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Dressler J, Njor SH, Rasmussen M, Jørgensen LN. Effect of colorectal cancer screening on colorectal cancer surgery outcomes: nationwide cohort study. BJS Open 2024; 8:zrae027. [PMID: 38502539 PMCID: PMC10949959 DOI: 10.1093/bjsopen/zrae027] [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] [Received: 11/05/2023] [Revised: 01/13/2024] [Accepted: 01/19/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND National colorectal cancer screening commenced in Denmark in 2014. Little is known about the effects of organized colorectal cancer screening on intraoperative and postoperative events. The aim of this nationwide cohort study was to evaluate the difference in intraoperative and postoperative outcomes between patients with screen-detected colorectal cancer and non-screen-detected colorectal cancer within the first 90 days after surgery. METHODS National register data were collected for Danish residents diagnosed with colorectal cancer between January 2014 and March 2018. Outcomes for the two cohorts were reported as relative risk or weighted mean difference. Intraoperative outcomes were blood loss, blood transfusion, tumour perforation, and organ lesion. Postoperative outcomes were complications (surgical and non-surgical) and 90-day mortality. Discrete data estimates were calculated from a general linear model. Analyses were adjusted for potential healthy user bias with respect to sex, age, location of the cancer (colon/rectum), and Charlson co-morbidity index. RESULTS In total, 10 606 patients were included. Compared with patients in the non-screen-detected colorectal cancer group (4497 patients), patients in the screen-detected colorectal cancer group (6109 patients) had reduced intraoperative blood loss (-52 mL, 95% c.i. -67 to -37, P < 0.001), a shorter duration of hospitalization (-2.3 days, 95% c.i. -2.8 to -1.8, P < 0.001), and reduced rates of intraoperative organ lesion (0.76, 95% c.i. 0.59 to 0.99, P = 0.042), surgical complications (0.79, 95% c.i. 0.73 to 0.87, P < 0.001), non-surgical complications (0.68, 95% c.i. 0.60 to 0.78, P < 0.001), and 90-day mortality (0.29, 95% c.i. 0.21 to 0.39, P < 0.001). CONCLUSION In comparison with non-screen-detected colorectal cancer, surgery for screen-detected colorectal cancer remains associated with improvement in several intraoperative and early postoperative outcomes after considering healthy user bias.
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Affiliation(s)
- Jannie Dressler
- Digestive Disease Centre, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Sisse H Njor
- Research Clinic for Cancer Screening, Randers Regional Hospital, Randers, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Morten Rasmussen
- Digestive Disease Centre, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Lars N Jørgensen
- Digestive Disease Centre, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Heyman H, Blom J, Saraste D. Colorectal cancer screening with faecal immunochemical test: Patterns of participation. J Med Screen 2024; 31:15-20. [PMID: 37464838 PMCID: PMC10877995 DOI: 10.1177/09691413231188275] [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: 02/08/2023] [Revised: 05/31/2023] [Accepted: 06/22/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVE To evaluate participation and participation patterns in a population-based screening programme for colorectal cancer (CRC) using the faecal immunochemical test (FIT). METHODS All individuals invited to three consecutive screening rounds in the population-based CRC screening between October 2015 and December 2020 in the Stockholm-Gotland Region, Sweden were included. Patterns of participation were assessed. RESULTS The study included 26 541 individuals which resulted in 79 623 screening events. The overall uptake rate was 71.5% and women had a significantly higher participation rate. The participation rate increased significantly between the first and third screening round for both men and women, and the increase was larger among men than women (66.1 to 70.7% vs. 73.1 to 75.4%). In total, 80.9% participated at least once. Consistent participation was the most common participation pattern (61.0%). The probability of attending all three consecutive rounds after initial participation was 87.7%. Over the three rounds, 17.4% participated after a reminder letter. Screening individuals attending after a reminder letter had a higher proportion of drop-outs in the following screening round compared to initial participants (15.4% vs 6.2%). CONCLUSION A constant and high participation rate was observed in population-based FIT-screening for CRC. Initial participation was a strong predictor for continuous participation. The need for a reminder letter before participation was a risk factor for subsequent drop-out.
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Affiliation(s)
- Hanna Heyman
- Department of Surgery, Södersjukhuset, Stockholm and Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Johannes Blom
- Department of Surgery, Södersjukhuset, Stockholm and Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Deborah Saraste
- Department of Surgery, Södersjukhuset, Stockholm and Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
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3
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Granger SP, Preece RAD, Thomas MG, Dixon SW, Chambers AC, Messenger DE. Colorectal cancer incidence trends by tumour location among adults of screening-age in England: a population-based study. Colorectal Dis 2023; 25:1771-1782. [PMID: 37553121 DOI: 10.1111/codi.16666] [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: 01/09/2023] [Revised: 05/04/2023] [Accepted: 05/07/2023] [Indexed: 08/10/2023]
Abstract
AIM Proximal and distal colorectal cancers (CRCs) exhibit different clinical, molecular and biological patterns. The aim of this study was to determine temporal trends in the age-standardized incidence rates (ASIRs) of proximal and distal CRC following the introduction of the English Bowel Cancer Screening Programme (BCSP) in 2006. METHOD The National Cancer Registration and Analysis Service database was used to identify incident cases of CRC among adults of screening age (60-74 years) between 2001 and 2017. ASIRs were calculated using the European Standard Population 2013 and incidence trends analysed by anatomical subsite (proximal, caecum to descending colon; distal, sigmoid to rectum), sex and Index of Multiple Deprivation (IMD) quintile using Joinpoint regression software. RESULTS Between 2001 and 2017, 541 515 incident cases of CRC were diagnosed [236 167 proximal (43.6%) and 305 348 distal (56.4%)]. A marginal reduction in the proximal ASIR was noted from 2008 [annual percentage change (APC) -1.4% (95% CI -2.0% to -0.9%)] compared with a greater reduction in distal ASIR from 2011 to 2014 [APC -6.6% (95% CI -11.5% to -1.5%)] which plateaued thereafter [APC -0.5% (95% CI -3.2% to 2.2%)]. Incidence rates decreased more rapidly in men than women. Adults in IMD quintiles 4-5 experienced the greatest reduction in distal tumours [APC -3.5% (95% CI -4.3% to -2.7%)]. CONCLUSION Following the introduction of the English BCSP, the incidence of CRC has subsequently reduced among adults of screening age, with this trend being most pronounced in distal tumours and in men. There is also evidence of a reduction in the deprivation gap for distal tumour incidence. Strategies to improve the detection of proximal tumours are warranted.
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Affiliation(s)
- Sam P Granger
- Department of Colorectal Surgery, Bristol Royal Infirmary, Bristol, UK
| | - Ryan A D Preece
- Department of Colorectal Surgery, Bristol Royal Infirmary, Bristol, UK
| | - Michael G Thomas
- Department of Colorectal Surgery, Bristol Royal Infirmary, Bristol, UK
| | - Steven W Dixon
- Department of Gastroenterology, Bristol Royal Infirmary, Bristol, UK
| | - Adam C Chambers
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - David E Messenger
- Department of Colorectal Surgery, Bristol Royal Infirmary, Bristol, UK
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4
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Zauber AG, Winawer SJ, O'Brien MJ, Mills GM, Allen JI, Feld AD, Jordan PA, Fleisher M, Orlow I, Meester RGS, Lansdorp-Vogelaar I, Rutter CM, Knudsen AB, Mandelson M, Shaukat A, Mendelsohn RB, Hahn AI, Lobaugh SM, Soto Palmer B, Serrano V, Kumar JR, Fischer SE, Chen JC, Bayuga-Miller S, Kuk D, O'Connell K, Church TR. Randomized Trial of Facilitated Adherence to Screening Colonoscopy vs Sequential Fecal-Based Blood Test. Gastroenterology 2023; 165:252-266. [PMID: 36948424 PMCID: PMC10330012 DOI: 10.1053/j.gastro.2023.03.206] [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: 06/02/2022] [Revised: 03/01/2023] [Accepted: 03/08/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND & AIMS Colorectal cancer (CRC) screening guidelines include screening colonoscopy and sequential high-sensitivity fecal occult blood testing (HSgFOBT), with expectation of similar effectiveness based on the assumption of similar high adherence. However, adherence to screening colonoscopy compared with sequential HSgFOBT has not been reported. In this randomized clinical trial, we assessed adherence and pathology findings for a single screening colonoscopy vs sequential and nonsequential HSgFOBTs. METHODS Participants aged 40-69 years were enrolled at 3 centers representing different clinical settings. Participants were randomized into a single screening colonoscopy arm vs sequential HSgFOBT arm composed of 4-7 rounds. Initial adherence to screening colonoscopy and sequential adherence to HSgFOBT, follow-up colonoscopy for positive HSgFOBT tests, crossover to colonoscopy, and detection of advanced neoplasia or large serrated lesions (ADN-SERs) were measured. RESULTS There were 3523 participants included in the trial; 1761 and 1762 participants were randomized to the screening colonoscopy and HSgFOBT arms, respectively. Adherence was 1473 (83.6%) for the screening colonoscopy arm vs 1288 (73.1%) for the HSgFOBT arm after 1 round (relative risk [RR], 1.14; 95% CI, 1.10-1.19; P ≤ .001), but only 674 (38.3%) over 4 sequential HSgFOBT rounds (RR, 2.19; 95% CI, 2.05-2.33). Overall adherence to any screening increased to 1558 (88.5%) in the screening colonoscopy arm during the entire study period and 1493 (84.7%) in the HSgFOBT arm (RR, 1.04; 95% CI, 1.02-1.07). Four hundred thirty-six participants (24.7%) crossed over to screening colonoscopy during the first 4 rounds. ADN-SERs were detected in 121 of the 1473 participants (8.2%) in the colonoscopy arm who were adherent to protocol in the first 12 months of the study, whereas detection of ADN-SERs among those who were not sequentially adherent (n = 709) to HSgFOBT was subpar (0.6%) (RR, 14.72; 95% CI, 5.46-39.67) compared with those who were sequentially adherent (3.3%) (n = 647) (RR, 2.52; 95% CI, 1.61-3.98) to HSgFOBT in the first 4 rounds. When including colonoscopies from HSgFOBT patients who were never positive yet crossed over (n = 1483), 5.5% of ADN-SERs were detected (RR, 1.50; 95% CI, 1.15-1.96) in the first 4 rounds. CONCLUSIONS Observed adherence to sequential rounds of HSgFOBT was suboptimal compared with a single screening colonoscopy. Detection of ADN-SERs was inferior when nonsequential HSgFOBT adherence was compared with sequential adherence. However, the greatest number of ADN-SERs was detected among those who crossed over to colonoscopy and opted to receive a colonoscopy. The effectiveness of an HSgFOBT screening program may be enhanced if crossover to screening colonoscopy is permitted. CLINICALTRIALS gov, Number: NCT00102011.
