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Ola I, Cardoso R, Hoffmeister M, Brenner H. Utilization of colorectal cancer screening tests: a systematic review and time trend analysis of nationally representative data. EClinicalMedicine 2024; 75:102783. [PMID: 39263675 PMCID: PMC11388351 DOI: 10.1016/j.eclinm.2024.102783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 07/24/2024] [Accepted: 07/26/2024] [Indexed: 09/13/2024] Open
Abstract
Background The substantial and increasing global burden of colorectal cancer (CRC) underscores the imperative to enhance implementation and utilization of effective CRC screening offers. Therefore, we examined the lifetime and up-to-date use of CRC screening tests across various countries, and described utilization trends over time. Methods We conducted a systematic review on the extent and recent trends of utilization of CRC screening tests among people 45 years or older in different countries around the globe. PubMed/Medline, Web of Science, and Embase electronic databases were screened for eligible studies from inception to June 30, 2024. The study protocol was registered with international prospective register of systematic reviews (PROSPERO) (CRD42023391344). Findings A total of 50 studies, based on nationally-representative data, were finally included - 27 from the United States (US) and 23 from other countries. The overall utilization of CRC screening has steadily increased over time in many countries, reaching 74.9% in Denmark in 2018-2020, 64% in Korea in 2020, and 72% in the US in 2021. Nevertheless, the utilization rates remain far below the national or continental targets in most countries. In contrast to European and Asian countries, where screening was predominantly fecal test-based, the approach in the US was primarily driven by colonoscopy, and the uptake of fecal tests and sigmoidoscopy gradually declined in the past two decades. Interpretation Despite ongoing progress in CRC screening offers and utilization, there remains large potential for enhanced roll-out and utilization of effective CRC screening programs for enhanced control of CRC incidence and mortality in the years ahead. 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), 69120, Heidelberg, Germany
- Medical Faculty Heidelberg, University of Heidelberg, 69120, Heidelberg, Germany
| | - Rafael Cardoso
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120, Heidelberg, Germany
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120, Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120, Heidelberg, Germany
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), 69120, Heidelberg, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), 69120, Heidelberg, Germany
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Ribe E, Cezard GI, Marshall A, Keenan K. Younger but sicker? Cohort trends in disease accumulation among middle-aged and older adults in Scotland using health-linked data from the Scottish Longitudinal Study. Eur J Public Health 2024; 34:696-703. [PMID: 38604658 PMCID: PMC11293808 DOI: 10.1093/eurpub/ckae062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND In the United Kingdom, rising prevalence of multimorbidity-the co-occurrence of two or more chronic conditions- is coinciding with stagnation in life expectancy. We investigate patterns of disease accumulation and how they vary by birth cohort, social and environmental inequalities in Scotland, a country which has long suffered from excess mortality and poorer health outcomes relative to its neighbours. METHODS Using a dataset which links census data from 1991, 2001 and 2011 to disease registers and hospitalization data, we follow cohorts of adults aged 30-69 years for 18 years. We model physical and mental disease accumulation using linear mixed-effects models. RESULTS Recent cohorts experience higher levels of chronic disease accumulation compared to their predecessors at the same ages. Moreover, in more recently born cohorts we observe socioeconomic status disparities emerging earlier in the life course, which widen over time and with every successive cohort. Patterns of chronic conditions are also changing, and the most common diseases suffered by later born cohorts are cancer, hypertension, asthma, drug and alcohol problems and depression. CONCLUSION We recommend policies which target prevention of chronic disease in working age adults, considering how and why certain conditions are becoming more prevalent across time and space.
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Affiliation(s)
- Eloi Ribe
- School of Economic, Social and Political Sciences, University of Southampton, Southampton, UK
| | - Genevieve Isabelle Cezard
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK
| | - Alan Marshall
- School of Social and Political Science, University of Edinburgh, Edinburgh, UK
| | - Katherine Keenan
- School of Geography and Sustainable Development, University of St Andrews, St Andrews, UK
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3
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Turan G, Turan M, Ikiisik H, Yildirim ME, Cakir M, Maral I. Evaluation of the effectiveness of colorectal cancer screening intervention. Cancer Causes Control 2024; 35:761-769. [PMID: 38172469 DOI: 10.1007/s10552-023-01839-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 11/28/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE The effectiveness of the Colorectal Cancer (CRC) screening program is assessed based on the reduction in CRC mortality and incidence rates over time. To accurately estimate the long-term impact, it is advisable to monitor additional indicators such as age and stage-specific incidence rates. Our objective is to evaluate the effectiveness of the National CRC Screening Program in Turkey and analyze its influence on disease stage at diagnosis and survival rates. METHODS The National CRC Screening Program was considered an intervention and the distribution of local, regional, and distant diseases, and survival estimates were assessed before and after the intervention to evaluate the effectiveness of the intervention. RESULTS 518 patients were included in the study. At the time of diagnosis, localized, regional, and distant disease in pre-intervention were 31.3%, 42.9%, 25.8%, while post-intervention were 42.8%, 33.3%, 23.9%, respectively (p = 0.020). The relative effectiveness of the intervention in males, females, and 50-70 ages were calculated as 1.2[95% CI 0.95-1.73], 1.5[95% CI 1.04-2.18], and 1.6[95% CI 1.21-2.28] in localized disease, 0.8[95% CI 0.67-1.18], 0.6[95% CI 0.43-0.90], and 0.6[95% CI 0.46-0.81] in regional diseases, 0.8[95% CI 0.57-1.20], 1.1[95% CI 0.66-1.84], and 1.0[95% CI 0.70-1.57] in distant disease, respectively. CONCLUSION A noticeable shift in the disease stage at the time of diagnosis was observed; however, this shift varied among gender and age groups. To effectively evaluate the impact of a cancer screening program on reducing the incidence and mortality rates of the disease, it is essential to monitor and analyze these indicators alongside 5-10-year survival estimates and stage changes at the time of diagnosis.
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Affiliation(s)
- Guven Turan
- Republic of Turkey Ministry of Health Aydın Efeler District Health Directorate, Aydın, Turkey.
| | - Merve Turan
- Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Adnan Menderes University, Aydın, Turkey
| | - Hatice Ikiisik
- Department of Public Health, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Mahmut Emre Yildirim
- Department of Medical Oncology, Istanbul Dr. Lütfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Cakir
- Department of Public Health, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Isil Maral
- Department of Public Health, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
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4
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Scobie H, Robb KA, Macdonald S, Harrow S, Sullivan F. Optimising recruitment to a lung cancer screening trial: A comparison of general practitioner and community-based recruitment. J Med Screen 2024; 31:46-52. [PMID: 37525582 PMCID: PMC10878003 DOI: 10.1177/09691413231190785] [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: 03/03/2023] [Revised: 06/07/2023] [Accepted: 07/11/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVES Pre-trial focus groups of the Early detection of Cancer of the Lung Scotland (ECLS) trial indicated that those at high risk of lung cancer are more likely to engage with community-based recruitment methods. The current study aimed to understand if general practitioner (GP) and community-based recruitment might attract different groups of people, and to quantitatively explore the demographic and psychosocial differences between people responding to GP or community-based recruitment. DESIGN Secondary data analysis of ECLS trial baseline data. METHODS Adults (n = 11,164) aged 50 to 75 years completed a baseline questionnaire as part of their participation in the ECLS trial. The questionnaire assessed smoking behaviour, health state, health anxiety and illness perception. Alongside demographic characteristics, how participants were made aware of the study/participant recruitment method (GP recruitment/community recruitment) was also obtained via trial records. RESULTS The likelihood of being recruited via community-based methods increased as deprivation level decreased. Those recruited via the community had higher levels of perceived personal control of developing lung cancer and were more likely to understand their own risk of developing lung cancer, compared to those who were recruited to the trial via their GP. Health state and health anxiety did not predict recruitment methods in multivariable analysis. CONCLUSIONS Community and opportunistic screening invitations were associated with uptake in people from less-deprived backgrounds, and therefore might not be the optimal method to reach those at high risk of lung cancer and living in more deprived areas.
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Affiliation(s)
- Hannah Scobie
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Kathryn A Robb
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Sara Macdonald
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Stephen Harrow
- Edinburgh Cancer Centre, Western General Hospital, NHS Lothian, Edinburgh, UK
| | - Frank Sullivan
- School of Medicine, University of St Andrews, St Andrews, Fife, UK
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Baum S. Spatial variability in socio-demographic factors affecting participation in the Australian national bowel cancer screening program. PUBLIC HEALTH IN PRACTICE 2023; 6:100452. [PMID: 38099090 PMCID: PMC10719410 DOI: 10.1016/j.puhip.2023.100452] [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: 07/19/2023] [Revised: 10/29/2023] [Accepted: 11/15/2023] [Indexed: 12/17/2023] Open
Abstract
Objectives The objective of this paper is to analyse the socio-demographic and spatial patterns associated with bowel cancer screening in Australia. Despite the importance of screening in reducing mortality via early intervention, it remains the case that overall screening rates are uneven between different socio-demographic groups and geographic regions. Notwithstanding this, there is limited knowledge in Australia regarding the interplay between socio-demographics and geography in relation to bowel cancer screening. Thus, this paper explores the socio-demographic and spatial patterns of screening participation across Australian regions to better inform public health policy and programs. Study design This is a nationwide ecological study based on aggregate spatial data. Methods An ecological study is conducted using bowel cancer screening rates and selected socio-demographic data measured at the Statistical Area 3 level. Geographically weighted regression software is used to conduct global and spatial regression analysis. Results The global regression results show that higher rates of screening participation were associated with employment/education disengagement and volunteering while in contrast, lower rates of participation were associated with higher rates of indigenous populations, people with chronic health conditions, and people with poor English skills. Considering the spatial analysis, the analysis shows that once the spatial non-stationarity in the data is considered the influence of the variables shown to be significant in the global model, has significant spatial variability. Conclusion From a public health perspective, addressing shortfalls in bowel cancer screening participation is an important priority. In order to understand differences in participation rates it is important to consider both socio-demographic factors as well as the geographic or spatial distribution of these factors.
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Affiliation(s)
- Scott Baum
- School of Environment and Built Environment, Griffith University, Nathan, Queensland, Australia
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Malcomson FC, Parra-Soto S, Ho FK, Lu L, Celis-Morales C, Sharp L, Mathers JC. Adherence to the 2018 World Cancer Research Fund (WCRF)/American Institute for Cancer Research (AICR) Cancer Prevention Recommendations and risk of 14 lifestyle-related cancers in the UK Biobank prospective cohort study. BMC Med 2023; 21:407. [PMID: 38012714 PMCID: PMC10683228 DOI: 10.1186/s12916-023-03107-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 10/05/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND The World Cancer Research Fund (WCRF)/American Institute for Cancer Research (AICR) Cancer Prevention Recommendations are lifestyle-based recommendations which aim to reduce cancer risk. This study investigated associations between adherence, assessed using a standardised scoring system, and the risk of all cancers combined and of 14 cancers for which there is strong evidence for links with aspects of lifestyle in the UK. METHODS We used data from 94,778 participants (53% female, mean age 56 years) from the UK Biobank. Total adherence scores (range 0-7 points) were derived from dietary, physical activity, and anthropometric data. Associations between total score and cancer risk (all cancers combined; and prostate, breast, colorectal, lung, uterine, liver, pancreatic, stomach, oesophageal, head and neck, ovarian, kidney, bladder, and gallbladder cancer) were investigated using Cox proportional hazard models, adjusting for age, sex, deprivation index, ethnicity, and smoking status. RESULTS Mean total score was 3.8 (SD 1.0) points. During a median follow-up of 8 years, 7296 individuals developed cancer. Total score was inversely associated with risk of all cancers combined (HR: 0.93; 95%CI: 0.90-0.95 per 1-point increment), as well as breast (HR: 0.90; 95%CI: 0.86-0.95), colorectal (HR: 0.90; 95%CI: 0.84-0.97), kidney (HR: 0.82; 95%CI: 0.72-0.94), oesophageal (HR: 0.84; 95%CI: 0.71-0.98), ovarian (HR: 0.76; 95%CI: 0.65-0.90), liver (HR: 0.78; 95%CI: 0.63-0.97), and gallbladder (HR: 0.70; 95%CI: 0.53-0.93) cancers. CONCLUSIONS Greater adherence to lifestyle-based recommendations was associated with reduced risk of all cancers combined and of breast, colorectal, kidney, oesophageal, ovarian, liver, and gallbladder cancers. Our findings support compliance with the Cancer Prevention Recommendations for cancer prevention in the UK.
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Affiliation(s)
- Fiona C Malcomson
- Human Nutrition & Exercise Research Centre, Centre for Healthier Lives, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
- Centre for Cancer, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Solange Parra-Soto
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
- School of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Department of Nutrition and Public Health, Universidad del Bío-Bío, Chillan, Chile
| | - Frederick K Ho
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Liya Lu
- Centre for Cancer, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Carlos Celis-Morales
- School of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Human Performance Lab, Education, Physical Activity and Health Research Unit, University Católica del Maule, Talca, Chile
| | - Linda Sharp
- Centre for Cancer, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - John C Mathers
- Human Nutrition & Exercise Research Centre, Centre for Healthier Lives, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK.
