thousand one hundred and fifty‐nine (51.5%) individuals attended sigmoidoscopy and 40 931 (58.5%) FIT screening. Male gender, young age, low education and income, being retired or unemployed, living alone, being an immigrant, long driving time to screening centre, and use of antidiabetic and psychotropic drugs were associated with low participation in both screening groups. Many of these factors also predicted low acceptance of colonoscopy after positive FIT. While male gender, young age and living alone were more strongly associated with nonparticipation in FIT than sigmoidoscopy, low education and income, being retired or immigrant and long driving time were more strongly associated with nonparticipation in sigmoidoscopy than FIT. In conclusion, participation was lower in sigmoidoscopy than FIT. Predictors of nonparticipation were similar between arms. However, low socioeconomic status, being an immigrant and long driving time affected participation more in sigmoidoscopy screening, suggesting that FIT may guarantee more equal access to screening services than sigmoidoscopy.
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Affiliation(s)
- Edoardo Botteri
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway.,Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Geir Hoff
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway.,Department of Research and Development, Telemark Hospital Trust, Skien, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kristin R Randel
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | - Øyvind Holme
- Department of Medicine, Sørlandet Hospital, Kristiansand, Norway.,Institute for Health and Society, University of Oslo, Oslo, Norway
| | - Thomas de Lange
- Department of Medicine, Sahlgrenska University Hospital- Mölndal, Region Västra Götaland, Sweden.,Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.,Department of Medical Research, Baerum Hospital, Gjettum, Norway
| | - Tomm Bernklev
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Research and Innovation, Vestfold Hospital, Tønsberg, Norway
| | - Eline Aas
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway.,Norwegian Institute of Public Health, Oslo, Norway
| | - Mona Berthelsen
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | - Erik Natvig
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | - Benedicte Kirkøen
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway.,Regional Center for Child and Adolescent Mental Health (RBUP), Oslo, Norway
| | - Markus D Knudsen
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway.,Department of Transplantation Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Norwegian PSC Research Center, Oslo University Hospital, Oslo, Norway.,Departments of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ane S Kvaerner
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | - Anna L Schult
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Medical Research, Baerum Hospital, Gjettum, Norway
| | - Giske Ursin
- Cancer Registry of Norway, Oslo, Norway.,Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Anita Jørgensen
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | - Paula Berstad
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
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Heinävaara S, Gini A, Sarkeala T, Anttila A, de Koning H, Lansdorp-Vogelaar I. Optimizing screening with faecal immunochemical test for both sexes - Cost-effectiveness analysis from Finland. Prev Med 2022; 157:106990. [PMID: 35150749 DOI: 10.1016/j.ypmed.2022.106990] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 11/30/2021] [Accepted: 02/06/2022] [Indexed: 11/28/2022]
Abstract
A faecal immunochemical test (FIT) screening pilot was introduced in Finland in 2019 with sex-specific screening strategies. This study aims to model cost-effectiveness of sex-specific strategies for the whole population, and to assess whether the current strategies are optimal. We developed separate MISCAN-Colon models, including different FIT performances, for the Finnish men and women using the first-year data of the FIT screening pilot. We evaluated 180 FIT strategies varying in FIT cut-off, screening interval, age to start, and age to stop screening, and compared them to no-screening by sex. We used incremental cost-effectiveness ratios (ICERs) to identify the optimal strategy after combining all male and female strategies and restricting the analysis by costs and referral rate to diagnostic colonoscopies. Offering annual FIT screening with a cut-off of 25 μg/g at 50-79 years in men and with a cut-off of 10 μg/g at 55-69 years in women was optimal. This combined strategy prevented 28% of colorectal cancer (CRC) cases and 55% of CRC deaths with acceptable costs (ICER = 9000€/life-years gained). Screening at the current target age of 60-74 years was suboptimal for both sexes. Among strategies with the same target age and interval for both sexes, expected benefits from optimal screening were lower but still reasonable. Our results support a wider age range of screening in men, and a lower cut-off for a positive test in women when restrictions on colonoscopy capacity and costs are in place. National FIT screening program should start at younger age.
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Affiliation(s)
- Sirpa Heinävaara
- Finnish Cancer Registry, Cancer Society of Finland, Unioninkatu 22, 00130 Helsinki, Finland; Department of Public Health, 00014 University of Helsinki, Finland.