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Affiliation(s)
- Ann G Zauber
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Sidney J Winawer
- Gastroenterology, Hepatology, and Nutrition Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael J O'Brien
- Department of Pathology and Laboratory Medicine, Boston University Medical Center, Boston, Massachusetts
| | | | - John I Allen
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Andrew D Feld
- Department of Gastroenterology, Kaiser Permanente Washington, Seattle, Washington
| | - Paul A Jordan
- Department of Medicine, Louisiana State University Health, Shreveport, Louisiana
| | - Martin Fleisher
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Irene Orlow
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Reinier G S Meester
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Carolyn M Rutter
- Biostatistics Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Hutchinson Institute for Cancer Outcomes Research, Seattle, Washington
| | - Amy B Knudsen
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | | | - Aasma Shaukat
- Division of Gastroenterology, Department of Medicine Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, Minnesota; Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota; Division of Gastroenterology, Department of Medicine, NYU Langone Health, New York, New York
| | - Robin B Mendelsohn
- Gastroenterology, Hepatology, and Nutrition Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Anne I Hahn
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stephanie M Lobaugh
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | - Julie R Kumar
- Investigative Initiative Trials and Compassionate Use Studies, Novartis, East Hanover, New Jersey
| | - Sara E Fischer
- Department of Government, Georgetown University, Washington, District of Columbia
| | - Jennifer C Chen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sharon Bayuga-Miller
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Kelli O'Connell
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Timothy R Church
- Division of Gastroenterology, Department of Medicine Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, Minnesota; Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
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Chen YN, Shih CY, Guo SL, Liu CY, Shen MH, Chang SC, Ku WC, Huang CC, Huang CJ. Potential prognostic and predictive value of UBE2N, IMPDH1, DYNC1LI1 and HRASLS2 in colorectal cancer stool specimens. Biomed Rep 2023; 18:22. [PMID: 36846616 PMCID: PMC9945078 DOI: 10.3892/br.2023.1604] [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: 08/31/2022] [Accepted: 12/20/2022] [Indexed: 02/10/2023] Open
Abstract
Colorectal cancer (CRC) is the most common gastrointestinal malignancy worldwide. The poor specificity and sensitivity of the fecal occult blood test has prompted the development of CRC-related genetic markers for CRC screening and treatment. Gene expression profiles in stool specimens are effective, sensitive and clinically applicable. Herein, a novel advantage of using cells shed from the colon is presented for cost-effective CRC screening. Molecular panels were generated through a series of leave-one-out cross-validation and discriminant analyses. A logistic regression model following reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and immunohistochemistry was used to validate a specific panel for CRC prediction. The panel, consisting of ubiquitin-conjugating enzyme E2 N (UBE2N), inosine monophosphate dehydrogenase 1 (IMPDH1), dynein cytoplasmic 1 light intermediate chain 1 (DYNC1LI1) and phospholipase A and acyltransferase 2 (HRASLS2), accurately recognized patients with CRC and could thus be further investigated as a potential prognostic and predictive biomarker for CRC. UBE2N, IMPDH1 and DYNC1LI1 expression levels were upregulated and HRASLS2 expression was downregulated in CRC tissues. The predictive power of the panel was 96.6% [95% confidence interval (CI), 88.1-99.6%] sensitivity and 89.7% (95% CI, 72.6-97.8%) specificity at a predicted cut-off value at 0.540, suggesting that this four-gene panel testing of stool specimens can faithfully mirror the state of the colon. On the whole, the present study demonstrates that screening for CRC or cancer detection in stool specimens collected non-invasively does not require the inclusion of an excessive number of genes, and colonic defects can be identified via the detection of an aberrant protein in the mucosa or submucosa.
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Affiliation(s)
- Yu-Nung Chen
- Division of Colorectal Surgery, Department of Surgery, Cathay General Hospital, Taipei 10630, Taiwan, R.O.C
| | - Cheng-Yen Shih
- Division of Gastroenterology, Department of Internal Medicine, Sijhih Cathay General Hospital, New Taipei 22174, Taiwan, R.O.C
| | - Shu-Lin Guo
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei 24205, Taiwan, R.O.C.,Department of Anesthesiology, Cathay General Hospital, Taipei 10630, Taiwan, R.O.C,Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei 11490, Taiwan, R.O.C
| | - Chih-Yi Liu
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei 24205, Taiwan, R.O.C.,Division of Pathology, Sijhih Cathay General Hospital, New Taipei City 22174, Taiwan, R.O.C
| | - Ming-Hung Shen
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei 24205, Taiwan, R.O.C.,Department of Surgery, Fu Jen Catholic University Hospital, New Taipei 24352, Taiwan, R.O.C.,PhD Program in Nutrition and Food Science, College of Medicine, Fu Jen Catholic University, New Taipei 24205, Taiwan, R.O.C
| | - Shih-Chang Chang
- Division of Colorectal Surgery, Department of Surgery, Cathay General Hospital, Taipei 10630, Taiwan, R.O.C
| | - Wei-Chi Ku
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei 24205, Taiwan, R.O.C
| | - Chi-Cheng Huang
- Comprehensive Breast Health Center, Department of Surgery, Taipei Veterans General Hospital, Taipei 11217, Taiwan, R.O.C.,Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei 10090, Taiwan, R.O.C.,Correspondence to: Dr Chi-Cheng Huang, Comprehensive Breast Health Center, Department of Surgery, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Road, Taipei 11217, Taiwan, R.O.C.
| | - Chi-Jung Huang
- Department of Medical Research, Cathay General Hospital, Taipei 10630, Taiwan, R.O.C.,Department of Biochemistry, National Defense Medical Center, Taipei 11490, Taiwan, R.O.C.,Correspondence to: Dr Chi-Cheng Huang, Comprehensive Breast Health Center, Department of Surgery, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Road, Taipei 11217, Taiwan, R.O.C.
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6
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Kupper BEC, Ferreira FO, Nakagawa WT, Calsavara VF, Chulam TC, Lopes A, Aguiar-Junior S. COLORECTAL CANCER: ASSOCIATION BETWEEN SOCIODEMOGRAPHIC VARIABLES AND THE ADHERENCE TO CANCER SCREENING. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2023; 36:e1729. [PMID: 37194861 DOI: 10.1590/0102-672020230002e1729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 01/30/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) is a worldwide health problem whose control depends on public policy establishment and effective prevention and screening programs. In Brazil, there are few studies related to adherence to screening methods. AIMS The aim of this study was to evaluate the association between demographic and socioeconomic to adherence to CRC screening with fecal immunochemical test (FIT) among average-risk individuals for CRC. METHODS In this prospective cross-sectional study, conducted between March 2015 and April 2016, 1,254 asymptomatic individuals aged 50-75 years, participating in a hospital screening campaign in Brazil, were invited to participate in the study. RESULTS The adherence rate to FIT was 55.6% (697/1,254). In the multivariable logistic regression analysis, patients aged 60-75 years (odds ratio (OR)=1.30; 95% confidence interval (CI): 1.02-1.66; p=0.03), religious belief (OR=2.04; 95% CI: 1.34-3.11; p<0.01), previous fecal occult blood test (OR=2.07; 95% CI: 1.55-2.76; p<0.01), and full/part-time working status (OR=0.66; 95% CI: 0.49-0.89; p<0.01) were independently associated with adherence to CRC screening. CONCLUSION The results of the present study highlight the importance of considering the labor aspects when implementing screening programs, suggesting that campaigns conducted in the workplace and repeated over the years may be more effective.