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Bailey JA, Morton AJ, Jones J, Chapman CJ, Oliver S, Morling JR, Patel H, Banerjea A, Humes DJ. Sociodemographic variations in the uptake of faecal immunochemical tests in primary care: a retrospective study. Br J Gen Pract 2023; 73:e843-e849. [PMID: 37845084 PMCID: PMC10587902 DOI: 10.3399/bjgp.2023.0033] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 05/16/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Faecal immunochemical test (FIT) usage for symptomatic patients is increasing, but variations in use caused by sociodemographic factors are unknown. A clinical pathway for colorectal cancer (CRC) was introduced in primary care for symptomatic patients in November 2017. The pathway was commissioned to provide GPs with direct access to FITs. AIM To identify whether sociodemographic factors affect FIT return in symptomatic patients. DESIGN AND SETTING A retrospective study was undertaken in Nottingham, UK, following the introduction of FIT as triage tool in primary care. It was mandated for all colorectal referrals (except rectal bleeding or mass) to secondary care. FIT was used, alongside full blood count and ferritin, to stratify CRC risk. METHOD All referrals from November 2017 to December 2021 were retrospectively reviewed. Sociodemographic factors affecting FIT return were analysed by multivariate logistic regression. RESULTS A total of 35 289 (90.7%) patients returned their index FIT, while 3631 (9.3%) did not. On multivariate analysis, males were less likely to return an FIT (odds ratio [OR] 1.11, 95% confidence interval [CI] = 1.03 to 1.19). Patients aged ≥65 years were more likely to return an FIT (OR 0.78 for non-return, 95% CI = 0.72 to 0.83). Unreturned FIT more than doubled in the most compared with the least deprived quintile (OR 2.20, 95% CI = 1.99 to 2.43). Patients from Asian (OR 1.82, 95% CI = 1.58 to 2.10), Black (OR 1.21, 95% CI = 0.98 to 1.49), and mixed or other ethnic groups (OR 1.29, 95% CI = 1.05 to 1.59) were more likely to not return an FIT compared with patients from a White ethnic group. A total of 599 (1.5%) CRCs were detected; 561 in those who returned a first FIT request. CONCLUSION FIT return in those suspected of having CRC varied by sex, age, ethnic group, and socioeconomic deprivation. Strategies to mitigate effects on FIT return and CRC detection should be considered as FIT usage expands.
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Affiliation(s)
- James A Bailey
- Nottingham Colorectal Service, Nottingham University Hospitals NHS Trust; School of Medicine, University of Nottingham, Nottingham
| | - Alastair J Morton
- Nottingham Colorectal Service, Nottingham University Hospitals NHS Trust; School of Medicine, University of Nottingham, Nottingham; National Institute for Health and Care Research (NIHR) Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham
| | - James Jones
- Nottingham Colorectal Service, Nottingham University Hospitals NHS Trust, Nottingham
| | - Caroline J Chapman
- Eastern Hub, Bowel Cancer Screening Programme, Nottingham University Hospitals NHS Trust, Nottingham
| | - Simon Oliver
- Nottingham and Nottinghamshire Integrated Care Board, Nottingham
| | - Joanne R Morling
- NIHR Nottingham BRC, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham; School of Medicine, University of Nottingham, Nottingham
| | - Heetan Patel
- Nottingham and Nottinghamshire Integrated Care Board, Nottingham
| | - Ayan Banerjea
- Nottingham Colorectal Service, Nottingham University Hospitals NHS Trust, Nottingham
| | - David J Humes
- Nottingham Colorectal Service, Nottingham University Hospitals NHS Trust; NIHR Nottingham BRC, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham
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Kayal G, Kerrison R, Hirst Y, von Wagner C. Patients' experience of using colonoscopy as a diagnostic test after a positive FOBT/FIT: a systematic review of the quantitative literature. BMJ Open 2023; 13:e071391. [PMID: 37734900 PMCID: PMC10514644 DOI: 10.1136/bmjopen-2022-071391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 08/23/2023] [Indexed: 09/23/2023] Open
Abstract
OBJECTIVES Faecal occult blood testing (FOBT) and faecal immunochemical testing (FIT) are among the most used screening modalities for colorectal cancer (CRC). Colonoscopy is also widely used as a screening and diagnostic test for adults with a positive FOBT/FIT. Patient experience of colonoscopy is an important component for most CRC screening programmes. Individuals with negative experiences are less likely to engage with colonoscopy in the future and can deter others from attending colonoscopy when invited. This review synthesised data on patient experience with colonoscopy, following a positive result, to provide insights into how to improve patient experience within the English Bowel Cancer Screening Programme. METHODS MEDLINE, EMBASE and PsycINFO were searched for quantitative questionnaire studies evaluating patient-reported experience with colonoscopy, following a positive screening FOB/FIT result. The search was limited to studies published between 2000 and 2021 (ie, when the first FOBT/FIT screening programmes for CRC were introduced). Data-driven and narrative summary techniques were used to summarise the literature. RESULTS In total, six studies from the UK (n=4), Spain (n=1) and the Netherlands (n=1) were included in the review (total participants: 152 329; response rate: 68.0-79.3%). Patient experiences were categorised into three 'stages': 'pre-colonoscopy', 'during the test' and 'post-colonoscopy'. Overall, patients reported a positive experience in all six studies. Bowel preparation was the most frequently endorsed issue experienced pre-test (experienced by 10.0-41.0% of individuals, across all studies), pain and discomfort for during the test (experienced by 10.0-21.0% of participants) and abdominal pain and discomfort after the test (these were experienced by 14.8-22% of patients). CONCLUSION This review highlighted that patient-reported experiences associated with colonoscopy were generally positive. To improve the colonoscopy experience, bowel screening centres should investigate means to: make bowel preparation more acceptable, make colonoscopy less painful and reduce post-colonoscopy symptoms.
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Affiliation(s)
- Ghalia Kayal
- Department of Behavioural Science and Health, University College London, London, UK
| | - Robert Kerrison
- School of Health Science, University of Surrey, Guildford, UK
| | - Yasemin Hirst
- Health Technology Assessment, University of Central Lancashire, Preston, UK
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Sturley C, Norman P, Morris M, Downing A. Contrasting socio-economic influences on colorectal cancer incidence and survival in England and Wales. Soc Sci Med 2023; 333:116138. [PMID: 37579558 DOI: 10.1016/j.socscimed.2023.116138] [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: 02/06/2023] [Revised: 06/15/2023] [Accepted: 08/01/2023] [Indexed: 08/16/2023]
Abstract
Colorectal cancer (CRC) is the third most commonly diagnosed cancer in the world and second most common cause of cancer death. The relationship between socio-economic deprivation and CRC incidence is unclear and previous findings have been inconsistent. There is stronger evidence of an association between area-level deprivation and CRC survival; however, few studies have investigated the association between individual-level socio-economic status (SES) and CRC survival. Data from the Office for National Statistics Longitudinal Study (LS) in England and Wales was used. LS members aged 50+ were stratified by individual-level educational attainment, social class, housing tenure and area deprivation quintile, measured at the 2001 Census. Time-to-event analysis examined associations between indicators of SES and CRC incidence and survival (all-cause and CRC death), over a 15-year follow-up period. Among 178116 LS members, incidence of CRC was lower among those with a degree, compared to those with no degree and higher among those employed in manual occupations compared to non-manual occupations. No clear relationship was observed between CRC incidence and the area-based measure of deprivation. Disparities were greater for survival. Among 5016 patients diagnosed with CRC aged 50+, probability of death from all-causes was lower among those with a degree, compared to no degree and higher among those employed in manual occupations, compared to non-manual occupations and among those living in social-rented housing, compared to owner-occupiers. Individual indicators of SES were also associated with probability of death from CRC. Those living in the most deprived areas had a higher probability of death (from all-causes and CRC) compared to those in the least deprived areas. Both individual and area-based indicators of SES were associated with CRC survival, and the relationships were stronger than those observed for CRC incidence. These findings could help inform more effective targeting of public health interventions for CRC.
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Affiliation(s)
- Charlotte Sturley
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK; Leeds Institute of Medical Research, University of Leeds, Leeds, UK.
| | - Paul Norman
- School of Geography, University of Leeds, Leeds, UK
| | - Michelle Morris
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK; Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Amy Downing
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK; Leeds Institute of Medical Research, University of Leeds, Leeds, UK
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10
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Abdul Latip SNB, Chen SE, Im YR, Zielinska AP, Pawa N. Systematic review of randomised controlled trials on interventions aimed at promoting colorectal cancer screening amongst ethnic minorities. ETHNICITY & HEALTH 2023; 28:661-695. [PMID: 36352539 DOI: 10.1080/13557858.2022.2139815] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 10/16/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Significant disparities exist between different ethnic groups when it comes to participation in colorectal cancer (CRC) screening programmes. A variety of interventions have been proposed to improve participation rates of ethnic minorities for CRC screening. This systematic review aims to appraise the evidence available from published randomised controlled trials (RCTs) and to identify effective interventions aimed at promoting CRC screening amongst underserved ethnic minorities. DESIGN We searched EmBASE, Medline, PsychInfo, Scopus and CINAHL for RCTs that analysed interventions to promote CRC screening in all ethnic minorities. CRC screening was measured as documented or self-reported screening rates. The protocol of this study was registered prospectively on PROSPERO with the registration number CRD42020216384. RESULTS We identified 42 relevant RCT articles, out of 1805 articles highlighted by the initial search. All except one were conducted in the US. The most frequently studied ethnic groups were African-Americans (33%), East Asians (30%), and Hispanics/Latinos (23%). In total, 7/42 (16%) RCTs had multiple arms. Interventions mainly intended to educate (52%), provide patient navigation services (21%), or provide a combination of these interventions (19%). We demonstrate that combination methods are most effective. CONCLUSION Many RCTs, mostly in the US, have trialed interventions aimed to increase CRC screening uptake amongst ethnic minorities to varying success. We conclude that using a combination of methods with patient navigation, education, and cultural tailoring is most effective at increasing CRC screening uptake amongst ethnic minorities. This highlights that multiple factors may hinder CRC screening and finding a one-size-fits-all solution that can be reliably implemented among different cultures and countries may be complex.
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Affiliation(s)
- Siti Nadiah Binte Abdul Latip
- Department of Colorectal Surgery, West Middlesex University Hospital, Chelsea and Westminster NHS Foundation Trust, Isleworth, UK
| | | | - Yu Ri Im
- Department of Colorectal Surgery, West Middlesex University Hospital, Chelsea and Westminster NHS Foundation Trust, Isleworth, UK
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - Agata P Zielinska
- Department of Colorectal Surgery, West Middlesex University Hospital, Chelsea and Westminster NHS Foundation Trust, Isleworth, UK
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - Nikhil Pawa
- Department of Colorectal Surgery, West Middlesex University Hospital, Chelsea and Westminster NHS Foundation Trust, Isleworth, UK
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11
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Jadallah K, Khatatbeh M, Mazahreh T, Sweidan A, Ghareeb R, Tawalbeh A, Masaadeh A, Alzubi B, Khader Y. Colorectal cancer screening barriers and facilitators among Jordanians: A cross-sectional study. Prev Med Rep 2023; 32:102149. [PMID: 36852311 PMCID: PMC9958352 DOI: 10.1016/j.pmedr.2023.102149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 12/23/2022] [Accepted: 02/10/2023] [Indexed: 02/16/2023] Open
Abstract
The factors affecting the adherence of Jordanians to colorectal cancer (CRC) screening remain underexplored. We examined the inhibitory and facilitating factors that influence the uptake of CRC screening among Jordanians. We conducted questionnaire interviews between April 2020 and June 2021 with 861 Jordanians aged 50-75. We analyzed the differences between proportions using the chi-square test. Binary logistic regression was conducted to determine factors associated with awareness of CRC and its screening. Of all participants, 41.7 % were aware of the necessity of screening for CRC, and 27.2 % were aware of at least one of the tests for CRC screening. However, only 17.2 % of participants underwent screening. In the multivariate analysis, participants with higher income (p-value < 0.001, odds ratio[OR] = 1.9, 95 % confidence interval [CI]: 1.4-2.7), higher level of education (p-value < 0.001, OR = 2.6, 95 % CI: 1.8-3.7), family history of colon cancer (p-value < 0.001, OR = 2.8, 95 % CI = 1.7-4.5), and those who had been screened for other cancers (p-value = 0.003, OR = 1.7, 95 % CI: 1.2-2.5) were more aware of the necessity of screening. Concerning barriers to screening, 'feeling well,' lack of physician endorsement, and difficult access to health care were the most commonly reported inhibitory factors (53.9 %, 52.3 %, and 31.9 %, respectively). The most commonly stated incentivizing factor was physician endorsement (82.3 %). Screening rates for CRC in eligible Jordanians remain low, albeit more than one-third of participants are aware of the necessity of screening. Enhanced awareness of barriers and incentivizing factors should help to prioritize national strategies to improve screening rates.
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Affiliation(s)
- Khaled Jadallah
- Department of Internal Medicine, King Abdullah University Hospital, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Moawiah Khatatbeh
- Department of Basic Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid, Jordan, and School of Health and Environmental Studies, Hamdan Bin Mohammed Smart University, Dubai, United Arab Emirates
| | - Tagleb Mazahreh
- Department of Surgery, King Abdullah University Hospital, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Aroob Sweidan
- Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Razan Ghareeb
- Department of Internal Medicine, Jordan University Hospital, Faculty of Medicine, University of Jordan, Amman, Jordan
| | - Aya Tawalbeh
- Department of Internal Medicine, King Abdullah University Hospital, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Ansam Masaadeh
- Department of Internal Medicine, King Abdullah University Hospital, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Bara Alzubi
- Department of Internal Medicine, King Abdullah University Hospital, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Yousef Khader
- Department of Community Medicine, Public Health, and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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12
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Bright D, Hillier S, Song J, Huws DW, Greene G, Hodgson K, Akbari A, Griffiths R, Davies AR, Gjini A. Inequalities in colorectal cancer screening uptake in Wales: an examination of the impact of the temporary suspension of the screening programme during the COVID-19 pandemic. BMC Public Health 2023; 23:546. [PMID: 36949447 PMCID: PMC10031708 DOI: 10.1186/s12889-023-15345-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 02/28/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Response to the early stages of the COVID-19 pandemic resulted in the temporary disruption of cancer screening in the UK, and strong public messaging to stay safe and to protect NHS capacity. Following reintroduction in services, we explored the impact on inequalities in uptake of the Bowel Screening Wales (BSW) programme to identify groups who may benefit from tailored interventions. METHODS Records within the BSW were linked to electronic health records (EHR) and administrative data within the Secured Anonymised Information Linkage (SAIL) Databank. Ethnic group was obtained from a linked data method available within SAIL. We examined uptake for the first 3 months of invitations (August to October) following the reintroduction of BSW programme in 2020, compared to the same period in the preceding 3 years. Uptake was measured across a 6 month follow-up period. Logistic models were conducted to analyse variations in uptake by sex, age group, income deprivation quintile, urban/rural location, ethnic group, and clinically extremely vulnerable (CEV) status in each period; and to compare uptake within sociodemographic groups between different periods. RESULTS Uptake during August to October 2020 (period 2020/21; 60.4%) declined compared to the same period in 2019/20 (62.7%) but remained above the 60% Welsh standard. Variation by sex, age, income deprivation, and ethnic groups was observed in all periods studied. Compared to the pre-pandemic period in 2019/20, uptake declined for most demographic groups, except for older individuals (70-74 years) and those in the most income deprived group. Uptake continues to be lower in males, younger individuals, people living in the most income deprived areas and those of Asian and unknown ethnic backgrounds. CONCLUSION Our findings are encouraging with overall uptake achieving the 60% Welsh standard during the first three months after the programme restarted in 2020 despite the disruption. Inequalities did not worsen after the programme resumed activities but variations in CRC screening in Wales associated with sex, age, deprivation and ethnic group remain. This needs to be considered in targeting strategies to improve uptake and informed choice in CRC screening to avoid exacerbating disparities in CRC outcomes as screening services recover from the pandemic.