| | - Andrea Gini
- Department of Public Health, Erasmus Medical Center, P.O.Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Tytti Sarkeala
- Finnish Cancer Registry, Cancer Society of Finland, Unioninkatu 22, 00130 Helsinki, Finland
| | - Ahti Anttila
- Finnish Cancer Registry, Cancer Society of Finland, Unioninkatu 22, 00130 Helsinki, Finland
| | - Harry de Koning
- Department of Public Health, Erasmus Medical Center, P.O.Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus Medical Center, P.O.Box 2040, 3000 CA Rotterdam, the Netherlands
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13
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Knudsen MD, Kvaerner AS, Botteri E, Holme Ø, Hjartåker A, Song M, Thiis-Evensen E, Randel KR, Hoff G, Berstad P. Lifestyle predictors for inconsistent participation to fecal based colorectal cancer screening. BMC Cancer 2022; 22:172. [PMID: 35168592 PMCID: PMC8848967 DOI: 10.1186/s12885-022-09287-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 02/03/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Consistent participation in colorectal cancer (CRC) screening with repeated fecal immunochemical test (FIT) is important for the success of the screening program. We investigated whether lifestyle risk factors for CRC were related to inconsistent participation in up to four rounds of FIT-screening. METHOD We included data from 3,051 individuals who participated in up to four FIT-screening rounds and returned a lifestyle questionnaire. Using logistic regression analyses, we estimated associations between smoking habits, body mass index (BMI), physical activity, alcohol consumption, diet and a healthy lifestyle score (from least favorable 0 to most favorable 5), and inconsistent participation (i.e. not participating in all rounds of eligible FIT screening invitations). RESULTS Altogether 721 (24%) individuals were categorized as inconsistent participants Current smoking and BMI ≥30 kg/m2 were associated with inconsistent participation; odds ratios (ORs) and 95% confidence intervals (CIs) were 1.54 (1.21-2.95) and 1.54 (1.20-1.97), respectively. A significant trend towards inconsistent participation by a lower healthy lifestyle score was observed (p < 0.05). CONCLUSIONS Lifestyle behaviors were associated with inconsistent participation in FIT-screening. Initiatives aimed at increasing participation rates among those with the unhealthiest lifestyle have a potential to improve the efficiency of screening.
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Affiliation(s)
- Markus Dines Knudsen
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, P.O. Box 5313, 0304, Majorstuen, Oslo, Norway.
- Department of Transplantation Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Norwegian PSC Research Center, Oslo University Hospital, P.O. Box 4950, 0424, Rikshospitalet, Nydalen, Oslo, Norway.
- Departments of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, 02115, Boston, MA, USA.
| | - Ane Sørlie Kvaerner
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, P.O. Box 5313, 0304, Majorstuen, Oslo, Norway
| | - Edoardo Botteri
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, P.O. Box 5313, 0304, Majorstuen, Oslo, Norway
- Department of Research, Cancer Registry of Norway, P.O. Box 5313, 0304, Majorstuen, Oslo, Norway
| | - Øyvind Holme
- Department of Medicine, Sørlandet Hospital Kristiansand, P.O. Box 416, 4604, Lundsiden, Kristiansand, Norway
- Department of Health Management and Health Economis, Institute of Health and Society, University of Oslo, P.O. Box 1089, 0317, Blindern, Oslo, Norway
| | - Anette Hjartåker
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, P.O. Box 1046, 0317, Blindern, Oslo, Norway
| | - Mingyang Song
- Departments of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, 02115, Boston, MA, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, 02114, Boston, MA, USA
- Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, 02114, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, MA, Boston, USA
| | - Espen Thiis-Evensen
- Department of Transplantation Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Norwegian PSC Research Center, Oslo University Hospital, P.O. Box 4950, 0424, Rikshospitalet, Nydalen, Oslo, Norway
| | - Kristin Ranheim Randel
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, P.O. Box 5313, 0304, Majorstuen, Oslo, Norway
| | - Geir Hoff
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, P.O. Box 5313, 0304, Majorstuen, Oslo, Norway
- Department of Health Management and Health Economis, Institute of Health and Society, University of Oslo, P.O. Box 1089, 0317, Blindern, Oslo, Norway
- Department of Research and Development, Telemark Hospital Trust, Ulefossvegen 55, 3710, Skien, Norway
| | - Paula Berstad
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, P.O. Box 5313, 0304, Majorstuen, Oslo, Norway
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Feng L, Wang W, Wu M, Ma H. Effect of WeChat-Based Health Education Combined with Satir Model on Self-Management Behaviors and Social Adaptation in Colorectal Cancer Patients during the Perioperative Period. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:2701039. [PMID: 34925730 PMCID: PMC8683238 DOI: 10.1155/2021/2701039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 11/19/2021] [Accepted: 11/25/2021] [Indexed: 11/17/2022]
Abstract
Objective To explore the effect of WeChat-based health education combined with the Satir model on self-management behaviors and social adaptation in colorectal cancer (CRC) patients during the perioperative period. Methods A total of 100 CRC patients treated in our hospital from April 2018 to April 2020 were selected as the objects for the retrospective study and divided into the observation group and the reference group according to their admission order, with 50 cases each. The patients in both groups accepted health education based on the WeChat platform, and additionally, those in the observation group received the Satir group intervention on self-approval for 3 months to compare the patients' scores on self-management behaviors, social adaptation, and self-care agency before and after the intervention between the two groups. Results Between the observation group and the reference group, the patients' general information, including age, gender ratio, and course of the disease, was not statistically different (P > 0.05). After nursing intervention, the scores on patients' self-management behaviors, social adaptation, and self-care agency were significantly higher in the observation group than in the reference group (P < 0.001). Conclusion Combining the WeChat-based health education with the Satir model can improve the self-management awareness in the CRC patients during the perioperative period, enhance their self-care agency and self-management behaviors, and promote their social adaptation, demonstrating that such a nursing intervention model is worthy of clinical promotion.
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Affiliation(s)
- Limin Feng
- Department of Gastrointestinal Surgery, Yantai Yuhuangding Hospital, Yantai 264000, Shandong Province, China
| | - Weina Wang
- Department of Surgical Care, Rizhao Hospital of Traditional Chinese Medicine, Rizhao 276800, Shandong Province, China
| | - Meiying Wu
- Health Management Center, Qingdao Fuwai Cardiovascular Hospital, Qingdao 266011, Shandong Province, China
| | - Huili Ma
- Department of Emergency Surgery, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
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