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Affiliation(s)
| | | | | | | | - Thiago Celestino Chulam
- AC Camargo Cancer Center, Department of Prevention and Early Diagnosis - São Paulo (SP), Brazil
| | - Ademar Lopes
- AC Camargo Cancer Center, Colorectal Cancer Department - São Paulo (SP), Brazil
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7
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Flander L, Dekker E, Andersen B, Larsen MB, Steele RJ, Malila N, Sarkeala T, van der Vlugt M, de Klerk C, Knottnerus B, Bertels L, Woudstra A, Spaander MCW, Fransen M, Heinavaara S, Dillon M, Ait Ouakrim D, Jenkins M. What can We Learn From High-Performing Screening Programs to Increase Bowel Cancer Screening Participation in Australia? Cancer Control 2022; 29:10732748221121383. [PMID: 35969473 PMCID: PMC9381723 DOI: 10.1177/10732748221121383] [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] [Indexed: 11/17/2022] Open
Abstract
Background Colorectal cancer (CRC) is the second most diagnosed cancer in men and women and second most common cause of cancer death in Australia; Australia’s CRC incidence and mortality are among the world’s highest. The Australian National Bowel Cancer Screening Program began in 2006; however, only 33% of those approached for the first time by the Program between 2018 and 2019 returned the kit. Of the 5.7 million kits sent during this period, only 44% were returned. Our aim was to identify practices and features of national bowel cancer screening programs in countries with similar programs but higher screening participation, to identify potential interventions for optimising Australian CRC screening participation. Methods We searched published and grey literature for CRC screening programs reporting at least 50% screening participation using postal invitation and free return of iFOBT home kits. Interviews were conducted with cancer registry staff and academic researchers, focused on participant and practitioner engagement in screening. Results National programs in Netherlands, Scotland, Denmark, and Finland reported over 50% screening participation rates for all invitation rounds. Shared characteristics include small populations within small geographic areas relative to Australia; relatively high literacy; a one-sample iFOBT kit; national registration systems for population cancer screening research; and screening program research including randomised trials of program features. Conclusions Apart from the one-sample kit, we identified no single solution to persistent Australian low uptake of screening. Research including randomised trials within the program promises to increase participation. Impact This screening program comparison suggests that within-program intervention trials will lead to increased Australian screening participation.
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Affiliation(s)
- Louisa Flander
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, 85084The University of Melbourne, Parkville, VIC, Australia
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, 26066Amsterdam UMC, AZ Amsterdam, Netherlands
| | - Berit Andersen
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, 53198Randers Regional Hospital, Randers, Denmark.,Department of Clinical Medicine, Aarhus University, Denmark
| | - Mette Bach Larsen
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, 53198Randers Regional Hospital, Randers, Denmark
| | - Robert J Steele
- Ninewells Hospital & Medical School, 3042University of Dundee, Dundee, UK
| | - Nea Malila
- Finnish Cancer Registry, Helsinki, Finland
| | | | - Manon van der Vlugt
- Department of Gastroenterology and Hepatology, 26066Amsterdam UMC, AZ Amsterdam, Netherlands
| | - Clasine de Klerk
- Department of Gastroenterology and Hepatology, 26066Amsterdam UMC, AZ Amsterdam, Netherlands
| | - Bart Knottnerus
- 8123Netherlands Institute for Health Services Research (Nivel), Utrecht, Netherlands
| | - Lucinda Bertels
- 113896Erasmus School of Health Policy and Management, Rotterdam, Netherlands
| | - Anke Woudstra
- Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Manon C W Spaander
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Mirjam Fransen
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute 1105AZ Amsterdam, Netherlands
| | | | - Mary Dillon
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, 85084The University of Melbourne, Parkville, VIC, Australia.,Department of Information and Service Management, 4321Aalto University, Finland
| | - Driss Ait Ouakrim
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, 85084The University of Melbourne, Parkville, VIC, Australia
| | - Mark Jenkins
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, 85084The University of Melbourne, Parkville, VIC, Australia
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8
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Lofters AK, Gatov E, Lu H, Baxter NN, Corrado AM, Guilcher SJT, Kopp A, Vahabi M, Datta GD. Stage of colorectal cancer diagnosis for immigrants: a population-based retrospective cohort study in Ontario, Canada. Cancer Causes Control 2021; 32:1433-1446. [PMID: 34463874 PMCID: PMC8541965 DOI: 10.1007/s10552-021-01491-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 08/20/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) is the second most common cause of cancer death in Canada. Immigrants in Ontario, Canada's most populous province, are known to have lower rates of CRC screening, but differences in stage of CRC diagnosis are not known. METHODS We utilized linked administrative databases to compare early (stage I-II) versus late (stage III-IV) stage of CRC diagnosis for immigrants versus long-term residents among patients diagnosed in Ontario between 2012 and 2017 (n = 37,717) and examined the association of immigration-related, sociodemographic, and healthcare-related factors with stage. RESULTS Almost 45% of those with CRC were diagnosed at a late stage. Immigrants were slightly more likely to be diagnosed at a late stage than their long-term resident counterparts [Adjusted relative risks (ARRs) 1.06 (95% CI 1.02-1.10)], but after adjusting for age and sex, this difference was no longer significant. In fully adjusted models, we observed a higher likelihood of late-stage diagnosis for people with the fewest co-morbidities (ARR 0.86 [95% CI 0.83-0.89]) and those with no visits to primary care (versus a high level of continuity of care) [ARR 1.07 (95% CI 1.03-1.12)]. CONCLUSION Immigrants were not more likely to have a late-stage CRC diagnosis after adjusting for relevant factors, but access to primary care and healthcare contact was significantly associated with diagnostic stage. IMPACT Attachment to a primary care provider who provides regular preventive care may play a role in more favorable stage at diagnosis for CRC and thus should be a healthcare system priority.
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Affiliation(s)
- A K Lofters
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada.
- Women's College Hospital Research Institute, Toronto, Canada.
- Peter Gilgan Centre for Women's Cancers, Women's College Hospital, 76 Grenville St., Toronto, ON, M5S 1B2, Canada.
- ICES, Toronto, Canada.
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada.
| | | | | | - N N Baxter
- ICES, Toronto, Canada
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - A M Corrado
- Peter Gilgan Centre for Women's Cancers, Women's College Hospital, 76 Grenville St., Toronto, ON, M5S 1B2, Canada
| | - S J T Guilcher
- ICES, Toronto, Canada
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | | | - M Vahabi
- ICES, Toronto, Canada
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Canada
| | - G D Datta
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, Canada
- Research Center of the University of Montreal Hospital Center (CR-CHUM), Montreal, Canada
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9
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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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10
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Doria-Rose VP, Lansdorp-Vogelaar I, McCarthy S, Puricelli-Perin DM, Butera V, Segnan N, Taplin SH, Senore C. Measures of longitudinal adherence to fecal-based colorectal cancer screening: Literature review and recommended approaches. Int J Cancer 2021; 149:316-326. [PMID: 33811643 DOI: 10.1002/ijc.33589] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/11/2021] [Accepted: 03/12/2021] [Indexed: 12/14/2022]
Abstract
The success of fecal occult blood-based colorectal cancer screening programs is dependent on repeating screening at short intervals (ie, every 1-2 years). We conducted a literature review to assess measures that have been used to assess longitudinal adherence to fecal-based screening. Among 46 citations identified and included in this review, six broad classifications of longitudinal adherence were identified: (a) stratified single-round attendance, (b) all possible adherence permutations, (c) consistent/inconsistent/never attendance, (d) number of times attended, (e) program adherence and (f) proportion of time covered. Advantages and disadvantages of these measures are described, and recommendations on which measures to use based on data availability and scientific question are also given. Stratified single round attendance is particularly useful for describing the yield of screening, while programmatic adherence measures are best suited to evaluating screening efficacy. We recommend that screening programs collect detailed longitudinal, individual-level data, not only for the screening tests themselves but additionally for diagnostic follow-up and surveillance exams, to allow for maximum flexibility in reporting adherence patterns using the measure of choice.