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Affiliation(s)
- Diana Bright
- Research and Evaluation Division, Knowledge and Research Directorate, Public Health Data, Public Health Wales, Floor 5, Number 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ, UK.
| | - Sharon Hillier
- Health Protection and Screening Services Directorate. Public Health Wales, Cardiff, Wales
| | - Jiao Song
- Communicable Disease Surveillance Centre. Public Health Wales, Cardiff, Wales
| | - Dyfed W Huws
- Research and Evaluation Division, Knowledge and Research Directorate, Public Health Data, Public Health Wales, Floor 5, Number 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ, UK
- Population Data Science, Faculty of Medicine, Health & Life Science, Swansea University Medical School, Swansea University, Swansea, Wales
| | - Giles Greene
- Research and Evaluation Division, Knowledge and Research Directorate, Public Health Data, Public Health Wales, Floor 5, Number 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ, UK
| | - Karen Hodgson
- Research and Evaluation Division, Knowledge and Research Directorate, Public Health Data, Public Health Wales, Floor 5, Number 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ, UK
| | - Ashley Akbari
- Population Data Science, Faculty of Medicine, Health & Life Science, Swansea University Medical School, Swansea University, Swansea, Wales
| | - Rowena Griffiths
- Population Data Science, Faculty of Medicine, Health & Life Science, Swansea University Medical School, Swansea University, Swansea, Wales
| | - Alisha R Davies
- Research and Evaluation Division, Knowledge and Research Directorate, Public Health Data, Public Health Wales, Floor 5, Number 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ, UK
| | - Ardiana Gjini
- Health Protection and Screening Services Directorate. Public Health Wales, Cardiff, Wales
- Cardiff University, Cardiff, UK
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13
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Gascoyne C, Broun K, Morley B, Wyatt K, Feletto E, Durkin SJ. Engaging lower screening groups: a field experiment to evaluate the impact of a multiwave national campaign on participation in the National Bowel Cancer Screening Program. BMJ Open 2023; 13:e065124. [PMID: 36921953 PMCID: PMC10030563 DOI: 10.1136/bmjopen-2022-065124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
OBJECTIVES This field study evaluated a multiwave media campaign that aired in 2019 to promote participation in the Australian National Bowel Cancer Screening Program (NBCSP), which provides free biennial mailed-out immunochemical faecal occult blood test (iFOBT) kits to Australians aged 50-74 years. DESIGN Adjusted negative binomial regression models determined rate ratios of iFOBT kits returned during and following three campaign waves compared with 2018 (baseline). Interaction terms determined whether effects differed by gender×age group, socioeconomic status (SES) and previous participation. SETTING Australia. PARTICIPANTS All Australians eligible for the NBCSP (men and women aged 50-74 years) who returned an iFOBT kit between 1 January 2018 and 30 October 2019. INTERVENTIONS A multiwave national integrated media campaign to promote participation in the NBCSP. MAIN OUTCOME MEASURES iFOBT kit return rate and number of iFOBT kits returned during and immediately following campaign activity overall and within historically lower screening groups (men, 50-59 years old; lower SES; never participants). RESULTS The rate of iFOBT kits returned increased significantly during all three campaign waves, with evidence of carry-over effects of the second wave coinciding with a general practitioner mail-out strategy (all p<0.001). At each wave, effects were observed among men and women in the younger (50-59 years old) age group, but were less consistent for the older age group. Each SES group and both never and previous participants had increased return rates at each wave, but increases were stronger among mid-higher SES and those who had never participated. An estimated 93 075 extra iFOBT kits were returned due to the campaign. CONCLUSIONS The campaign increased participation, especially among those who were younger and never previously screened-key groups to recruit given reparticipation rates of over 80%. Ongoing investment in national integrated media campaigns of sufficient duration and intensity can increase bowel cancer screening and ultimately save lives.
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Affiliation(s)
- Claudia Gascoyne
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Kate Broun
- Prevention Division, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Belinda Morley
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Kerryann Wyatt
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Eleonora Feletto
- Cancer Research Division, Cancer Council New South Wales, Woolloomooloo, New South Wales, Australia
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Sarah J Durkin
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
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14
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Ameen S, Wong MC, Turner P, Yee KC. Improving colorectal cancer screening - consumer-centred technological interventions to enhance engagement and participation amongst diverse cohorts. Clin Res Hepatol Gastroenterol 2023; 47:102064. [PMID: 36494072 DOI: 10.1016/j.clinre.2022.102064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 09/30/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022]
Abstract
The current "Gold Standard" colorectal cancer (CRC) screening approach of faecal occult blood test (FOBT) with follow-up colonoscopy has been shown to significantly improve morbidity and mortality, by enabling the early detection of disease. However, its efficacy is predicated on high levels of population participation in screening. Several international studies have shown continued low rates of screening participation, especially amongst highly vulnerable lower socio-economic cohorts, with minimal improvement using current recruitment strategies. Research suggests that a complex of dynamic factors (patient, clinician, and the broader health system) contribute to low citizen engagement. This paper argues that the challenges of screening participation can be better addressed by (1) developing dynamic multifaceted technological interventions collaboratively across stakeholders using human-centered design; (2) integrating consumer-centred artificial intelligence (AI) technologies to maximise ease of use for CRC screening; and (3) tailored strategies that maximise population screening engagement, especially amongst the most vulnerable.
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Affiliation(s)
- Saleem Ameen
- College of Health and Medicine, University of Tasmania, Hobart 7000, Tasmania, Australia.
| | - Ming Chao Wong
- College of Sciences and Engineering, University of Tasmania, Hobart 7000, Tasmania, Australia
| | - Paul Turner
- College of Sciences and Engineering, University of Tasmania, Hobart 7000, Tasmania, Australia
| | - Kwang Chien Yee
- College of Health and Medicine, University of Tasmania, Hobart 7000, Tasmania, Australia
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15
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Crosbie PAJ, Gabe R, Simmonds I, Hancock N, Alexandris P, Kennedy M, Rogerson S, Baldwin D, Booton R, Bradley C, Darby M, Eckert C, Franks KN, Lindop J, Janes SM, Møller H, Murray RL, Neal RD, Quaife SL, Upperton S, Shinkins B, Tharmanathan P, Callister MEJ. Participation in community-based lung cancer screening: the Yorkshire Lung Screening Trial. Eur Respir J 2022; 60:2200483. [PMID: 35777775 PMCID: PMC9684623 DOI: 10.1183/13993003.00483-2022] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 05/17/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Screening with low-dose computed tomography (LDCT) reduces lung cancer mortality; however, the most effective strategy for optimising participation is unknown. Here we present data from the Yorkshire Lung Screening Trial, including response to invitation, screening eligibility and uptake of community-based LDCT screening. METHODS Individuals aged 55-80 years, identified from primary care records as having ever smoked, were randomised prior to consent to invitation to telephone lung cancer risk assessment or usual care. The invitation strategy included general practitioner endorsement, pre-invitation and two reminder invitations. After telephone triage, those at higher risk were invited to a Lung Health Check (LHC) with immediate access to a mobile CT scanner. RESULTS Of 44 943 individuals invited, 50.8% (n=22 815) responded and underwent telephone-based risk assessment (16.7% and 7.3% following first and second reminders, respectively). A lower response rate was associated with current smoking status (adjusted OR 0.44, 95% CI 0.42-0.46) and socioeconomic deprivation (adjusted OR 0.58, 95% CI 0.54-0.62 for the most versus the least deprived quintile). Of those responding, 34.4% (n=7853) were potentially eligible for screening and offered a LHC, of whom 86.8% (n=6819) attended. Lower uptake was associated with current smoking status (adjusted OR 0.73, 95% CI 0.62-0.87) and socioeconomic deprivation (adjusted OR 0.78, 95% CI 0.62-0.98). In total, 6650 individuals had a baseline LDCT scan, representing 99.7% of eligible LHC attendees. CONCLUSIONS Telephone risk assessment followed by a community-based LHC is an effective strategy for lung cancer screening implementation. However, lower participation associated with current smoking status and socioeconomic deprivation underlines the importance of research to ensure equitable access to screening.
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Affiliation(s)
- Philip A J Crosbie
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
- Manchester Thoracic Oncology Centre, Manchester University NHS Foundation Trust, Manchester, UK
- These two authors contributed equally
| | - Rhian Gabe
- Centre for Cancer Prevention, Queen Mary University of London, London, UK
- These two authors contributed equally
| | - Irene Simmonds
- Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Neil Hancock
- Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Panos Alexandris
- Centre for Cancer Prevention, Queen Mary University of London, London, UK
| | | | | | - David Baldwin
- Dept of Respiratory Medicine, Nottingham University Hospitals, Nottingham, UK
| | - Richard Booton
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
- Manchester Thoracic Oncology Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Claire Bradley
- Craigavon Area Hospital, Southern Health and Social Care Trust, Portadown, UK
| | - Mike Darby
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Claire Eckert
- Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Kevin N Franks
- Institute of Health Sciences, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Sam M Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Henrik Møller
- The Danish Clinical Quality Program and Clinical Registries (RKKP), Aarhus, Denmark
| | - Rachael L Murray
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Richard D Neal
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Samantha L Quaife
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | | | | | | | - Matthew E J Callister
- Institute of Health Sciences, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
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16
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The impact of driving time on participation in colorectal cancer screening with sigmoidoscopy and faecal immunochemical blood test. Cancer Epidemiol 2022; 80:102244. [DOI: 10.1016/j.canep.2022.102244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/20/2022] [Accepted: 08/26/2022] [Indexed: 11/18/2022]
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17
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Nichol BAB, Hurlbert AC, Read JCA. Predicting attitudes towards screening for neurodegenerative diseases using OCT and artificial intelligence: Findings from a literature review. J Public Health Res 2022; 11:22799036221127627. [PMID: 36310821 PMCID: PMC9597051 DOI: 10.1177/22799036221127627] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/02/2022] [Indexed: 11/25/2022] Open
Abstract
Recent developments in artificial intelligence (AI) and machine learning raise the possibility of screening and early diagnosis for neurodegenerative diseases, using 3D scans of the retina. The eventual value of such screening will depend not only on scientific metrics such as specificity and sensitivity but, critically, also on public attitudes and uptake. Differential screening rates for various screening programmes in England indicate that multiple factors influence uptake. In this narrative literature review, some of these potential factors are explored in relation to predicting uptake of an early screening tool for neurodegenerative diseases using AI. These include: awareness of the disease, perceived risk, social influence, the use of AI, previous screening experience, socioeconomic status, health literacy, uncontrollable mortality risk, and demographic factors. The review finds the strongest and most consistent predictors to be ethnicity, social influence, the use of AI, and previous screening experience. Furthermore, it is likely that factors also interact to predict the uptake of such a tool. However, further experimental work is needed both to validate these predictions and explore interactions between the significant predictors.
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Affiliation(s)
- Beth AB Nichol
- Department of Social Work, Education,
and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | - Anya C Hurlbert
- Biosciences Institute, Newcastle
University, Newcastle upon Tyne, UK
| | - Jenny CA Read
- Biosciences Institute, Newcastle
University, Newcastle upon Tyne, UK
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18
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Martins T, Abel G, Ukoumunne OC, Mounce LTA, Price S, Lyratzopoulos G, Chinegwundoh F, Hamilton W. Ethnic inequalities in routes to diagnosis of cancer: a population-based UK cohort study. Br J Cancer 2022; 127:863-871. [PMID: 35661833 PMCID: PMC9427836 DOI: 10.1038/s41416-022-01847-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 04/08/2022] [Accepted: 05/06/2022] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND UK Asian and Black ethnic groups have poorer outcomes for some cancers and are less likely to report a positive care experience than their White counterparts. This study investigated ethnic differences in the route to diagnosis (RTD) to identify areas in patients' cancer journeys where inequalities lie, and targeted intervention might have optimum impact. METHODS We analysed data of 243,825 patients with 10 cancers (2006-2016) from the RTD project linked to primary care data. Crude and adjusted proportions of patients diagnosed via six routes (emergency, elective GP referral, two-week wait (2WW), screen-detected, hospital, and Other routes) were calculated by ethnicity. Adjusted odds ratios (including two-way interactions between cancer and age, sex, IMD, and ethnicity) determined cancer-specific differences in RTD by ethnicity. RESULTS Across the 10 cancers studied, most patients were diagnosed via 2WW (36.4%), elective GP referral (23.2%), emergency (18.2%), hospital routes (10.3%), and screening (8.61%). Patients of Other ethnic group had the highest proportion of diagnosis via the emergency route, followed by White patients. Asian and Black group were more likely to be GP-referred, with the Black and Mixed groups also more likely to follow the 2WW route. However, there were notable cancer-specific differences in the RTD by ethnicity. CONCLUSION Our findings suggest that, where inequalities exist, the adverse cancer outcomes among Asian and Black patients are unlikely to be arising solely from a poorer diagnostic process.