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Affiliation(s)
- V Paul Doria-Rose
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, USA
| | | | - Sharon McCarthy
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, USA
| | - Douglas M Puricelli-Perin
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA
| | - Vicent Butera
- Center for Global Health, National Cancer Institute, Bethesda, Maryland, USA
| | - Nereo Segnan
- AOU Cittadella Salute e della Scienza, Centro di Prevenzione Oncologica Piemonte, Turin, Italy
| | - Stephen H Taplin
- Center for Global Health, National Cancer Institute, Bethesda, Maryland, USA
| | - Carlo Senore
- AOU Cittadella Salute e della Scienza, Centro di Prevenzione Oncologica Piemonte, Turin, Italy
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11
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Lam TYT, Wu PI, Tang RSY, Luk AKC, Ng S, Sung JJY. Mobile messenger-initiated reminders improve longitudinal adherence in a community-based, opportunistic colorectal cancer screening program: A single-blind, crossover randomized controlled study. Cancer 2020; 127:914-921. [PMID: 33216357 DOI: 10.1002/cncr.33336] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/23/2020] [Accepted: 10/29/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND The fecal immunochemical test (FIT) is a cost-effective colorectal cancer (CRC) screening tool. However, longitudinal adherence, a factor that is critical to the success to any FIT-based screening program, often is poor. The authors hypothesized that reminders sent via mobile messengers, such as WhatsApp, improve such adherence. METHODS In the current single-blind, randomized study, subjects from an opportunistic FIT screening program who had a negative FIT result the year prior were randomly allocated (1:1) to receive either a 1-off reminder via the WhatsApp messenger (WR) 1 month prior to the due appointments or no reminder (NR). All subjects were blinded to study participation and group allocation. At 24 months after randomization, a crossover of intervention was performed among those individuals who remained in the FIT program. The primary outcome was FIT adherence, defined as the pick-up and on-time return of the FIT. The secondary outcome was FIT adherence after the crossover. RESULTS A total of 500 subjects were randomized to receive WR (250 subjects) or NR (250 subjects). Three individuals were excluded from analysis (1 died and 2 underwent colonoscopy). Both the FIT pick-up rate (80.3% vs 59.3%; P < .001) and return rate (79.9% vs 57.3%; P < .001) were significantly higher in the WR group compared with the NR group. After crossover of intervention (452 subjects), the WR group again was found to have a higher FIT pick-up rate (79.1% vs 52.9%; P < .001) and return rate (78.2% vs 52.4%; P < .001). CONCLUSIONS Text reminders sent via mobile messenger appear to improve the longitudinal adherence to FIT-based opportunistic CRC screening programs. The routine use of this technology in CRC screening should be considered.
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Affiliation(s)
- Thomas Y T Lam
- Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Peter I Wu
- Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong, Hong Kong.,Department of Gastroenterology and Hepatology, St. George Hospital, University of New South Wales, Sydney, New South Wales, Australia
| | - Raymond S Y Tang
- Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Arthur K C Luk
- Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Simpson Ng
- Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Joseph J Y Sung
- Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong, Hong Kong
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12
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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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13
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Murphy CC, Halm EA, Skinner CS, Balasubramanian BA, Singal AG. Challenges and Approaches to Measuring Repeat Fecal Immunochemical Test for Colorectal Cancer Screening. Cancer Epidemiol Biomarkers Prev 2020; 29:1557-1563. [PMID: 32457184 DOI: 10.1158/1055-9965.epi-20-0230] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/14/2020] [Accepted: 05/11/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Colorectal cancer screening with fecal immunochemical testing (FIT) can reduce colorectal cancer-related mortality. Effectiveness of FIT may be compromised when patients do not adhere to a regular schedule. However, having no standard measure of repeat FIT presents challenges for assessing effectiveness across populations and settings. We compared three measures of repeat FIT in a large, integrated health care system in Dallas, Texas. METHODS We identified 18,257 patients age-eligible (50-60 years) for FIT in January 1-December 31, 2010 and followed over four rounds of screening. Measures included: (i) repeat FIT in prior screeners, or completion of FIT within 9-15 months of the previous; (ii) yes-no patterns, whereby patients were assigned yes or no in 9-15 month windows; and 3) proportion of time covered (PTC), or the amount of time patients were up-to-date with screening relative to time eligible. RESULTS Repeat FIT varied by measure. Using a prior screeners measure, 15.8% of patients with a normal FIT in round 1 completed repeat FIT in round 2. Repeat FIT was notably higher (52.3%) using PTC. The most common yes-no pattern was YNNN or "one-and-done," and only 9.4% of patients completed two consecutive FITs across all rounds (YYNN). CONCLUSIONS Different measures of repeat FIT yielded a range of estimates, making comparison across studies difficult. Researchers should weigh the advantages and disadvantages of each measure and select the most appropriate to their research question. IMPACT Our study highlights the need for future research of repeat FIT measures that best approximate screening effectiveness.
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Affiliation(s)
- Caitlin C Murphy
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas.
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
| | - Ethan A Halm
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
| | - Celette Sugg Skinner
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
- Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
| | - Bijal A Balasubramanian
- Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
- Department of Epidemiology, Human Genetics, and Environmental Science, UTHealth School of Public Health in Dallas, Dallas, Texas
| | - Amit G Singal
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
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14
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Tinmouth J, Patel J, Austin PC, Baxter NN, Brouwers MC, Earle CC, Levitt C, Lu Y, MacKinnon M, Paszat L, Rabeneck L. Directly Mailing gFOBT Kits to Previous Responders Being Recalled for Colorectal Cancer Screening Increases Participation. J Can Assoc Gastroenterol 2019; 3:197-203. [PMID: 32905094 PMCID: PMC7464595 DOI: 10.1093/jcag/gwz012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 04/29/2019] [Indexed: 11/14/2022] Open
Abstract
Background Colorectal cancer (CRC) screening with guaiac fecal occult blood test (gFOBT) reduces CRC-related death. Average risk individuals should be recalled for screening with gFOBT every 2 years in order to maximize effectiveness. However, adherence with repeated testing is often suboptimal. Our aim was to evaluate whether adding a gFOBT kit to a mailed recall letter improves participation compared with a mailed recall letter alone, among previous responders to a mailed invitation. Methods We conducted a cluster randomized controlled trial, with the primary care provider as the unit of randomization. Eligible patients had completed a gFOBT and tested negative in an earlier pilot study and were now due for recall. The intervention group received a mailed CRC screening recall letter from their primary care provider plus a gFOBT kit (n = 431) while the control group received a mailed CRC screening mailed recall letter alone (n = 452). The primary outcome was the uptake of gFOBT or colonoscopy within 6 months. Results gFOBT uptake was higher in the intervention group (61.3%, n = 264) compared with the control group (50.4%, n = 228) with an absolute difference between the two groups of 10.8% (95% confidence interval [CI]: 1.4 to 20.2%, P = <0.01). Patients in the intervention group were more likely to complete the gFOBT compared with the control group (odds ratio [OR] = 1.4; 95% CI: 1.1 to 1.9). Conclusion Our findings show that adding gFOBT kits to the mailed recall letter increased participation among persons recalled for screening. Nine gFOBT kits would have to be sent by mail in order to screen one additional person.
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Affiliation(s)
- Jill Tinmouth
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Cancer Care Ontario, Toronto, Ontario, Canada
| | - Jigisha Patel
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Peter C Austin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Nancy N Baxter
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Department of Surgery and Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | | | - Craig C Earle
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Cheryl Levitt
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Yan Lu
- Critical Care Services Ontario, University Health Network, Toronto, Ontario, Canada
| | | | - Lawrence Paszat
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Linda Rabeneck
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Cancer Care Ontario, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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15
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Yamamoto H, Hayashi K, Scherb H. Association between the detection rate of thyroid cancer and the external radiation dose-rate after the nuclear power plant accidents in Fukushima, Japan. Medicine (Baltimore) 2019; 98:e17165. [PMID: 31517868 PMCID: PMC6750239 DOI: 10.1097/md.0000000000017165] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
A thyroid cancer ultrasonography screening for all residents 18 years old or younger living in the Fukushima prefecture started in October 2011 to investigate the possible effect of the radiological contamination after the Fukushima Daiichi Nuclear Power Plant accidents as of March 12 to 15, 2011. Thyroid cancer in 184 cases was reported by February 2017. The question arises to which extent those cancer cases are a biological consequence of the radiation exposure or an artefactual result of the intense screening of a large population.Experiences with the Chernobyl accident suggest that the external dose may be considered a valid surrogate for the internal dose of the thyroid gland. We, therefore, calculated the average external effective dose-rate (μSv/h) for the 59 municipalities of the Fukushima prefecture based on published data of air and soil radiation. We further determined the municipality-specific absolute numbers of thyroid cancers found by each of the two screening rounds in the corresponding municipality-specific exposed person-time observed. A possible association between the radiation exposure and the thyroid cancer detection rate was analyzed with Poisson regression assuming Poisson distributed thyroid cancer cases in the exposed person-time observed per municipality.The target populations consisted of 367,674 and 381,286 children and adolescents for the 1st and the 2nd screening rounds, respectively. In the 1st screening, 300,476 persons participated and 270,489 in the 2nd round. From October 2011 to March 2016, a total of 184 cancer cases were found in 1,079,786 person-years counted from the onset of the exposure to the corresponding examination periods in the municipalities. A significant association between the external effective dose-rate and the thyroid cancer detection rate exists: detection rate ratio (DRR) per μSv/h 1.065 (1.013, 1.119). Restricting the analysis to the 53 municipalities that received less than 2 μSv/h, and which represent 176 of the total 184 cancer cases, the association appears to be considerably stronger: DRR per μSv/h 1.555 (1.096, 2.206).The average radiation dose-rates in the 59 municipalities of the Fukushima prefecture in June 2011 and the corresponding thyroid cancer detection rates in the period October 2011 to March 2016 show statistically significant relationships.
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Affiliation(s)
- Hidehiko Yamamoto
- Osaka Red Cross Hospital Attached Facility of Physically Handicapped Children, 5-30 Fudegasaki-cho, Tennouji-ku
| | - Keiji Hayashi
- Hayashi Children's Clinic, 4-6-11-1F Nagata, Joto-ku, Osaka-Shi Osaka, Japan
| | - Hagen Scherb
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Computational Biology, Ingolstädter Landstr. 1, D-85764 Neuherberg, Germany
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16
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Impact of the supine position versus left horizontal position on colonoscopy insertion: a 2-center, randomized controlled trial. Gastrointest Endosc 2019; 89:1193-1201.e1. [PMID: 30660634 DOI: 10.1016/j.gie.2019.01.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 01/04/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Colonoscopy insertion is painful for some patients and is one of the main barriers to screening colonoscopy. Few studies have assessed the impact of the supine position (SP) on colonoscopy insertion, especially for unsedated patients. The aim of this randomized controlled trial was to clarify this issue. METHODS Unsedated patients were randomized to SP or left horizontal position (LHP) as the starting position of colonoscopy insertion. The primary outcome measure was cecal intubation time (CIT), and the secondary outcome measures were descending colon intubation time (DIT), pain score of patients, difficulty score according to the endoscopist, and patients' acceptance of unsedated colonoscopy. RESULTS A total of 347 patients were randomized to the SP group (175) or the LHP group (172). The CIT in the SP group was significantly shorter than that in the LHP group (275.0 seconds [interquartile range (IQR), 234.0-328.5 seconds] versus 316.0 seconds [IQR, 261.0-370.0 seconds], P < .001). The DIT was also shorter in the SP group (64.5 seconds [IQR, 52.0-86.3 seconds] versus 74.0 seconds [IQR, 62.0-92.0 seconds], P = .001). Compared with the LHP, the SP had a lower pain score (3.3 versus 3.9, P = .002), a lower difficulty score (3.1 versus 3.7, P < .001), a lower frequency of position change (7.1% versus 38.0%, P < .001), and less need for abdominal compression (39.1% versus 45.5%, P = .02). SP was the only modifiable and independent factor identified to reduce CIT and pain score and improve patients' acceptance of unsedated colonoscopy. CONCLUSIONS As an economical and convenient method, SP can reduce CIT, ease pain, and improve patients' acceptance of unsedated colonoscopy. (Clinical trial registration number: NCT03289442.).
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17
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Kerrison RS, McGregor LM, Counsell N, Marshall S, Prentice A, Isitt J, Rees CJ, von Wagner C. Use of Two Self-referral Reminders and a Theory-Based Leaflet to Increase the Uptake of Flexible Sigmoidoscopy in the English Bowel Scope Screening Program: Results From a Randomized Controlled Trial in London. Ann Behav Med 2018; 52:941-951. [PMID: 30346495 PMCID: PMC6196365 DOI: 10.1093/abm/kax068] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background We previously initiated a randomized controlled trial to test the effectiveness of two self-referral reminders and a theory-based leaflet (sent 12 and 24 months after the initial invitation) to increase participation within the English Bowel Scope Screening program. Purpose This study reports the results following the second reminder. Methods Men and women included in the initial sample (n = 1,383) were re-assessed for eligibility 24 months after their invitation (12 months after the first reminder) and excluded if they had attended screening, moved away, or died. Eligible adults received the same treatment they were allocated 12 months previous, that is, no reminder ("control"), or a self-referral reminder with either the standard information booklet ("Reminder and Standard Information Booklet") or theory-based leaflet designed using the Behavior Change Wheel ("Reminder and Theory-Based Leaflet"). The primary outcome was the proportion screened within each group 12 weeks after the second reminder. Results In total, 1,218 (88.1%) individuals were eligible. Additional uptake following the second reminder was 0.4% (2/460), 4.8% (19/399), and 7.9% (29/366) in the control, Reminder and Standard Information Booklet, and Reminder and Theory-Based Leaflet groups, respectively. When combined with the first reminder, the overall uptake for each group was 0.7% (3/461), 14.5% (67/461), and 21.5% (99/461). Overall uptake was significantly higher in the Reminder and Standard Information Booklet and Reminder and Theory-Based Leaflet groups than in the control (odds ratio [OR] = 26.1, 95% confidence interval [CI] = 8.1-84.0, p < .001 and OR = 46.9, 95% CI = 14.7-149.9, p < .001, respectively), and significantly higher in the Reminder and Theory-Based Leaflet group than in the Reminder and Standard Information Booklet group (OR = 1.8, 95% CI = 1.3-2.6, p < .001). Conclusion A second reminder increased uptake among former nonparticipants. The added value of the theory-based leaflet highlights a potential benefit to reviewing the current information booklet. Trials Registry Number ISRCTN44293755.
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Affiliation(s)
- Robert S Kerrison
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Lesley M McGregor
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Nicholas Counsell
- Cancer Research UK & UCL Cancer Trials Centre, University College London, London, UK
| | - Sarah Marshall
- St Mark’s Bowel Cancer Screening Centre, St Mark’s Hospital, Middlesex, UK
| | - Andrew Prentice
- St Mark’s Bowel Cancer Screening Centre, St Mark’s Hospital, Middlesex, UK
| | - John Isitt
- Partners in Creation, Top Studio, London, UK
| | - Colin J Rees
- South Tyneside NHS Foundation Trust, South Tyneside School of Medicine, Pharmacy and Health, Durham University, Durham, UK
| | - Christian von Wagner
- Research Department of Behavioural Science and Health, University College London, London, UK
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18
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Hamashima C, Sano H. Association between age factors and strategies for promoting participation in gastric and colorectal cancer screenings. BMC Cancer 2018; 18:345. [PMID: 29587681 PMCID: PMC5870209 DOI: 10.1186/s12885-018-4244-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 03/19/2018] [Indexed: 11/21/2022] Open
Abstract
Background Despite the long history of cancer screening in Japan, the participation rates in gastric and colorectal cancer screenings have not increased. Strategies for improving the participation rates have been proposed, but differences in their effects among different age groups remain unclear. Methods The Japanese government conducted a national survey in all municipalities in Japan in 2010 to investigate whether the implementation of promotion strategies increased participation in cancer screening. We investigated the association between age factors and strategies for promoting participation in cancer screening based on this national survey. Multiple regression analysis with generalized linear model was performed using the participation rates in gastric and colorectal cancer screenings as dependent variables, and the following strategies for promoting participation as independent variables: 1) personal invitation letters, 2) household invitation letters, 3) home visits by community nurses, 4) screenings in medical offices, and 5) free cancer screening programs. Results One thousand six hundred thirty nine municipalities for gastric cancer screening and 1666 municipalities for colorectal cancer screening were selected for the analysis. In gastric and colorectal cancer screenings, the participation rates of individuals aged 60–69 years was higher than those of other age groups. Personal and household invitation letters were effective promotion strategies for all age groups, which encouraged even older people to participate in gastric and colorectal cancer screenings. Screening in medical offices and free screenings were not effective in all age groups. Home visits were effective, but their adoption was limited to small municipalities. Conclusions To clarify whether promotion strategies can increase the participation rate in cancer screening among different age groups, 5 strategies were assessed on the basis of a national survey. Although personal and household invitation letters were effective strategies for promoting participation in cancer screening for all age groups, these strategies equally encouraged older people to participate in gastric and colorectal cancer screenings. If resource for sending invitation letters are limited, priority should be given to individuals who are in their 50s and 60s for gastric and colorectal cancer screening.
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Affiliation(s)
- Chisato Hamashima
- Division of Cancer Screening Assessment and Management, Center for Public Health Science, National Cancer Center, 5-1-1 Tsukiji Chuo-ku, Tokyo, 104-0045, Japan.
| | - Hiroshi Sano
- Faculty of Economics, Shiga University, 1-1-1 Baba-cho, Hikone, Japan
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19
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Vanaclocha-Espi M, Ibáñez J, Molina-Barceló A, Pérez E, Nolasco A, Font R, Pérez-Riquelme F, de la Vega M, Arana-Arri E, Oceja M, Espinàs JA, Portillo I, Salas D. Factors influencing participation in colorectal cancer screening programs in Spain. Prev Med 2017; 105:190-196. [PMID: 28887191 DOI: 10.1016/j.ypmed.2017.08.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 07/10/2017] [Accepted: 08/16/2017] [Indexed: 12/31/2022]
Abstract
To analyze the sociodemographic and organizational factors influencing participation in population-based colorectal cancer screening programs (CRCSP) in Spain, a retrospective study was conducted in a cohort of people invited to participate in the first 3 screening rounds of 6 CRCSP from 2000 to 2012. Mixed logistic regression models were used to analyze the relationship between sociodemographic and organizational factors, such as the type of fecal occult blood test (FOBT) used and the FOBT delivery type. The analysis was performed separately in groups (Initial screening-first invitation, Subsequent invitation for previous never-responders, Subsequent invitation-regular, Subsequent invitation-irregular intervals). The results showed that, in the Initial screening-first invitation group, participation was higher in women than in men in all age groups (OR 1.05 in persons aged 50-59years and OR 1.12 in those aged 60-69years). Participation was also higher when no action was required to receive the FOBT kit, independently of the type of screening (Initial screening-first invitation [OR 2.24], Subsequent invitation for previous never-responders [OR 2.14], Subsequent invitation-regular [OR 2.03], Subsequent invitation-irregular intervals [OR 9.38]) and when quantitative rather than qualitative immunological FOBT (FIT) was offered (Initial screening-first invitation [OR 0.70], Subsequent invitation for previous never-responders [OR 0.12], Subsequent invitation-regular [OR 0.20]) or guaiac testing (Initial screening-first invitation [OR 0.81], Subsequent invitation for previous never-responders [OR 0.88], Subsequent invitation-regular [OR 0.73]). In conclusion, the results of this study show that screening participation could be enhanced by inclusion of the FOBT kit with the screening invitation and the use of the quantitative FIT.