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Affiliation(s)
- Tanimola Martins
- College of Medicine and Health, University of Exeter, College House, St Luke's Campus, Magdalen Road, Exeter, EX1 2LU, UK.
| | - Gary Abel
- College of Medicine and Health, University of Exeter, College House, St Luke's Campus, Magdalen Road, Exeter, EX1 2LU, UK
| | - Obioha C Ukoumunne
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), University of Exeter, Exeter, UK
| | - Luke T A Mounce
- College of Medicine and Health, University of Exeter, College House, St Luke's Campus, Magdalen Road, Exeter, EX1 2LU, UK
| | - Sarah Price
- College of Medicine and Health, University of Exeter, College House, St Luke's Campus, Magdalen Road, Exeter, EX1 2LU, UK
| | - Georgios Lyratzopoulos
- Epidemiology of Cancer Healthcare & Outcomes (ECHO) Group, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Frank Chinegwundoh
- Barts Health NHS Trust & Department of Health Sciences, University of London, London, UK
| | - William Hamilton
- College of Medicine and Health, University of Exeter, College House, St Luke's Campus, Magdalen Road, Exeter, EX1 2LU, UK
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19
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Thomas C, Mandrik O, Whyte S. Modelling cost-effective strategies for minimising socioeconomic inequalities in colorectal cancer screening outcomes in England. Prev Med 2022; 162:107131. [PMID: 35803353 DOI: 10.1016/j.ypmed.2022.107131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 06/17/2022] [Accepted: 06/27/2022] [Indexed: 11/18/2022]
Abstract
Colorectal cancer (CRC) incidence and mortality is higher in socioeconomically deprived groups for a variety of reasons, but is exacerbated by poorer screening uptake. However, many strategies for improving screening participation exist. This analysis aimed to model the impact of screening on CRC inequalities in England and then compare different strategies for increasing participation, to determine the most cost-effective methods for reducing screening-induced inequalities. An existing health economic model, Microsimulation Model in Cancer of the Bowel was adapted. Screening-eligible individuals were simulated to investigate the impact of screening on CRC inequalities. Following this, four strategies for promoting screening participation were compared: 1) annual re-invitation of screening non-participants; 2) a national media advertising campaign; 3) text message reminders for non-participants; 4) health promotion in deprived populations. Cost-effectiveness, CRC outcomes, resource impacts and effects on CRC inequalities were assessed. Inequalities analysis was based on age-standardised CRC mortality by socioeconomic group. Screening was found to be highly cost-effective but CRC inequalities increased as screening effectiveness improved. Annual re-invitation of non-participants was most cost-effective for promoting particiption (incremental cost-effectiveness ratio = £4404 per quality-adjusted life-year), reducing CRC mortality (11,129 deaths averted), and reducing screening-induced inequality (slope of inequalities reduced from 20.80 to 19.38), although it required 42% more screening kits to be sent out. Other strategies were cost-effective compared with screening alone, and improved CRC outcomes, but had varying impacts on inequalities. Whilst bowel cancer screening increases socioeconomic inequalities in CRC mortality, effective and cost-effective strategies are available for mitigating screening-induced inequalities.
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Affiliation(s)
- Chloe Thomas
- School of Health and Related Research, University of Sheffield, Regent Court, Sheffield S1 4DA, United Kingdom.
| | - Olena Mandrik
- School of Health and Related Research, University of Sheffield, Regent Court, Sheffield S1 4DA, United Kingdom
| | - Sophie Whyte
- School of Health and Related Research, University of Sheffield, Regent Court, Sheffield S1 4DA, United Kingdom
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20
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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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21
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Stoffel ST, McGregor L, Hirst Y, Hanif S, Morris L, von Wagner C. Evaluation of the Call for a Kit intervention to increase bowel cancer screening uptake in Lancashire, England. J Med Screen 2022; 29:166-171. [PMID: 35410541 PMCID: PMC9381688 DOI: 10.1177/09691413221089184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the 'Call for a Kit' health promotion intervention that was initiated in Lancashire, England to improve bowel cancer screening uptake. METHODS Within the intervention, screening non-responders are called and invited to attend a consultation with a health promotion team member at their primary care practice. In this audit, we analysed the proportion of those contacted who attended the in-person clinic versus those who received a phone consultation, the number returning a test kit from in-person versus phone consultations, and the extent to which test kit return was moderated by sociodemographic characteristics. RESULTS In 2019, 68 practices participated in the intervention which led to 10,772 individuals being contacted; 2464 accepted the invitation to an in-person consultation, of whom 1943 attended. A further 1065 agreed to and attended a consultation over the phone. The 3008 consultations resulted in 2890 test kits being ordered, of which 1608 (55.6%) were returned. The intervention therefore yielded a 14.9% response rate in the total cohort; 71.5% of test kits came from individuals attending the in-person consultation. Women and those registered with a practice in socioeconomically deprived areas were less likely to return the test kit. Individuals with a black, mixed or a non-Indian/Pakistani Asian ethnic background were significantly more likely to accept the offer of an in-person consultation and return the test kit. CONCLUSION Our analysis demonstrated the strong likelihood of people returning a test kit after an in-person appointment but also the usefulness of using phone consultations as a safety net for people unable or unwilling to attend in-person clinics.
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Affiliation(s)
- Sandro T Stoffel
- Research Department of Behavioural Science and Health, University College London, London, UK.,Institute for Pharmaceutical Medicine, 27209University of Basel, Basel, Switzerland
| | - Lesley McGregor
- Division of Psychology, Faculty of Natural Sciences, 7622University of Stirling, Stirling, UK
| | - Yasemin Hirst
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Sahida Hanif
- 1756Blackpool Teaching Hospitals, NHS Foundation Trust, Blackpool, UK
| | - Lorraine Morris
- 1756Blackpool Teaching Hospitals, NHS Foundation Trust, Blackpool, UK
| | - Christian von Wagner
- Research Department of Behavioural Science and Health, University College London, London, UK
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22
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Syriopoulou E, Gasparini A, Humphreys K, Andersson TML. Assessing lead time bias due to mammography screening on estimates of loss in life expectancy. Breast Cancer Res 2022; 24:15. [PMID: 35197123 PMCID: PMC8867879 DOI: 10.1186/s13058-022-01505-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 01/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An increasingly popular measure for summarising cancer prognosis is the loss in life expectancy (LLE), i.e. the reduction in life expectancy following a cancer diagnosis. The proportion of life lost (PLL) can also be derived, improving comparability across age groups as LLE is highly age-dependent. LLE and PLL are often used to assess the impact of cancer over the remaining lifespan and across groups (e.g. socioeconomic groups). However, in the presence of screening, it is unclear whether part of the differences across population groups could be attributed to lead time bias. Lead time is the extra time added due to early diagnosis, that is, the time from tumour detection through screening to the time that cancer would have been diagnosed symptomatically. It leads to artificially inflated survival estimates even when there are no real survival improvements. METHODS In this paper, we used a simulation-based approach to assess the impact of lead time due to mammography screening on the estimation of LLE and PLL in breast cancer patients. A natural history model developed in a Swedish setting was used to simulate the growth of breast cancer tumours and age at symptomatic detection. Then, a screening programme similar to current guidelines in Sweden was imposed, with individuals aged 40-74 invited to participate every second year; different scenarios were considered for screening sensitivity and attendance. To isolate the lead time bias of screening, we assumed that screening does not affect the actual time of death. Finally, estimates of LLE and PLL were obtained in the absence and presence of screening, and their difference was used to derive the lead time bias. RESULTS The largest absolute bias for LLE was 0.61 years for a high screening sensitivity scenario and assuming perfect screening attendance. The absolute bias was reduced to 0.46 years when the perfect attendance assumption was relaxed to allow for imperfect attendance across screening visits. Bias was also present for the PLL estimates. CONCLUSIONS The results of the analysis suggested that lead time bias influences LLE and PLL metrics, thus requiring special consideration when interpreting comparisons across calendar time or population groups.
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Affiliation(s)
- Elisavet Syriopoulou
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Alessandro Gasparini
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Keith Humphreys
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Therese M-L Andersson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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23
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Bozhar H, McKee M, Spadea T, Veerus P, Heinävaara S, Anttila A, Senore C, Zielonke N, de Kok I, van Ravesteyn N, Lansdorp-Vogelaar I, de Koning H, Heijnsdijk E. Socio-economic Inequality of Utilization of Cancer Testing in Europe: A Cross-Sectional Study. Prev Med Rep 2022; 26:101733. [PMID: 35198362 PMCID: PMC8850331 DOI: 10.1016/j.pmedr.2022.101733] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 12/06/2021] [Accepted: 02/06/2022] [Indexed: 12/27/2022] Open
Abstract
There are currently screening programmes for breast, cervical and colorectal cancer in many European countries. However, the uptake of cancer screening in general may vary within and between countries. The aim of this study is to assess the inequalities in testing utilization by socio-economic status and whether the amount of inequality varies across European regions. We conducted an analysis based on cross-sectional data from the second wave of the European Health Interview Survey from 2013 to 2015. We analysed the use of breast, cervical, and colorectal cancer testing by socio-economic position (household income, educational level and employment status), socio-demographic factors, self-perceived health and smoking behaviour, by using multinomial logistic models, and inequality measurement based on the Slope index of inequality (SII) and Relative index of inequality (RII). The results show that the utilization of mammography (Odds Ratio (OR) = 0.55, 95% confidence interval (95%CI):0.50–0.61), cervical smear tests (OR = 0.60, 95%CI:0.56–0.65) and colorectal testing (OR = 0.82, 95%CI:0.78–0.86) was overall less likely among individuals within a low household income compared to a high household income. Also, individuals with a non-EU country of birth, low educational level and being unemployed (or retired) were overall less likely to be tested. The income-based inequality in breast (SII = 0.191;RII = 1.260) and colorectal testing utilization (SII = 0.161;RII = 1.487) was the greatest in Southern Europe. For cervical smears, this inequality was greatest in Eastern Europe (SII = 0.122;RII = 1.195). We concluded that there is considerable inequality in the use of cancer tests in Europe, with inequalities associated with household income, educational level, employment status, and country of birth.
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24
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Franklyn J, Lomax J, Labib P, Baker A, Hosking J, Moran B, Smolarek S. Colorectal cancer outcomes determined by mode of presentation: analysis of population data in England between 2010 and 2014. Tech Coloproctol 2022; 26:363-372. [PMID: 35084620 DOI: 10.1007/s10151-022-02574-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 01/13/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The purpose of this study was to investigate associations between mode of presentation; categorized as emergency, suspected cancer outpatient referral pathway (2-week wait or 2WW pathway), non-cancer suspected outpatient referral (non-2-week wait pathway) or following screening, and stage of diagnosis and survival in patients with colorectal cancer in England. METHODS This was a retrospective cohort observational study of patients diagnosed with colorectal cancer between January 2010 and December 2014 in England using data from Public Health England collated from regional cancer registries. RESULTS The most common route to diagnosis among 167,501 patients diagnosed with colorectal cancer was via the non-cancer suspect (non-2WW) outpatient referral pathway (35.1%) followed by the suspected cancer (2WW) referral pathway (31.6%), emergency presentation (22.8%) and most infrequently following screening (10.6%) (p < 0.01). Screening confers the greatest likelihood of early-stage diagnosis (61.6%) compared to other modes of presentation. The 5-year overall survival was 81.8%, 53.3%, 53.0% and 27.6% in those diagnosed via screening, 2WW, non-2WW pathway and emergency presentation, respectively. Patients from most deprived regions were more likely to be diagnosed following emergency presentation (27.7 vs 19.7%, p < 0.01) and less likely via screening (8.1 vs 12%, p < 0.01). CONCLUSIONS Asymptomatic individuals diagnosed following screening have earlier stage cancers and better survival, the opposite was observed in those diagnosed following emergency presentation. Patients referred via the 2WW pathway do not have better survival outcomes when compared to those referred via the non-2WW pathway. In addition, this study has identified socio-economic groups that need to be targeted with public health campaigns to improve screening uptake.
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Affiliation(s)
- J Franklyn
- Basingstoke and North Hampshire Hospitals NHS Trust, Aldermaston Road, Basingstok, RG249NA, UK. .,University Hospital Plymouth NHS Trust, Plymouth, UK.
| | - J Lomax
- University of Plymouth, Plymouth, UK
| | - P Labib
- University Hospital Plymouth NHS Trust, Plymouth, UK
| | - A Baker
- University of Plymouth, Plymouth, UK
| | - J Hosking
- Medical Statistics, University of Plymouth, Plymouth, UK
| | - B Moran
- Basingstoke and North Hampshire Hospitals NHS Trust, Aldermaston Road, Basingstok, RG249NA, UK.,Peritoneal Malignancy Institute Basingstoke, Basingstoke and North Hampshire Hospitals, Basingstok, UK
| | - S Smolarek
- University Hospital Plymouth NHS Trust, Plymouth, UK
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25
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Cross AJ, Myles J, Greliak P, Hackshaw A, Halloran S, Benton SC, Addison C, Chapman C, Djedovic N, Smith S, Wagner CV, Duffy SW, Raine R. Including a general practice endorsement letter with the testing kit in the Bowel Cancer Screening Programme: Results of a cluster randomised trial. J Med Screen 2021; 28:419-425. [PMID: 33645308 DOI: 10.1177/0969141321997480] [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] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To evaluate the effect of general practitioner endorsement accompanying the screening kit rather than with the invitation letter on participation in the NHS Bowel Cancer Screening Programme and on the socioeconomic gradient in participation in the Programme. METHODS The NHS Bowel Cancer Screening Programme in England is delivered via five regional hubs. In early 2016, we carried out a cluster-randomised trial, with hub-day of invitation as the randomisation unit. We randomised 150 hub-days of invitation to the intervention group, GP endorsement on the letter accompanying the guaiac faecal occult blood testing kit (75 hub-days, 197,366 individuals) or control, usual letter (75 hub-days, 197,476 individuals). The endpoint was participation, defined as return of a valid kit within 18 weeks of initial invitation. Because of the cluster randomisation, data were analysed by a hierarchical logistic regression, allowing a random effect for date of invitation. Socioeconomic status was represented by the index of multiple deprivation. RESULTS Participation was 59.4% in the intervention group and 58.7% in the control group, a significant difference (p = 0.04). There was no heterogeneity of the effect of intervention by index of multiple deprivation. We found that there was some confounding between date and screening episode order (first or subsequent screen). This in turn may have induced confounding with age and slightly diluted the result. CONCLUSIONS General practitioner endorsement induces a modest increase in participation in bowel cancer screening, but does not affect the socioeconomic gradient. When considering cluster randomisation as a research method, careful scrutiny of potential confounding is indicated in advance if possible and in analysis otherwise.
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Affiliation(s)
- Amanda J Cross
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Jonathan Myles
- Wolfson Institute for Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Paul Greliak
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Allan Hackshaw
- Cancer Research UK and UCL Cancer Trials Centre, Cancer Institute, University College London, London, UK
| | - Stephen Halloran
- Bowel Cancer Screening Southern Programme Hub, Surrey Research Park, Guildford, UK
- Department of Biomedical Sciences, University of Surrey, Guildford, UK
| | - Sally C Benton
- Bowel Cancer Screening Southern Programme Hub, Surrey Research Park, Guildford, UK
- Berkshire and Surrey Pathology Services, Royal Surrey County Hospital, Guildford, UK
| | - Caroline Addison
- Bowel Cancer Screening North East Programme Hub, Queen Elizabeth Hospital, Gateshead, UK
| | - Caroline Chapman
- Bowel Cancer Screening Eastern Programme Hub, University of Nottingham, Nottingham, UK
| | - Natasha Djedovic
- Bowel Cancer Screening London Programme Hub, Northwick Park & St Mark's Hospitals, Harrow, UK
| | - Stephen Smith
- Bowel Cancer Screening Midlands & North West Programme Hub, Hospital of St Cross, Rugby, UK
| | | | - Stephen W Duffy
- Wolfson Institute for Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Rosalind Raine
- Department of Applied Health Research, University College London, London, UK
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26
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Walker MJ, Meggetto O, Gao J, Espino-Hernández G, Jembere N, Bravo CA, Rey M, Aslam U, Sheppard AJ, Lofters AK, Tammemägi MC, Tinmouth J, Kupets R, Chiarelli AM, Rabeneck L. Measuring the impact of the COVID-19 pandemic on organized cancer screening and diagnostic follow-up care in Ontario, Canada: A provincial, population-based study. Prev Med 2021; 151:106586. [PMID: 34217413 PMCID: PMC9755643 DOI: 10.1016/j.ypmed.2021.106586] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/16/2021] [Accepted: 04/25/2021] [Indexed: 12/14/2022]
Abstract
It is essential to quantify the impacts of the COVID-19 pandemic on cancer screening, including for vulnerable sub-populations, to inform the development of evidence-based, targeted pandemic recovery strategies. We undertook a population-based retrospective observational study in Ontario, Canada to assess the impact of the pandemic on organized cancer screening and diagnostic services, and assess whether patterns of cancer screening service use and diagnostic delay differ across population sub-groups during the pandemic. Provincial health databases were used to identify age-eligible individuals who participated in one or more of Ontario's breast, cervical, colorectal, and lung cancer screening programs from January 1, 2019-December 31, 2020. Ontario's screening programs delivered 951,000 (-41%) fewer screening tests in 2020 than in 2019 and volumes for most programs remained more than 20% below historical levels by the end of 2020. A smaller percentage of cervical screening participants were older (50-59 and 60-69 years) during the pandemic when compared with 2019. Individuals in the oldest age groups and in lower-income neighborhoods were significantly more likely to experience diagnostic delay following an abnormal breast, cervical, or colorectal cancer screening test during the pandemic, and individuals with a high probability of living on a First Nation reserve were significantly more likely to experience diagnostic delay following an abnormal fecal test. Ongoing monitoring and management of backlogs must continue. Further evaluation is required to identify populations for whom access to cancer screening and diagnostic care has been disproportionately impacted and quantify impacts of these service disruptions on cancer incidence, stage, and mortality. This information is critical to pandemic recovery efforts that are aimed at achieving equitable and timely access to cancer screening-related care.
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Affiliation(s)
- Meghan J Walker
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Olivia Meggetto
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Julia Gao
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | | | | | | | - Michelle Rey
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Usman Aslam
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Amanda J Sheppard
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Aisha K Lofters
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, Ontairo, Canada; IC/ES, Toronto, Ontario, Canada; Department of Family & Community Medicine, University of Toronto, Toronto, Canada
| | - Martin C Tammemägi
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; Brock University, St. Catharines, Ontario, Canada
| | - Jill Tinmouth
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; IC/ES, Toronto, Ontario, Canada; Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rachel Kupets
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; Division of Gynecologic Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
| | - Anna M Chiarelli
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Linda Rabeneck
- Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; IC/ES, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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27
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Young B, Robb KA. Understanding patient factors to increase uptake of cancer screening: a review. Future Oncol 2021; 17:3757-3775. [PMID: 34378403 DOI: 10.2217/fon-2020-1078] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Early detection of cancer through organized screening is a central component of population-level strategies to reduce cancer mortality. For screening programs to be effective, it is important that those invited to screening participate. However, uptake rates are suboptimal in many populations and vary between screening programs, indicating a complex combination of patient factors that require elucidation to develop evidence-based strategies to increase participation. In this review, the authors summarize individual-level (sociodemographic and psychosocial) factors associated with cancer screening uptake and evidence for the effectiveness of behavioral interventions to increase uptake. The authors reflect on current trends and future directions for behavioral cancer screening research to overcome challenges and address unmet needs in reducing cancer mortality.
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Affiliation(s)
- Ben Young
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, G12 0XH, UK
| | - Kathryn A Robb
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, G12 0XH, UK
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28
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Ramli NS, Manaf MRA, Hassan MR, Ismail MI, Nawi AM. Effectiveness of Colorectal Cancer Screening Promotion Using E-Media Decision Aids: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158190. [PMID: 34360481 PMCID: PMC8345994 DOI: 10.3390/ijerph18158190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/30/2021] [Accepted: 07/30/2021] [Indexed: 12/09/2022]
Abstract
Colorectal cancer (CRC)-screening reduces mortality, yet remains underutilized. The use of electronic media (e-media) decision aids improves saliency and fosters informed decision-making. This systematic review aimed to determine the effectiveness of CRC-screening promotion, using e-media decision aids in primary healthcare (PHC) settings. Three databases (MEDLINE, Web of Science, and the Cochrane Library) were searched for eligible studies. Studies that evaluated e-media decision aids compared to usual care or other conditions were selected. Quality was assessed by using Cochrane tools. Their effectiveness was measured by CRC-screening completion rates, and meta-analysis was conducted to calculate the pooled estimates. Ten studies involving 9393 patients were included in this review. Follow-up durations spanned 3–24 months. The two types of decision-aid interventions used were videos and interactive multimedia programs, with durations of 6–15 min. Data from nine feasible studies with low or some risk of bias were synthesized for meta-analysis. A random-effects model revealed that CRC-screening promotion using e-media decision aids were almost twice as likely to have screening completion than their comparisons (OR 1.62, 95% CI: 1.03–2.62, p < 0.05). CRC-screening promotion through e-media has great potential for increasing screening participation in PHC settings. Thus, its development should be prioritized, and it should be integrated into existing programs.
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Affiliation(s)
- Nur Suhada Ramli
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaakob Latif, Cheras, Kuala Lumpur 56000, Malaysia; (N.S.R.); (M.R.A.M.); (M.R.H.)
- Ministry of Health, Malaysia, Federal Government Administrative Centre, Putrajaya 62514, Malaysia
| | - Mohd Rizal Abdul Manaf
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaakob Latif, Cheras, Kuala Lumpur 56000, Malaysia; (N.S.R.); (M.R.A.M.); (M.R.H.)
| | - Mohd Rohaizat Hassan
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaakob Latif, Cheras, Kuala Lumpur 56000, Malaysia; (N.S.R.); (M.R.A.M.); (M.R.H.)
| | - Muhamad Izwan Ismail
- Department of Surgery, Hospital Sultanah Aminah, Jalan Persiaran Abu Bakar Sultan, Johor Bahru 80100, Malaysia;
| | - Azmawati Mohammed Nawi
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaakob Latif, Cheras, Kuala Lumpur 56000, Malaysia; (N.S.R.); (M.R.A.M.); (M.R.H.)
- Correspondence:
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29
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Thomas C, Mandrik O, Saunders CL, Thompson D, Whyte S, Griffin S, Usher-Smith JA. The Costs and Benefits of Risk Stratification for Colorectal Cancer Screening Based On Phenotypic and Genetic Risk: A Health Economic Analysis. Cancer Prev Res (Phila) 2021; 14:811-822. [PMID: 34039685 PMCID: PMC7611464 DOI: 10.1158/1940-6207.capr-20-0620] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/15/2021] [Accepted: 05/24/2021] [Indexed: 01/07/2023]
Abstract
Population-based screening for colorectal cancer is an effective and cost-effective way of reducing colorectal cancer incidence and mortality. Many genetic and phenotypic risk factors for colorectal cancer have been identified, leading to development of colorectal cancer risk scores with varying discrimination. However, these are not currently used by population screening programs. We performed an economic analysis to assess the cost-effectiveness, clinical outcomes, and resource impact of using risk-stratification based on phenotypic and genetic risk, taking a UK National Health Service perspective. Biennial fecal immunochemical test (FIT), starting at an age determined through risk-assessment at age 40, was compared with FIT screening starting at a fixed age for all individuals. Compared with inviting everyone from age 60, using a risk score with area under the receiver operating characteristic curve of 0.721 to determine FIT screening start age, produces 418 QALYs, costs £247,000, and results in 218 fewer colorectal cancer cases and 156 fewer colorectal cancer deaths per 100,000 people, with similar FIT screening invites. There is 96% probability that risk-stratification is cost-effective, with net monetary benefit (based on £20,000 per QALY threshold) estimated at £8.1 million per 100,000 people. The maximum that could be spent on risk-assessment and still be cost-effective is £114 per person. Lower benefits are produced with lower discrimination risk scores, lower mean screening start age, or higher FIT thresholds. Risk-stratified screening benefits men more than women. Using risk to determine FIT screening start age could improve the clinical outcomes and cost effectiveness of colorectal cancer screening without using significant additional screening resources. PREVENTION RELEVANCE: Colorectal cancer screening is essential for early detection and prevention of colorectal cancer, but implementation is often limited by resource constraints. This work shows that risk-stratification using genetic and phenotypic risk could improve the effectiveness and cost-effectiveness of screening programs, without using substantially more screening resources than are currently available.
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Affiliation(s)
- Chloe Thomas
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom.
| | - Olena Mandrik
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Catherine L Saunders
- The Primary Care Unit, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Deborah Thompson
- Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, United Kingdom
| | - Sophie Whyte
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Simon Griffin
- The Primary Care Unit, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Juliet A Usher-Smith
- The Primary Care Unit, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
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30
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Protani MM, Jordan SJ, Kendall BJ, Siskind D, Lawrence D, Sara G, Brophy L, Kisely S. Colorectal cancer Outcomes in people with Severe Mental Illness Cohort (COSMIC): a protocol for an Australian retrospective cohort using linked administrative data. BMJ Open 2021; 11:e044737. [PMID: 34103315 PMCID: PMC8190058 DOI: 10.1136/bmjopen-2020-044737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 05/21/2021] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Colorectal cancer (CRC) mortality is significantly higher in those with severe mental illness (SMI) compared with the general population, despite similar incidence rates, suggesting that barriers to optimal screening and cancer care may contribute to disparities in CRC mortality in those with SMI. This study aims to compare participation in Australia's National Bowel Cancer Screening Programme (NBCSP) in those with SMI and those in the general population. We will also investigate treatment pathways after diagnosis to determine whether treatment variations could explain differences in CRC mortality. METHODS AND ANALYSIS We will undertake a retrospective cohort study of Australians using linked administrative data to assess differences in screening and cancer care between those with and without SMI, aged 50-74 years on or after 1 January 2006. People with SMI will be defined using antipsychotic medication prescription data. The comparison group will be people enrolled in Medicare (Australia's universal healthcare system) who have not been prescribed antipsychotic medication. Data on outcomes (NBCSP participation, follow-up colonoscopy, CRC incidence and CRC-cause and all-cause mortality) and confounders will be obtained from national-based and state-based administrative health datasets. All people in New South Wales, aged 50-74 with a new diagnosis of CRC on or after 1 January 2006, will be ascertained to examine stage at diagnosis and cancer treatment in those with and without SMI. Poisson regression will be used to calculate incidence rates and rate ratios for each outcome. ETHICS AND DISSEMINATION Ethics approval has been obtained from the University of Queensland Human Research Ethics Committee, the Australian Institute of Health and Welfare Ethics Committee and data custodians from every Australian State/Territory. Findings will be disseminated via publications in peer-reviewed journals and presented at appropriate conferences. TRIAL REGISTRATION NUMBER ACTRN12620000781943.