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Affiliation(s)
| | - Josefa Ibáñez
- Cancer and Public Health Area, FISABIO - Public Health, Valencia, Spain; General Directorate Public Health, Valencian Community, Spain
| | | | - Elena Pérez
- Cancer and Public Health Area, FISABIO - Public Health, Valencia, Spain; General Directorate Public Health, Valencian Community, Spain
| | | | - Rebeca Font
- Catalan Cancer Strategy, Department of Health, Catalonia, Spain; Biomedical Research Institute, Bellvitge, (IDIBELL) - L'Hospitalet de LLob, Barcelona, Spain
| | - Francisco Pérez-Riquelme
- General Directorate Public Health, Murcia, Spain; Biomedical Research Institute of Murcia (IMIB-Arrixaca-UMU), University Clinical Hospital "Virgen de la Arrixaca", University of Murcia, Spain
| | | | | | | | - Josep Alfons Espinàs
- Catalan Cancer Strategy, Department of Health, Catalonia, Spain; Biomedical Research Institute, Bellvitge, (IDIBELL) - L'Hospitalet de LLob, Barcelona, Spain
| | | | - Dolores Salas
- Cancer and Public Health Area, FISABIO - Public Health, Valencia, Spain; General Directorate Public Health, Valencian Community, Spain.
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Quyn AJ, Fraser CG, Stanners G, Carey FA, Carden C, Shaukat A, Steele RJ. Uptake trends in the Scottish Bowel Screening Programme and the influences of age, sex, and deprivation. J Med Screen 2017; 25:24-31. [PMID: 29183246 DOI: 10.1177/0969141317694065] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Objective Age, sex, and deprivation are known factors influencing colorectal (bowel) cancer screening uptake. We investigated the influence of these factors on uptake over time. Methods Data from the Scottish Bowel Screening Programme (SBoSP) were collected between 2007 and 2014. End-points for analysis were uptake, faecal occult blood test positivity, and disease detection, adjusted for age, sex, deprivation, and year of screening. Results From 5,308,336 individual screening episodes documented, uptake gradually increased with increasing age up to 65-69 and was lower in men than women (52.4% vs. 58.7%, respectively). Deprivation had a significant effect on uptake by men and women of all age groups, with the most deprived least likely to complete a screening test. Uptake has increased with time in both sexes and across the deprivation gradient. The number needed to screen to detect significant neoplasia was significantly lower in men than women overall (170 vs. 365), and this held over all age and deprivation groups. The number needed to screen was also lower in the more deprived population. Conclusions Although lower age, male sex, and increased deprivation are associated with lower bowel cancer screening uptake in Scotland, uptake has increased since SBoSP introduction in all age groups, both sexes, and across the deprivation gradient. Despite a lower uptake, the number needed to screen to find significant disease was lower in men and in those with higher levels of deprivation.
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Affiliation(s)
- Aaron J Quyn
- 1 Centre for Research into Cancer Prevention and Screening, University of Dundee, Dundee, UK
| | - Callum G Fraser
- 1 Centre for Research into Cancer Prevention and Screening, University of Dundee, Dundee, UK
| | - Greig Stanners
- 2 Information Services Division, NHS National Services Scotland, Glasgow, UK
| | - Francis A Carey
- 3 Department of Pathology, Ninewells Hospital and Medical School, Dundee, UK
| | - Claire Carden
- 1 Centre for Research into Cancer Prevention and Screening, University of Dundee, Dundee, UK
| | - Aasma Shaukat
- 4 University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Robert Jc Steele
- 1 Centre for Research into Cancer Prevention and Screening, University of Dundee, Dundee, UK
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22
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Kerrison RS, McGregor LM, Marshall S, Isitt J, Counsell N, Rees CJ, von Wagner C. Improving uptake of flexible sigmoidoscopy screening: a randomized trial of nonparticipant reminders in the English Screening Programme. Endoscopy 2017; 49:35-43. [PMID: 27997965 PMCID: PMC6193284 DOI: 10.1055/s-0042-118452] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 08/29/2016] [Indexed: 12/14/2022]
Abstract
Background and study aims Uptake of flexible sigmoidoscopy screening in the English Bowel Scope Screening (BSS) Programme is low. The aim of this study was to test the impact of a nonparticipant reminder and theory-based leaflet to promote uptake among former nonresponders (previously did not confirm their appointment) and nonattenders (previously confirmed their appointment but did not attend). Patients and methods Eligible adults were men and women in London who had not attended a BSS appointment within 12 months of their invitation. Individuals were randomized (1:1:1) to receive no reminder (control), a 12-month reminder plus standard information booklet (TMR-SIB), or a 12-month reminder plus bespoke theory-based leaflet (TMR-TBL) designed to address barriers to screening. The primary outcome of the study was the proportion of individuals screened within each group 12 weeks after the delivery of the reminder. Results A total of 1383 men and women were randomized and analyzed as allocated (n = 461 per trial arm). Uptake was 0.2 % (n = 1), 10.4 % (n = 48), and 15.2 % (n = 70) in the control, TMR-SIB, and TMR-TBL groups, respectively. Individuals in the TMR-SIB and TMR-TBL groups were significantly more likely to attend screening than individuals in the control group (adjusted odds ratio [OR] 53.7, 95 % confidence interval [CI] 7.4 - 391.4, P < 0.001 and OR 89.0, 95 %CIs 12.3 - 645.4, P < 0.01, respectively). Individuals in the TMR-TBL group were also significantly more likely to attend screening than individuals in the TMR-SIB group (OR 1.7, 95 %CIs 1.1 - 2.5, P = 0.01). Across all groups, former nonattenders were more likely to participate in screening than former nonresponders (uptake was 14.2 % and 8.0 %, respectively; OR 2.5, 95 %CIs 1.4 - 4.4, P < 0.01). The adenoma detection rate among screened adults was 7.6 %, which is comparable to the rate in initial attenders. Conclusions Reminders targeting former nonparticipants can improve uptake and are effective for both former nonresponders and nonattenders. Theory-based information designed to target barriers to screening added significantly to this strategy.
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Affiliation(s)
- Robert S. Kerrison
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Lesley M. McGregor
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Sarah Marshall
- St Mark’s Bowel Cancer Screening Centre, St Mark’s Hospital, Harrow, United Kingdom
| | - John Isitt
- Resonant Behaviour Change and Social Marketing, London, United Kingdom
| | - Nicholas Counsell
- Cancer Research UK and University College London Cancer Trials Centre, University College London, London, United Kingdom
| | - Colin J. Rees
- South Tyneside NHS Foundation Trust, South Tyneside School of Medicine, Pharmacy and Health, Durham University, Durham, United Kingdom
| | - Christian von Wagner
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, United Kingdom
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Mancini S, Ravaioli A, Falcini F, Giuliani O, Corradini R, De Girolamo G, Goldoni C, Finarelli A, Naldoni C, Landi P, Sassoli de Bianchi P, Bucchi L. Strategies for delivery of faecal occult blood test kits and participation to colorectal cancer screening in the Emilia-Romagna Region of Italy. Eur J Cancer Care (Engl) 2016; 27. [DOI: 10.1111/ecc.12631] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2016] [Indexed: 12/23/2022]
Affiliation(s)
- S. Mancini
- Romagna Cancer Registry; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS; Meldola, Forlì Italy
| | - A. Ravaioli
- Romagna Cancer Registry; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS; Meldola, Forlì Italy
| | - F. Falcini
- Romagna Cancer Registry; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS; Meldola, Forlì Italy
- Azienda Usl della Romagna; Forlì Italy
| | - O. Giuliani
- Romagna Cancer Registry; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS; Meldola, Forlì Italy
| | | | | | | | - A.C. Finarelli
- Department of Health; Emilia-Romagna Region; Bologna Italy
| | - C. Naldoni
- Department of Health; Emilia-Romagna Region; Bologna Italy
| | - P. Landi
- Department of Health; Emilia-Romagna Region; Bologna Italy
| | | | - L. Bucchi
- Romagna Cancer Registry; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS; Meldola, Forlì Italy
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24
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Raine R, Moss SM, von Wagner C, Atkin W, Hans IK, Howe R, Solmi F, Morris S, Counsell N, Hackshaw A, Halloran S, Handley G, Logan RF, Rainbow S, Smith S, Snowball J, Seaman H, Thomas M, Smith SG, McGregor LM, Vart G, Wardle J, Duffy SW. A national cluster-randomised controlled trial to examine the effect of enhanced reminders on the socioeconomic gradient in uptake in bowel cancer screening. Br J Cancer 2016; 115:1479-1486. [PMID: 27875518 PMCID: PMC5155361 DOI: 10.1038/bjc.2016.365] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 09/20/2016] [Accepted: 10/13/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The NHS Bowel Cancer Screening Programme in England offers biennial guaiac faecal occult blood testing (gFOBt). There is a socioeconomic gradient in participation and socioeconomically disadvantaged groups have worse colorectal cancer survival than more advantaged groups. We compared the effectiveness and cost of an enhanced reminder letter with the usual reminder letter on overall uptake of gFOBt and the socioeconomic gradient in uptake. METHODS We enhanced the usual reminder by including a heading 'A reminder to you' and a short paragraph restating the offer of screening in simple language. We undertook a cluster-randomised trial of all 168 480 individuals who were due to receive a reminder over 20 days in 2013. Randomisation was based on the day of invitation. Blinding of individuals was not possible, but the possibility of bias was minimal owing to the lack of direct contact with participants. The enhanced reminder was sent to 78 067 individuals and 90 413 received the usual reminder. The primary outcome was the proportion of people adequately screened and its variation by quintile of Index of Multiple Deprivation. Data were analysed by logistic regression with conservative variance estimates to take account of cluster randomisation. RESULTS There was a small but statistically significant (P=0.001) increase in participation with the enhanced reminder (25.8% vs 25.1%). There was significant (P=0.005) heterogeneity of the effect by socioeconomic status with an 11% increase in the odds of participation in the most deprived quintile (from 13.3 to 14.1%) and no increase in the least deprived. We estimated that implementing the enhanced reminder nationally could result in up to 80 more people with high or intermediate risk colorectal adenomas and up to 30 more cancers detected each year if it were implemented nationally. The intervention incurred a small one-off cost of £78 000 to modify the reminder letter. CONCLUSIONS The enhanced reminder increases overall uptake and reduces the socioeconomic gradient in bowel cancer screening participation at little additional cost.