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Affiliation(s)
- Melinda M Protani
- School of Public Health, The University of Queensland, Herston, Queensland, Australia
| | - Susan J Jordan
- School of Public Health, The University of Queensland, Herston, Queensland, Australia
- Population Health Department, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Bradley J Kendall
- School of Clinical Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Dan Siskind
- School of Clinical Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Metro South Addiction and Mental Health Service, Brisbane, Queensland, Australia
| | - David Lawrence
- Graduate School of Education, University of Western Australia, Perth, Western Australia, Australia
| | - Grant Sara
- InforMH, System Information and Analytics Branch, NSW Ministry of Health, North Ryde, New South Wales, Australia
- Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Lisa Brophy
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Steve Kisely
- School of Clinical Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Metro South Addiction and Mental Health Service, Brisbane, Queensland, Australia
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31
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Geddes A, Fotheringham AS, Libby G, Steele RJC. Colorectal cancer screening participation: Exploring relationship heterogeneity and scale differences using multiscale geographically weighted regression. GEOSPATIAL HEALTH 2021; 16. [PMID: 34000795 DOI: 10.4081/gh.2021.967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 04/03/2021] [Indexed: 06/12/2023]
Abstract
Scotland has an organised colorectal cancer screening programme; however, despite proactively offering screening opportunities free to the at-risk population, and also despite using a screening test which may be completed at home, screening participation levels are unequal. Understanding causal pathways linking participation with other population characteristics may be aided by identifying how relationships between the two patterns vary across different localities, and such knowledge may also inform decisions regarding geographical targeting of screening promotion efforts. In this analysis, models calibrated using multiscale geographically weighted regression enabled the assessment of spatial variations of determinants of screening participation levels. The models were calibrated for localities across west central Scotland (n=409), where participation levels were relatively low, using aggregated individual-level screening records within a two-year window (2009-2011). Area deprivation was found to have a strong negative impact on participation levels across the study area, and ethnic population concentration had a significant impact on male participation levels on localities within Glasgow city. Estimates of local intercepts pointed to a systemic difference in screening participation between the two health board regions in the study area. Overall the results suggest that work to increase screening participation was necessary. They also suggest that barriers to participation could be addressed locally, and that differences between health board regions required further investigation.
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Affiliation(s)
- Alistair Geddes
- School of Social Sciences, University of Dundee, Dundee, Scotland.
| | - A Stewart Fotheringham
- School of Geographical Sciences and Urban Planning, Arizona State University, Tempe, AZ.
| | - Gillian Libby
- School of Medicine, University of Dundee, Ninewells Hospital, Dundee, Scotland.
| | - Robert J C Steele
- School of Medicine, University of Dundee, Ninewells Hospital, Dundee, Scotland.
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Jackson L, Al-Janabi H, Roberts T, Ross J. Exploring young people's preferences for STI screening in the UK: A qualitative study and discrete choice experiment. Soc Sci Med 2021; 279:113945. [PMID: 34010779 DOI: 10.1016/j.socscimed.2021.113945] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/16/2021] [Accepted: 04/14/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Stigma remains a key issue for many health screening interventions such as screening for sexually transmitted infections (STIs). Young people continue to experience the greatest burden of STI infection. In order to increase uptake, screening services need to be more patient-focused. This study sought to examine young people's preferences for sexual health screening to understand how scarce public health resources can optimise screening uptake. METHODS This study involved both qualitative and quantitative components. Focus groups and individual interviews were undertaken with young people aged 16-24 recruited from community settings and a specialist clinic. Themes which emerged from the focus groups were used to inform the design of a discrete choice experiment (DCE). A questionnaire survey (incorporating the DCE) was conducted with members of an internet panel, with over-sampling of black, Asian and minority ethnic groups. RESULTS Overall, 41 participants took part in eight focus groups and two in individual interviews. Six major themes emerged as important when making decisions about STI screening - stigma and embarrassment; knowledge about STIs and risk; where to get tested; how staff would treat them; what STIs to be tested for; and convenience (waiting times). Overall, 1946 participants took part in the survey. The DCE results revealed that the most important factors for young people are that all STIs are tested for, and that staff attitude is non-judgemental. The results also suggest that there is a preference for screening in specialist clinics and for full appointments over limited ones. Although respondents preferred shorter time periods for appointments and results, other 'process' factors were also important. CONCLUSION This study demonstrates that by combining qualitative and quantitative methods, a richer understanding of STI screening preferences is possible. The findings show that comprehensive testing and a perceived 'non-judgemental' attitude are particularly important to young people, as well as convenience.
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Affiliation(s)
- Louise Jackson
- Health Economics Unit, Institute of Applied Health Research, College of Medical & Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B152TT, UK.
| | - Hareth Al-Janabi
- Health Economics Unit, Institute of Applied Health Research, College of Medical & Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B152TT, UK
| | - Tracy Roberts
- Health Economics Unit, Institute of Applied Health Research, College of Medical & Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B152TT, UK
| | - Jonthan Ross
- Department of GU Medicine, University Hospitals Birmingham NHS Foundation Trust, Whittall Street Clinic, Whittall Street, Birmingham B4 6DH, UK
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Carlton J, Griffiths HJ, Horwood AM, Mazzone PP, Walker R, Simonsz HJ. Acceptability of childhood screening: a systematic narrative review. Public Health 2021; 193:126-138. [PMID: 33831694 PMCID: PMC8128098 DOI: 10.1016/j.puhe.2021.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/05/2021] [Accepted: 02/09/2021] [Indexed: 12/22/2022]
Abstract
Objectives A systematic narrative literature review was undertaken to assess the acceptability of childhood screening interventions to identify factors to consider when planning or modifying childhood screening programs to maximize participation and uptake. Study design This is a systematic narrative literature review. Methods Electronic databases were searched (MEDLINE, EMBASE, PsycINFO via Ovid, CINAHL, and Cochrane Library) to identify primary research studies that assessed screening acceptability. Studies were categorized using an existing theoretical framework of acceptability consisting of seven constructs: affective attitude, burden, ethicality, intervention coherence, opportunity costs, perceived effectiveness, and self-efficacy. A protocol was developed and registered with PROSPERO (registration no. CRD42018099763) Results The search identified 4529 studies, and 46 studies met the inclusion criteria. Most studies involved neonatal screening. Programs identified included newborn blood spot screening (n = 22), neonatal hearing screening (n = 13), Duchenne muscular dystrophy screening (n = 4), cystic fibrosis screening (n = 3), screening for congenital heart defects (n = 2), and others (n = 2). Most studies assessed more than one construct of acceptability. The most common constructs identified were affective attitude (how a parent feels about the program) and intervention coherence (parental understanding of the program, and/or the potential consequences of a confirmed diagnosis). Conclusions The main acceptability component identified related to parental knowledge and understanding of the screening process, the testing procedure(s), and consent. The emotional impact of childhood screening mostly explored maternal anxiety. Further studies are needed to examine the acceptability of childhood screening across the wider family unit. When planning new (or refining existing) childhood screening programs, it is important to assess acceptability before implementation. This should include assessment of important issues such as information needs, timing of information, and when and where the screening should occur.
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Affiliation(s)
- J Carlton
- School of Health and Related Research (ScHARR), Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - H J Griffiths
- Academic Unit of Ophthalmology and Orthoptics, The Medical School, University of Sheffield, Health Sciences School, Beech Hill Road, Sheffield, S10 2RX, UK.
| | - A M Horwood
- Infant Vision Laboratory, School of Psychology and Clinical Language Sciences, University of Reading, Infant Vision Laboratory, Earley Gate, Reading, RG6 6AL, UK.
| | - P P Mazzone
- School of Health and Related Research (ScHARR), Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - R Walker
- School of Health and Related Research (ScHARR), Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - H J Simonsz
- Department of Ophthalmology, Erasmus Medical Center, P.O. Box 2040, NL-3000CA, Rotterdam, the Netherlands.
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Clarke N, Kearney PM, Gallagher P, McNamara D, O'Morain CA, Sharp L. Negative emotions and cancer fatalism are independently associated with uptake of Faecal Immunochemical Test-based colorectal cancer screening: Results from a population-based study. Prev Med 2021; 145:106430. [PMID: 33482227 DOI: 10.1016/j.ypmed.2021.106430] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 01/13/2021] [Accepted: 01/16/2021] [Indexed: 12/24/2022]
Abstract
Although systematic colorectal cancer screening is efficacious, many programmes suffer from low uptake. Few behavioural or attitudinal factors have been identified as being associated with participation in colorectal cancer screening. We explored knowledge, beliefs about cancer, subjective health literacy, emotional attitudes to screening, and social influences among individuals invited to a population-based screening programme. Regression modelling of a cross-sectional survey of 2299 individuals (users and non-users) of a population-based Faecal Immunochemical Test (FIT) screening programme in Dublin was conducted. Questions were derived from previous theoretically-informed qualitative work and assessed using previously used and validated measures. The primary outcome variable was uptake status (User/Participation or Non-User/Non-participation); multivariable logistic regression was used to estimate the odds ratios (OR) for screening participation. Stronger fatalistic beliefs independently predicted lower uptake (OR = 0.94; 95% CI 0.90-0.98; P = 0.003). Those aged <65 who disagreed that "cancer can often be cured" also had lower uptake (OR = 0.43; 95% CI 0.22-0.82: P = 0.017). Agreement that the test was disgusting and tempting fate predicted lower uptake (OR = 0.16: 95% CI 0.10-0.27: p < 0.001), while the influence of a partner on decision to be screened was associated with higher uptake (OR = 1.32; 95% CI 1.15-1.50: P < 0.001). Negative cancer-related and screening-related beliefs and emotions are associated with non-participation in FIT (-based screening). Research is warranted to explore if these negative beliefs and emotions are modifiable and, if so, whether this would improve screening uptake. The association between the influence of a partner and screening participation present a challenge around improving uptake among those not in co-habiting relationships.
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Affiliation(s)
| | | | | | - Deirdre McNamara
- Department of Clinical Medicine, Trinity Centre for Health Sciences, Adelaide and Meath Hospital, Dublin, Ireland.
| | - Colm A O'Morain
- Faculty of Health Science, Trinity College Dublin, Dublin, Ireland.
| | - Linda Sharp
- Newcastle University Centre for Cancer, Population Health Sciences Institute, Newcastle University, England, UK.
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Saito MK, Quaresma M, Fowler H, Majano SB, Rachet B. Exploring socioeconomic differences in surgery and in time to elective surgery for colon cancer in England: Population-based study. Cancer Epidemiol 2021; 71:101896. [PMID: 33516139 DOI: 10.1016/j.canep.2021.101896] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/12/2020] [Accepted: 01/10/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND A persistent socioeconomic gap in colon cancer survival is observed in England. Provision of cancer care may also vary by socioeconomic status (SES). We investigated population-based data to explore differential surgical care by SES. METHODS We analysed a retrospective cohort of patients diagnosed with colon cancer in England (2010-2013). We examined patterns of presentation and surgery by SES, and whether socioeconomic differences exist in the length of time from diagnosis to elective major resection using linear regression. RESULTS Among a total of 68 169 patients with colon cancer, 21.0 % (3138/14 917) in the most affluent group had emergency presentation (EP) whereas 27.9 % (2901/10 386) in the most deprived. Among 45 332 (66.5 %) patients who underwent resection, the proportion of patients receiving urgent surgery (surgery before or ≤ 7 days of diagnosis) was higher in the most deprived group (39.9 %, 2685/6733) than the most affluent (35.4 %, 3595/10 146). Days from diagnosis to elective surgery (surgery > 7 days after diagnosis) ranged from 33.9 (95 % CI 33.1-34.8) in stage II to 38.2 (95 % CI 36.8-39.7) in stage I, but no socioeconomic differences in time were seen in all stages. CONCLUSIONS Time to elective surgery for colon cancer did not differ by SES, whereas a higher proportion among deprived patients tended to be diagnosed through EP and to receive urgent surgery. These results suggest that the waiting time target may not be an appropriate measure to assess access to cancer care. Reducing both EP and urgent surgery should be a key policy target.
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Affiliation(s)
- Mari Kajiwara Saito
- Inequalities in Cancer Outcomes Network, Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Manuela Quaresma
- Inequalities in Cancer Outcomes Network, Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Helen Fowler
- Inequalities in Cancer Outcomes Network, Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Sara Benitez Majano
- Inequalities in Cancer Outcomes Network, Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Bernard Rachet
- Inequalities in Cancer Outcomes Network, Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
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FitzPatrick ME, Badu-Boateng C, Huntley C, Morgan C. 'Attorneys of the poor': Training physicians to tackle health inequalities. Future Healthc J 2021; 8:12-18. [PMID: 33791453 DOI: 10.7861/fhj.2020-0242] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The stellar gains in life expectancy and health over the past century have been accompanied by an increase in societal and health inequalities. This health gap between the most and least fortunate in our society is widening, driven by complex social determinants of health, as well as healthcare systems themselves. Physicians are not just well-qualified and well-placed to act as advocates for change, but have a moral duty to do so: to stand by silently is to be complicit. Following a workshop on health inequalities and medical training at the Royal College of Physicians Trainees Committee, we sought to examine how health inequalities could be addressed through changes to the medical education system. We discuss the arguments for reform in recruitment to medicine, and changes to undergraduate, postgraduate and continuing medical education in order to equip the profession to deliver meaningful improvements in health inequalities. We propose a population health credential as a mechanism by which specialists can gain additional skills to take on leadership roles addressing health inequalities, allowing them to support colleagues in public health and bring in specialty-specific knowledge and experience.
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Breast cancer worry in higher-risk women offered preventive therapy: a UK multicentre prospective study. Breast Cancer Res Treat 2021; 188:703-712. [PMID: 33733302 PMCID: PMC8720078 DOI: 10.1007/s10549-021-06183-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 03/05/2021] [Indexed: 01/14/2023]
Abstract
Purpose Women’s worry about developing breast cancer may influence their decision to use preventive therapy. However, the direction of this relationship has been questioned. We prospectively investigated the relationship between breast cancer worry and uptake of preventive therapy. The socio-demographic and clinical factors associated with high breast cancer worry were also investigated. Methods Women at increased risk of developing breast cancer were recruited from clinics across England (n = 408). Participants completed a survey on their breast cancer worry, socio-demographic and clinical factors. Uptake of tamoxifen was recorded at 3 months (n = 258 women, 63.2%). Both primary and sensitivity analyses were conducted using different classifications of low, medium and high worry. Results 39.5% of respondents reported medium breast cancer worry at baseline and 21.2% reported high worry. Ethnic minority women were more likely to report high worry than white women (OR = 3.02, 95%CI 1.02, 8.91, p = 0.046). Women educated below degree level were more likely to report high worry than those with higher education (OR = 2.29, 95%CI 1.28, 4.09, p = 0.005). No statistically significant association was observed between worry and uptake. In the primary analysis, fewer respondents with medium worry at baseline initiated tamoxifen (low worry = 15.5%, medium = 13.5%, high = 15.7%). In the sensitivity analysis, participants with medium worry reported the highest uptake of tamoxifen (19.7%). Conclusions No association was observed between worry and uptake, although the relationship was affected by the categorisation of worry. Standardised reporting of the classification of worry is warranted to allow transparent comparisons across cohorts. Supplementary Information The online version contains supplementary material available at 10.1007/s10549-021-06183-x.