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Affiliation(s)
- Rosalind Raine
- Department of Applied Health Research, University College London, London, WC1E 7HB, UK
| | - Sue M Moss
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M6BQ, UK
| | - Christian von Wagner
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, WC1E 7HB, UK
| | - Wendy Atkin
- Cancer Screening and Prevention Group, Faculty of Medicine, Department of Surgery & Cancer, Imperial College London, London, SW7 2AZ UK
| | - Ines Kralj Hans
- Department of Biostatistics, King's Clinical Trials Unit, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Rosemary Howe
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Francesca Solmi
- UCL Division of Psychiatry, 6th Floor, Wing B, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK
| | - Stephen Morris
- Department of Applied Health Research, University College London, London, WC1E 7HB, UK
| | - Nicholas Counsell
- Cancer Research UK & UCL Cancer Trials Centre, Cancer Institute, University College London, 90 Tottenham Court Road, London, W1T 4TJ, UK
| | - Allan Hackshaw
- Cancer Research UK & UCL Cancer Trials Centre, Cancer Institute, University College London, 90 Tottenham Court Road, London, W1T 4TJ, UK
| | - Stephen Halloran
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey GU2 7XH, UK
| | - Graham Handley
- North East Bowel Cancer Screening Programme Hub, Biochemistry Department, Gateshead Health NHS Foundation Trust, Queen Elizabeth Hospital, Gateshead NE9 6SX, UK
| | - Richard F Logan
- Eastern Bowel Cancer Screening Programme Hub, Nottingham University Hospitals, Nottingham NG7 2UH, UK
| | - Sandra Rainbow
- London Bowel Cancer Screening Programme Hub, The Northwest London Hospitals NHS Trust, Northwick Park & St Mark's Hospitals, Watford Road, Harrow, Middlesex HA1 3UJ, UK
| | - Steve Smith
- Midlands and North West Bowel Cancer Screening Programme Hub, Hospital of St Cross, Barby Road, Rugby CV22 5PX, UK
| | - Julia Snowball
- Southern Bowel Cancer Screening Programme Hub, Surrey Research Park, 20 Priestly Road, Guildford Road, Surrey GU2 7YS, UK
| | - Helen Seaman
- Southern Bowel Cancer Screening Programme Hub, Surrey Research Park, 20 Priestly Road, Guildford Road, Surrey GU2 7YS, UK
| | - Mary Thomas
- NIHR CLAHRC North Thames, Department of Applied Health Research, University College London, London, WC1E 7HB, UK
| | - Samuel G Smith
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, WC1E 7HB, UK
| | - Lesley M McGregor
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, WC1E 7HB, UK
| | - Gemma Vart
- Research Office, University of Roehampton, London SW15 5PU UK
| | - Jane Wardle
- Department of Epidemiology and Public Health, Cancer Research UK Health Behaviour Research Centre, University College London, London, WC1E 7HB, UK
| | - Stephen W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK
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Duffy SW, Myles JP, Maroni R, Mohammad A. Rapid review of evaluation of interventions to improve participation in cancer screening services. J Med Screen 2016; 24:127-145. [PMID: 27754937 PMCID: PMC5542134 DOI: 10.1177/0969141316664757] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Objective Screening participation is spread differently across populations, according to factors such as ethnicity or socioeconomic status. We here review the current evidence on effects of interventions to improve cancer screening participation, focussing in particular on effects in underserved populations. Methods We selected studies to review based on their characteristics: focussing on population screening programmes, showing a quantitative estimate of the effect of the intervention, and published since 1990. To determine eligibility for our purposes, we first reviewed titles, then abstracts, and finally the full paper. We started with a narrow search and expanded this until the search yielded eligible papers on title review which were less than 1% of the total. We classified the eligible studies by intervention type and by the cancer for which they screened, while looking to identify effects in any inequality dimension. Results The 68 papers included in our review reported on 71 intervention studies. Of the interventions, 58 had significant positive effects on increasing participation, with increase rates of the order of 2%–20% (in absolute terms). Conclusions Across different countries and health systems, a number of interventions were found more consistently to improve participation in cancer screening, including in underserved populations: pre-screening reminders, general practitioner endorsement, more personalized reminders for non-participants, and more acceptable screening tests in bowel and cervical screening.
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Affiliation(s)
- Stephen W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Jonathan P Myles
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Roberta Maroni
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Abeera Mohammad
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Lee CL, Huang CJ, Yang SH, Chang CC, Huang CC, Chien CC, Yang RN. Discovery of genes from feces correlated with colorectal cancer progression. Oncol Lett 2016; 12:3378-3384. [PMID: 27900008 DOI: 10.3892/ol.2016.5069] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 07/20/2016] [Indexed: 12/17/2022] Open
Abstract
Colorectal cancer (CRC) is considered to develop slowly via a progressive accumulation of genetic mutations. Markers of CRC may serve to provide the basis for decision-making, and may assist in cancer prevention, detection and prognostic prediction. DNA and messenger (m)RNA molecules that are present in human feces faithfully represent CRC manifestations. In the present study, exogenous mouse cells verified the feasibility of total fecal RNA as a marker of CRC. Furthermore, five significant genes encoding solute carrier family 15, member 4 (SLC15A4), cluster of differentiation (CD)44, 3-oxoacid CoA-transferase 1 (OXCT1), placenta-specific 8 (PLAC8) and growth arrest-specific 2 (GAS2), which are differentially expressed in the feces of CRC patients, were verified in different CRC cell lines using quantitative polymerase chain reaction. The present study demonstrated that the mRNA level of SLC15A4 was increased in the majority of CRC cell lines evaluated (SW1116, LS123, Caco-2 and T84). An increased level of CD44 mRNA was only detected in an early-stage CRC cell line, SW1116, whereas OXCT1 was expressed at higher levels in the metastatic CRC cell line CC-M3. In addition, two genes, PLAC8 and GAS2, were highly expressed in the recurrent CRC cell line SW620. Genes identified in the feces of CRC patients differed according to their clinical characteristics, and this differential expression was also detected in the corresponding CRC cell lines. In conclusion, feces represent a good marker of CRC and can be interpreted through the appropriate CRC cell lines.