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Biermann O, Klüppelberg R, Lönnroth K, Viney K, Caws M, Atkins S. 'A double-edged sword': Perceived benefits and harms of active case-finding for people with presumptive tuberculosis and communities-A qualitative study based on expert interviews. PLoS One 2021; 16:e0247568. [PMID: 33705422 PMCID: PMC7951804 DOI: 10.1371/journal.pone.0247568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 02/09/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Active case-finding (ACF), also referred to as community-based tuberculosis screening, is a component of the World Health Organization's End TB Strategy. ACF has potential benefits but also harms, which need to be carefully assessed when developing and implementing ACF policies. While empirical evidence on the benefits of ACF is still weak, evidence on the harms is even weaker. This study aimed to explore experts' views on the benefits and harms of ACF for people with presumptive TB and communities. METHODS This was an exploratory study. Semi-structured interviews were conducted with a purposive sample of 39 experts from international, non-governmental/non-profit organizations, funders, government institutions, international societies, think tanks, universities and research institutions worldwide. Framework analysis was applied. RESULTS Findings elaborated perceived benefits of ACF, including reaching vulnerable populations, reducing patient costs, helping raise awareness for tuberculosis among individuals and engaging communities, and reducing tuberculosis transmission. Perceived harms included increasing stigma and discrimination, causing false-positive diagnoses, as well as triggering other unintended consequences related to screening for tuberculosis patients, such as deportation of migrants once confirmed to have tuberculosis. Most of the perceived benefits of ACF could be linked to its objective of finding and treating persons with tuberculosis early (theme 1), while ACF was also perceived as a "double-edged sword" and could cause harms, if inappropriately designed and implemented (theme 2). The analysis underlined the importance of considering the benefits and harms of ACF throughout the screening pathway. The study provides new insights into the perceived benefits and harms of ACF from the perspectives of experts in the field. CONCLUSION This study highlights gaps in the evidence base surrounding ACF and can stimulate further research, debate and analysis regarding the benefits and harms of ACF to inform contextual optimization of design and implementation of ACF strategies.
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Affiliation(s)
- Olivia Biermann
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Raina Klüppelberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Knut Lönnroth
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Kerri Viney
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Maxine Caws
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Birat Nepal Medical Trust, Lazimpat, Kathmandu, Nepal
| | - Salla Atkins
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- New Social Research and Global Health and Development, Faculty of Social Sciences, Tampere University, Tampere, Finland
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Baldwin DR, Brain K, Quaife S. Participation in lung cancer screening. Transl Lung Cancer Res 2021; 10:1091-1098. [PMID: 33718047 PMCID: PMC7947401 DOI: 10.21037/tlcr-20-917] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 12/04/2020] [Indexed: 11/06/2022]
Abstract
Although there is now strong evidence for the efficacy of low-radiation dose computed tomography in reducing lung cancer mortality, the challenge is to establish screening programmes that have the maximum impact on the disease. In screening programmes, participation rates are a major determinant of the success of the programme. Informed uptake, participation, and adherence (to successive screening rounds) determine the overall impact of the intervention by ensuring the maximum number of people at risk of the disease are screened regularly and therefore have the most chance of benefiting. Existing cancer screening programmes have taught us a great deal about methods that improve participation. Although evidence is emerging for the efficacy of some of those methods in lung cancer screening, there is still much work to do in the specific demographic that is most at risk of lung cancer. This demographic, characterised by higher levels of socioeconomic deprivation, may be less willing to engage with healthcare interventions and present a particular challenge in the process of ensuring informed choice. In this article we review the evidence for improving participation and describe the challenges that need to be addressed to ensure the successful implementation of CT screening programmes.
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Affiliation(s)
- David R. Baldwin
- Divison of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
- Department of Respiratory Medicine, Nottingham University Hospitals, Nottingham, UK
| | - Kate Brain
- Division of Population Medicine, Cardiff University, Heath Park, Cardiff, UK
| | - Samantha Quaife
- Department of Behavioural Science and Health, Institute of Epidemiology and Public Health, University College London, London, UK
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Im YR, Abdul Latip SNB, Zielinska AP, Pawa N. Ethnicity is a missing parameter in colorectal cancer screening programmes in the United Kingdom. Public Health 2020; 190:e14-e15. [PMID: 33323189 DOI: 10.1016/j.puhe.2020.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 11/04/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Yu Ri Im
- Department of Colorectal Surgery, West Middlesex University Hospital, Chelsea and Westminster NHS Foundation Trust, Twickenham Road, Isleworth, TW7 6AF, UK; Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, SW7 2AZ, UK
| | - Siti Nadiah Binte Abdul Latip
- Department of Colorectal Surgery, West Middlesex University Hospital, Chelsea and Westminster NHS Foundation Trust, Twickenham Road, Isleworth, TW7 6AF, UK
| | - Agata Pamela Zielinska
- Department of Colorectal Surgery, West Middlesex University Hospital, Chelsea and Westminster NHS Foundation Trust, Twickenham Road, Isleworth, TW7 6AF, UK; Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, SW7 2AZ, UK
| | - Nikhil Pawa
- Department of Colorectal Surgery, West Middlesex University Hospital, Chelsea and Westminster NHS Foundation Trust, Twickenham Road, Isleworth, TW7 6AF, UK.
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Hoeck S, van de Veerdonk W, De Brabander I, Kellen E. Does the Flemish colorectal cancer screening programme reach equity in FIT uptake? Eur J Public Health 2020; 29:1108-1114. [PMID: 30887054 DOI: 10.1093/eurpub/ckz043] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND To investigate colorectal cancer (CRC) screening rates by the faecal immunochemical test (FIT) according to sociodemographic characteristics and nationality. METHODS Men and women, aged 56-74, invited to participate in the Flemish CRC screening programme in 2013 and 2014 were included in this study. We analysed the association between CRC screening uptake and sex, age, (first and current) nationality and several proxies for socio-economic status (SES). The statistical analysis was based on descriptive analyses and logistic regression models. RESULTS A total of 1 184 426 persons were included in our analysis. The overall screening uptake was 52.3%, uptake varied by sex, age, nationality and SES. Lower participation rates were associated with the youngest and oldest age categories (56-60 and 70-74) and being male. All nationalities other than Belgian or Dutch were significantly less screened. Lower uptake of screening was also associated with several proxy's for low SES, such as having an allowance for being disabled, not being able to work, being an extended minor and having a social allowance/minimum wage. The descriptive analysis showed a 27% difference in CRC screening uptake between the (early) retired and the people entitled to a minimum wage. CONCLUSIONS There is a significant difference between screening uptake and demographic and socio-economic variables in the first 2 years of the population-based screening programme in Flanders. Based on the study results, implementing strategies to improve participation in those subgroups is needed.
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Affiliation(s)
- S Hoeck
- Centre for Cancer Detection, Bruges, Belgium.,Department of Social Epidemiology and Health Policy, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - W van de Veerdonk
- Department of Social Epidemiology and Health Policy, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | | | - E Kellen
- Centre for Cancer Detection, Bruges, Belgium.,University Hospital Leuven, Leuven, Belgium
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Deding U, Henig AS, Hindersson P, Torp-Pedersen C, Bøggild H. Determinants of non-participation in colon examination following positive stool sample in colorectal cancer screening. Eur J Public Health 2020; 29:1118-1124. [PMID: 31329870 DOI: 10.1093/eurpub/ckz072] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Social inequalities has been shown for participation in colorectal cancer screening and recently in the initial stool sample blood test. If these differences persist at follow-up colon examination after a positive stool test, it would suggest that social inequality in screening may be greater than the inequality observed in initial stool sample blood test. METHODS All data were derived from national registers. Using logistic regression analyses, odds of non-participation for follow-up colon examination were estimated based on age group, educational level, income quartile, immigration status and marital status in men and in women, who had participated in initial stool sample test for blood with a positive result. RESULTS Among 20 849 men and 16 565 women invited for follow-up colonoscopy in the period 2014-15, 10.63 and 11.37%, respectively, did not attend. In men, odds of non-participation were higher in the eldest, those with lower income and lower educational level, in immigrants and in singles. Odds ratio (OR) in males of highest income quartile was 0.54 [95% confidence interval (CI) 0.46; 0.63] compared with lowest income quartile. In women, the differences were not as large. OR in females of highest income quartile was 0.73 (95% CI 0.61; 0.87) compared with lowest income quartile. CONCLUSION Sociodemographic differences in odds of non-participation exist in follow-up colon examination in the Danish colorectal cancer screening. Differences were evident in all subgroups of the male population. The same patterns were seen in women. Social inequalities in participation for follow-up colon examination can increase overall social inequality and consequently, lead to health disparities.
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Affiliation(s)
- Ulrik Deding
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg Øst, Denmark
| | - Anna Sharon Henig
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg Øst, Denmark
| | - Peter Hindersson
- Clinical Biochemistry, Regional Hospital North, Hjørring, Denmark
| | - Christian Torp-Pedersen
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg Øst, Denmark.,Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Henrik Bøggild
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg Øst, Denmark.,Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark
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Campbell C, Douglas A, Williams L, Cezard G, Brewster DH, Buchanan D, Robb K, Stanners G, Weller D, Steele RJ, Steiner M, Bhopal R. Are there ethnic and religious variations in uptake of bowel cancer screening? A retrospective cohort study among 1.7 million people in Scotland. BMJ Open 2020; 10:e037011. [PMID: 33033017 PMCID: PMC7542953 DOI: 10.1136/bmjopen-2020-037011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 07/01/2020] [Accepted: 08/15/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Cancer screening should be equitably accessed by all populations. Uptake of colorectal cancer screening was examined using the Scottish Health and Ethnicity Linkage Study that links the Scottish Census 2001 to health data by individual-level self-reported ethnicity and religion. SETTING Data on 1.7 million individuals in two rounds of the Scottish Bowel Cancer Screening Programme (2007-2013) were linked to the 2001 Census using the Scottish Community Health Index number. MAIN OUTCOME MEASURE Uptake of colorectal cancer screening, reported as age-adjusted risk ratios (RRs) by ethnic group and religion were calculated for men and women with 95% CI. RESULTS In the first, incidence screening round, compared with white Scottish men, Other White British (RR 109.6, 95% CI 108.8 to 110.3) and Chinese (107.2, 95% CI 102.8 to 111.8) men had higher uptake. In contrast, men of all South Asian groups had lower uptake (Indian RR 80.5, 95% CI 76.1 to 85.1; Pakistani RR 65.9, 95% CI 62.7 to 69.3; Bangladeshi RR 76.6, 95% CI 63.9 to 91.9; Other South Asian RR 88.6, 95% CI 81.8 to 96.1). Comparable patterns were seen among women in all ethnic groups, for example, Pakistani (RR 55.5, 95% CI 52.5 to 58.8). Variation in uptake was also observed by religion, with lower rates among Hindu (RR (95%CI): 78.4 (71.8 to 85.6)), Muslim (69.5 (66.7 to 72.3)) and Sikh (73.4 (67.1 to 80.3)) men compared with the reference population (Church of Scotland), with similar variation among women: lower rates were also seen among those who reported being Jewish, Roman Catholic or with no religion. CONCLUSIONS There are important variations in uptake of bowel cancer screening by ethnic group and religion in Scotland, for both sexes, that require further research and targeted interventions.
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Affiliation(s)
| | - Anne Douglas
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Linda Williams
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Geneviève Cezard
- Population and Health research group, School of Geography and Sustainable Development, University of St Andrews, St Andrews, Fife, UK
| | | | | | - Kathryn Robb
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | | | - David Weller
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Robert Jc Steele
- Surgery and Molecular Oncology, University of Dundee, Dundee, UK
| | - Markus Steiner
- School of Medicine, Department of Child Health, University of Aberdeen, Aberdeen, UK
| | - Raj Bhopal
- Usher Institute, The University of Edinburgh, Edinburgh, UK
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44
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Crosbie PA, Gabe R, Simmonds I, Kennedy M, Rogerson S, Ahmed N, Baldwin DR, Booton R, Cochrane A, Darby M, Franks K, Hinde S, Janes SM, Macleod U, Messenger M, Moller H, Murray RL, Neal RD, Quaife SL, Sculpher M, Tharmanathan P, Torgerson D, Callister ME. Yorkshire Lung Screening Trial (YLST): protocol for a randomised controlled trial to evaluate invitation to community-based low-dose CT screening for lung cancer versus usual care in a targeted population at risk. BMJ Open 2020; 10:e037075. [PMID: 32912947 PMCID: PMC7485242 DOI: 10.1136/bmjopen-2020-037075] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 06/24/2020] [Accepted: 07/08/2020] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Lung cancer is the world's leading cause of cancer death. Low-dose computed tomography (LDCT) screening reduced lung cancer mortality by 20% in the US National Lung Screening Trial. Here, we present the Yorkshire Lung Screening Trial (YLST), which will address key questions of relevance for screening implementation. METHODS AND ANALYSIS Using a single-consent Zelen's design, ever-smokers aged 55-80 years registered with a general practice in Leeds will be randomised (1:1) to invitation to a telephone-based risk-assessment for a Lung Health Check or to usual care. The anticipated number randomised by household is 62 980 individuals. Responders at high risk will be invited for LDCT scanning for lung cancer on a mobile van in the community. There will be two rounds of screening at an interval of 2 years. Primary objectives are (1) measure participation rates, (2) compare the performance of PLCOM2012 (threshold ≥1.51%), Liverpool Lung Project (V.2) (threshold ≥5%) and US Preventive Services Task Force eligibility criteria for screening population selection and (3) assess lung cancer outcomes in the intervention and usual care arms. Secondary evaluations include health economics, quality of life, smoking rates according to intervention arm, screening programme performance with ancillary biomarker and smoking cessation studies. ETHICS AND DISSEMINATION The study has been approved by the Greater Manchester West research ethics committee (18-NW-0012) and the Health Research Authority following review by the Confidentiality Advisory Group. The results will be disseminated through publication in peer-reviewed scientific journals, presentation at conferences and on the YLST website. TRIAL REGISTRATION NUMBERS ISRCTN42704678 and NCT03750110.
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Affiliation(s)
- Philip Aj Crosbie
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester, Manchester, UK
| | - Rhian Gabe
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Irene Simmonds
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Martyn Kennedy
- Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Suzanne Rogerson
- Department of Research and Innovation, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Nazia Ahmed
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - David R Baldwin
- Department of Respiratory Medicine, City Campus, Nottingham University Hospitals, Nottingham, UK
| | - Richard Booton
- Lung Cancer and Thoracic Surgery Directorate, Heart and Lung Division, Manchester University NHS Foundation Trust, Manchester, UK
| | - Ann Cochrane
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Michael Darby
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Kevin Franks
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Sam M Janes
- Department of Respiratory Medicine, University College London, London, UK
| | - Una Macleod
- Hull York Medical School, University of Hull, Hull, UK
| | - Mike Messenger
- Leeds Centre for Personalised Medicine and Health, University of Leeds, Leeds, UK
| | - Henrik Moller
- Thames Cancer Registry, Kings College London, London, UK
| | - Rachael L Murray
- Division of Epidemiology and Public Health, Faculty of Medicine, University of Nottingham, Nottingham, UK
| | - Richard D Neal
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Samantha L Quaife
- Research Department of Epidemiology and Public Health, University College London, London, UK
| | - Mark Sculpher
- Centre for Health Economics, University of York, York, UK
| | | | - David Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Matthew Ej Callister
- Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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45
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Aberrant Methylation of LINE-1 Transposable Elements: A Search for Cancer Biomarkers. Cells 2020; 9:cells9092017. [PMID: 32887319 PMCID: PMC7563416 DOI: 10.3390/cells9092017] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/26/2020] [Accepted: 08/31/2020] [Indexed: 02/07/2023] Open
Abstract
Cancer remains one of the main causes of human mortality despite significant progress in its diagnostics and therapy achieved in the past decade. Massive hypomethylation of retrotransposons, in particular LINE-1, is considered a hallmark of most malignant transformations as it results in the reactivation of retroelements and subsequent genomic instability. Accumulating data on LINE-1 aberrant methylation in different tumor types indicates its significant role in cancer initiation and progression. However, direct evidence that LINE-1 activation can be used as a cancer biomarker is still limited. The objective of this review was to critically evaluate the published results regarding the diagnostic/prognostic potential of the LINE-1 methylation status in cancer. Our analysis indicates that LINE-1 hypomethylation is a promising candidate biomarker of cancer development, which, however, needs validation in both clinical and laboratory studies to confirm its applicability to different cancer types and/or stages. As LINE-1 is present in multiple cell-free copies in blood, it has advantages over single-copy genes regarding perspectives of using its methylation status as an epigenetic cancer biomarker for cell-free DNA liquid biopsy.
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46
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Colorectal Cancer Survival in 50- to 69-Year-Olds after Introducing the Faecal Immunochemical Test. Cancers (Basel) 2020; 12:cancers12092412. [PMID: 32854370 PMCID: PMC7565457 DOI: 10.3390/cancers12092412] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/14/2020] [Accepted: 08/20/2020] [Indexed: 12/15/2022] Open
Abstract
Population screening has improved early diagnosis of colorectal cancer (CRC). Nonetheless, most cases are diagnosed in symptomatic patients. Faecal immunochemical testing has been recommended for assessing patients with lower gastrointestinal symptoms, but whether it improves patient survival is unknown. Our objective was to compare CRC survival in 50- to 69-year-olds between asymptomatic screen-detected patients and symptomatic patients by route to diagnosis. Methods: We identified all cases of CRC diagnosed in 50-to 69-year-olds between 2009 and 2016, in Donostialdea (Gipuzkoa, Spain). Three groups were created: 1-screen-detected CRC; 2-CRC detected in symptomatic patients after a positive faecal immunochemical test(FIT); and 3-CRC detected in symptomatic patients without a FIT or after a negative result. We analysed survival using the Kaplan-Meier method and log-rank tests. Results: Of 930 patients diagnosed with CRC, 433 cases were detected through screening and 497 in symptomatic patients, 7.9% after a positive FIT and 45.5% by other means. The 3-year CRC survival was significantly lower in group 3 (69.5%) than groups 1 (93%; p = 0.007) or 2 (87.5%; p = 0.02). The risk of death was lower in groups 1 (HR 0.42, 95% CI 0.30–0.58) and 2 (HR 0.51; 95% CI 0.29–0.87). Conclusion: Half of CRC cases in 50- to 69-year-olds are diagnosed outside screening. Use of the FIT as a diagnostic strategy in symptomatic patients may improve survival.
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47
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National organization of uterine cervical cancer screening and social inequality in France. Eur J Cancer Prev 2020; 29:458-465. [PMID: 32740172 DOI: 10.1097/cej.0000000000000557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Some of the inequality in uterine cervical cancer (UCC) screening uptake are due to the socioeconomic deprivation of women. A national organized screening programme has proven to be effective in increasing the uptake, but may increase socioeconomic inequality. Therefore, we compared inequality in uptake of UCC screening between two French departments, one of which is experimenting an organized screening programme. We used reimbursement data from the main French health insurance scheme to compare screening rates in the municipalities of the two departments over a three-year period. The experimental department had higher screening rates, but the increase in deprivation in municipalities had a greater effect on the decrease in participation in this department. Moreover, while screening rates were higher in urban areas, the negative effect of deprivation on participation was greater in rural areas. Although these departments were compared at the same time under different conditions, socioeconomic inequality between them may have been greater before the experimentation started. However, screening may have led to an increase in socioeconomic inequality between women screened. Special attention must be paid to changes in socioeconomic and geographic inequality in the uptake of UCC screening when the programme is rolled out nationally.
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48
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Travis E, Ashley L, Pownall M, O'Connor DB. Barriers to flexible sigmoidoscopy colorectal cancer screening in low uptake socio-demographic groups: A systematic review. Psychooncology 2020; 29:1237-1247. [PMID: 32539187 DOI: 10.1002/pon.5443] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 06/03/2020] [Accepted: 06/06/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To synthesise qualitative evidence related to barriers and facilitators of flexible sigmoidoscopy screening (FSS) intention and uptake, particularly within low socio-demographic uptake groups. FSS uptake is lower amongst women, lower socio-economic status (SES), and Asian ethnic groups within the United Kingdom (UK) and United States of America. METHODS A total of 12 168 articles were identified from searches of four databases: EMBASE, MEDLINE, PsycINFO and Web of Science. Eligibility criteria included: individuals eligible to attend FSS and empirical peer-reviewed studies that analysed qualitative data. The Critical Appraisal Skills Program tool evaluated the methodological quality of included studies, and thematic synthesis was used to analyse the data. RESULTS Ten qualitative studies met the inclusion criteria. Key barriers to FSS intention and uptake centred upon procedural anxieties. Women, including UK Asian women, reported shame and embarrassment, anticipated pain, perforation risk, and test preparation difficulties to elevate anxiety levels. Religious and cultural-influenced health beliefs amongst UK Asian groups were reported to inhibit FSS intention and uptake. Competing priorities, such as caring commitments, particularly impeded women's ability to attend certain FSS appointments. The review identified a knowledge gap concerning factors especially associated with FSS participation amongst lower SES groups. CONCLUSIONS Studies mostly focussed on barriers and facilitators of intention to participate in FSS, particularly within UK Asian groups. To determine the barriers associated with FSS uptake, and further understand how screening intention translates to behaviour, it is important that future qualitative research is equally directed towards factors associated with screening behaviour.
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Affiliation(s)
| | - Laura Ashley
- Leeds School of Social Sciences, Leeds Beckett University, Leeds, UK
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49
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Solenberg AK, Hall JP, Veazey Brooks J. Barriers to colorectal cancer screening for people with spinal cord injuries and/or disorders: A qualitative study. Disabil Health J 2020; 14:100950. [PMID: 32624453 DOI: 10.1016/j.dhjo.2020.100950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 05/21/2020] [Accepted: 05/31/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Limited research has shown people with spinal cord injuries and/or disorders (SCID) are less likely to be up to date with colorectal cancer (CRC) screening and therefore more likely to be diagnosed with advanced stage CRC compared to people without SCID. OBJECTIVE The aims of this study were to assess knowledge about CRC, CRC screening, and self-reported barriers to CRC screening for people with SCID. METHODS Interviews with 30 individuals with SCID were conducted using a semi-structured interview guide, audio recorded, and transcribed. Coding was performed using a hybrid approach of inductive and deductive analysis. Thematic analysis was used to identify, review, and modify themes and sub-themes. RESULTS Themes identified included barriers to CRC screening, such as socioeconomic, health system, transportation, psychological, and environmental or accessibility barriers. While most respondents were able to describe one CRC screening method (usually colonoscopy), knowledge of other screening modalities was limited. Low CRC literacy and misinformation about CRC screening appeared to increase respondent association between CRC screening and colonoscopy. While most respondents associated CRC screening with colonoscopy, almost half reported the colonoscopy preparation was the most substantial barrier to screening. CONCLUSIONS In addition to addressing identified barriers such as accessibility and transportation, communication, and prevention interventions should be specifically targeted to ensure all people with SCID are informed about appropriate and various modalities and the benefits of screening. Specific, evidence-based guidelines on the use of stool specimens first with follow up direct visualization, if needed, should be developed for this population.
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Affiliation(s)
- Allen K Solenberg
- University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA.
| | - Jean P Hall
- University of Kansas, Institute for Health and Disability Policy Studies and Department of Applied Behavioral Science, 1000 Sunnyside Ave, Lawrence, KS, 66045, USA
| | - Joanna Veazey Brooks
- Department of Population Health, University of Kansas Cancer Center, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
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50
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Mahumud RA, Alam K, Keramat SA, Renzaho AMN, Hossain MG, Haque R, Ormsby GM, Dunn J, Gow J. Wealth stratified inequalities in service utilisation of breast cancer screening across the geographical regions: a pooled decomposition analysis. ACTA ACUST UNITED AC 2020; 78:32. [PMID: 32528677 PMCID: PMC7285540 DOI: 10.1186/s13690-020-00410-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 03/18/2020] [Indexed: 11/10/2022]
Abstract
Background Breast cancer is the most commonly occurring cancer among women in low-resourced countries. Reduction of its impacts is achievable with regular screening and early detection. The main aim of the study was to examine the role of wealth stratified inequality in the utilisation breast cancer screening (BCS) services and identified potential factors contribute to the observed inequalities. Methods A population-based cross-sectional multi-country analysis was used to study the utilisation of BCS services. Regression-based decomposition analyses were applied to examine the magnitude of the impact of inequalities on the utilisation of BCS services and to identify potential factors contributing to these outcomes. Observations from 140,974 women aged greater than or equal to 40 years were used in the analysis from 14 low-resource countries from the latest available national-level Demographic and Health Surveys (2008-09 to 2016). Results The population-weighted mean utilisation of BCS services was low at 15.41% (95% CI: 15.22, 15.60), varying from 80.82% in European countries to 25.26% in South American countries, 16.95% in North American countries, 15.06% in Asia and 13.84% in African countries. Women with higher socioeconomic status (SES) had higher utilisation of BCS services (15%) than those with lower SES (9%). A high degree of inequality in accessing and the use of BCS services existed in all study countries across geographical areas. Older women, access to limited mass media communication, being insured, rurality and low wealth score were found to be significantly associated with lower utilisation of BCS services. Together they explained approximately 60% in the total inequality in utilisation of BCS services. Conclusions The level of wealth relates to the inequality in accessing BCS amongst reproductive women in these 14 low-resource countries. The findings may assist policymakers to develop risk-pooling financial mechanisms and design strategies to increase community awareness of BCS services. These strategies may contribute to reducing inequalities associated with achieving higher rates of the utilisation of BCS services.
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Affiliation(s)
- Rashidul Alam Mahumud
- School of Social Sciences and Psychology, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia.,Translational Health Research Institute (THRI), Western Sydney University, Sydney, NSW Australia.,Health Economics and Policy Research, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, QLD 4350 Australia.,School of Commerce, University of Southern Queensland, Toowoomba, QLD 4350 Australia.,Health Economics and Financing Research, International Centre for Diarrhoeal Disease Research, Dhaka, 1212 Bangladesh
| | - Khorshed Alam
- Health Economics and Policy Research, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, QLD 4350 Australia.,School of Commerce, University of Southern Queensland, Toowoomba, QLD 4350 Australia
| | - Syed Afroz Keramat
- Department of Economics, American International University-Bangladesh (AIUB), Dhaka, 1212 Bangladesh
| | - Andre M N Renzaho
- School of Social Sciences and Psychology, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia.,Translational Health Research Institute (THRI), Western Sydney University, Sydney, NSW Australia
| | - Md Golam Hossain
- Health and Epidemiological Research Group, Department of Statistics, University of Rajshahi, Rajshahi, 6205 Bangladesh
| | - Rezwanul Haque
- Department of Economics, American International University-Bangladesh (AIUB), Dhaka, 1212 Bangladesh
| | - Gail M Ormsby
- Professional Studies, Faculty of Business, Education, Law and Arts, University of southern Queensland, Toowoomba, QLD 4350 Australia
| | - Jeff Dunn
- Health Economics and Policy Research, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, QLD 4350 Australia.,Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, QLD 4006 Australia.,Prostate Cancer Research Foundation of Australia, St Leonards, NSW 2065 Australia
| | - Jeff Gow
- Health Economics and Policy Research, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, QLD 4350 Australia.,School of Commerce, University of Southern Queensland, Toowoomba, QLD 4350 Australia.,School of Accounting, Economics and Finance, University of KwaZulu-Natal, Durban, 4000 South Africa
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