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Affiliation(s)
- Chia-Long Lee
- School of Medicine, Taipei Medical University, Taipei 11031, Taiwan, R.O.C.; Department of Internal Medicine, Cathay General Hospital, Taipei 10630, Taiwan, R.O.C.; School of Medicine, Fu Jen Catholic University, New Taipei 24205, Taiwan, R.O.C
| | - Chi-Jung Huang
- Department of Medical Research, Cathay General Hospital, Taipei 10630, Taiwan, R.O.C.; Department of Biochemistry, National Defense Medical Center, Taipei 11490, Taiwan, R.O.C.; School of Medicine, Fu Jen Catholic University, New Taipei 24205, Taiwan, R.O.C
| | - Shung-Haur Yang
- Department of Surgery, Taipei Veterans General Hospital, Taipei 11217, Taiwan, R.O.C.; School of Medicine, National Yang Ming University, Taipei 11221, Taiwan, R.O.C
| | - Chun-Chao Chang
- School of Medicine, Taipei Medical University, Taipei 11031, Taiwan, R.O.C.; Department of Internal Medicine, Division of Gastroenterology and Hepatology, Taipei Medical University Hospital, Taipei 11031, Taiwan, R.O.C
| | - Chi-Cheng Huang
- School of Medicine, Taipei Medical University, Taipei 11031, Taiwan, R.O.C.; School of Medicine, Fu Jen Catholic University, New Taipei 24205, Taiwan, R.O.C.; Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei 10617, Taiwan, R.O.C.; Department of General Surgery, Sijhih Cathay General Hospital, New Taipei 22174, Taiwan, R.O.C
| | - Chih-Cheng Chien
- Department of Medical Research, Cathay General Hospital, Taipei 10630, Taiwan, R.O.C.; School of Medicine, Fu Jen Catholic University, New Taipei 24205, Taiwan, R.O.C.; Department of Anesthesiology, Sijhih Cathay General Hospital, New Taipei 22174, Taiwan, R.O.C
| | - Ruey-Neng Yang
- Department of Nursing, Ching Kuo Institute of Management and Health, Keelung 20301, Taiwan, R.O.C.; Department of Internal Medicine, Sijhih Cathay General Hospital, New Taipei 22174, Taiwan, R.O.C
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Kobayashi LC, Waller J, von Wagner C, Wardle J. A lack of information engagement among colorectal cancer screening non-attenders: cross-sectional survey. BMC Public Health 2016; 16:659. [PMID: 27473593 PMCID: PMC4966703 DOI: 10.1186/s12889-016-3374-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 07/26/2016] [Indexed: 12/31/2022] Open
Abstract
Background The NHS Cancer Screening Programmes in England now operate a policy of ‘informed choice’ about participation in cancer screening. Engagement with written information about screening is important to facilitate informed choice, although the degree to which the screening-eligible public engages with the available information is unknown. We examined the association between reading of the standard informational booklet (‘Bowel Cancer Screening: The Facts') and participation in the nationally organised NHS Bowel Cancer Screening Programme in England. Methods Face-to-face interviews were conducted with 1307 adults who were age-eligible for nationally organised colorectal cancer (CRC; also called bowel cancer) in a population-based survey in England in 2014. Respondents were shown an image of ‘The Facts’ booklet and were asked how much of it they had read when they received their screening invitation (‘none’, ‘a little’, ‘some’, ‘most’, ‘almost all’, or ‘all’). Logistic regression was used to estimate the associations between screening uptake status (‘never’ vs. ‘ever’) and self-reported reading of ‘The Facts’ booklet (dichotomised to ‘none vs. ‘any’), adjusting for age, sex, ethnicity, educational attainment, and occupation-based social grade. Results Overall, 69 % of the sample (908/1307) had participated in CRC screening at least once (‘ever’ screeners). One-fifth of the sample reported that they had read ‘none’ of ‘The Facts’ booklet (22 %; 287/1307), while half reported having read ‘all’ of it (52 %; 680/1307). Reading of the booklet was strongly differential according to screening uptake status: nearly two-thirds of ‘never’ screeners had read none of ‘The Facts’ booklet (63 %; 251/399), compared to less than one in twenty ‘ever’ screeners (4 %; 36/908); adjusted OR = 39.0; 95 % CI: 26.2-58.1 for reading ‘none’ in ‘never’ vs. ‘ever’ screeners. Conclusions Although ‘The Facts’ booklet is intended to support informed choices about CRC screening, the majority of unscreened individuals report that they have read none of it. The degree to which public engagement with the decision-making process about cancer screening is socially unequal must be better understood so that comprehensive and equitable public communication strategies can be developed.
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Affiliation(s)
- Lindsay C Kobayashi
- Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK
| | - Jo Waller
- Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK.
| | - Christian von Wagner
- Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK
| | - Jane Wardle
- Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK
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Khatkov IE, Kagramanova AV, Zakharzhevskaya NB, Babikova EA, Generozov EV, Shcherbakov PL, Parfenov AI. [Current principles in the screening, diagnosis, and therapy of colorectal cancer]. TERAPEVT ARKH 2016; 88:90-96. [PMID: 27135106 DOI: 10.17116/terarkh201688290-96] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The data available in the literature on the prevalence of colorectal cancer (CRC), its risk factors and genetic aspects are analyzed. Basic screening tests and their diagnostic value are described. The paper indicates the importance of methods (colonoscopy, occult blood feces analysis, fecal immunochemical test, determination of molecular genetic profile of fecal enterocytes) for the early primary diagnosis of colonic epithelial tumors and techniques (echography, computed tomography, magnetic resonance imaging, positron emission tomography) that are required to specify clinical TNM staging and enable one to choose an optimal treatment policy for CRC patients owing to the estimation of tumor volume and to the diagnosis of reginal and distant metastases. It also shows that new screening methods based on the detection of molecular markers for early (premorphological) tumor stages are promising. The role of primary CRC prevention aimed at molding and maintaining a healthy lifestyle in the population is demonstrated.
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Affiliation(s)
- I E Khatkov
- Moscow Clinical Research and Practical Center, Moscow Healthcare Department, Moscow, Russia
| | - A V Kagramanova
- Moscow Clinical Research and Practical Center, Moscow Healthcare Department, Moscow, Russia
| | - N B Zakharzhevskaya
- Research Institute of Physicochemical Medicine, Federal Biomedical Agency of Russia, Moscow, Russia
| | - E A Babikova
- Research Institute of Physicochemical Medicine, Federal Biomedical Agency of Russia, Moscow, Russia
| | - E V Generozov
- Research Institute of Physicochemical Medicine, Federal Biomedical Agency of Russia, Moscow, Russia
| | - P L Shcherbakov
- Moscow Clinical Research and Practical Center, Moscow Healthcare Department, Moscow, Russia
| | - A I Parfenov
- Moscow Clinical Research and Practical Center, Moscow Healthcare Department, Moscow, Russia
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Reinvitation to screening colonoscopy: a randomized-controlled trial of reminding letter and invitation to educational meeting on attendance in nonresponders to initial invitation to screening colonoscopy (REINVITE). Eur J Gastroenterol Hepatol 2016; 28:538-42. [PMID: 26967693 DOI: 10.1097/meg.0000000000000578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES The response rate to initial invitation to population-based primary screening colonoscopy within the NordICC trial (NCT 00883792) in Poland is around 50%. The aim of this study was to compare the effect of a reinvitation letter and invitation to an educational intervention on participation in screening colonoscopy in nonresponders to initial invitation. METHODS Within the NordICC trial framework, individuals living in the region of Warsaw, who were drawn from Population Registries and assigned randomly to the screening group, received an invitation letter and a reminder with a prespecified screening colonoscopy appointment date. One thousand individuals, aged 55 to 64 years, who did not respond to both the invitation and the reminding letter were assigned randomly in a 1:1 ratio to the reinvitation group (REI) and the educational meeting group (MEET). The REI group was sent a reinvitation letter and reminder 6 and 3 weeks before the new colonoscopy appointment date, respectively. The MEET group was sent an invitation 6 weeks before an educational meeting date. Outcome measures were participation in screening colonoscopy within 6 months and response rate within 3 months from the date of reinvitation or invitation to an educational meeting. RESULTS The response rate and the participation rate in colonoscopy were statistically significantly higher in the REI group compared with the MEET group (16.5 vs. 4.3%; P<0.001 and 5.2 vs. 2.1%; P=0.008, respectively). CONCLUSION A simple reinvitation letter results in a higher response rate and participation rate to screening colonoscopy than invitation to tailored educational meeting in nonresponders to previous invitations. (NCT01183156).
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Kerrison RS, McGregor LM, Marshall S, Isitt J, Counsell N, Wardle J, von Wagner C. Use of a 12 months' self-referral reminder to facilitate uptake of bowel scope (flexible sigmoidoscopy) screening in previous non-responders: a London-based feasibility study. Br J Cancer 2016; 114:751-8. [PMID: 26977856 PMCID: PMC4984863 DOI: 10.1038/bjc.2016.43] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 12/07/2015] [Accepted: 02/01/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND In March 2013, NHS England extended its national Bowel Cancer Screening Programme to include 'one-off' Flexible Sigmoidoscopy screening (NHS Bowel Scope Screening, BSS) for men and women aged 55. With less than one in two people currently taking up the screening test offer, there is a strong public health mandate to develop system-friendly interventions to increase uptake while the programme is rolling out. This study aimed to assess the feasibility of sending a reminder to previous BSS non-responders, 12 months after the initial invitation, with consideration for its potential impact on uptake. METHOD This study was conducted in the ethnically diverse London Boroughs of Brent and Harrow, where uptake is below the national average. Between September and November 2014, 160 previous non-responders were randomly selected to receive a reminder of the opportunity to self-refer 12 months after their initial invitation. The reminder included instructions on how to book an appointment, and provided options for the time and day of the appointment and the gender of the endoscopist performing the test. To address barriers to screening, the reminder was sent with a brief locally tailored information leaflet designed specifically for this study. Participants not responding within 4 weeks were sent a follow-up reminder, after which there was no further intervention. Self-referral rates were measured 8 weeks after the delivery of the follow-up reminder and accepted as final. RESULTS Of the 155 participants who received the 12 months' reminder (returned to sender, n=5), 30 (19.4%) self-referred for an appointment, of which 24 (15.5%) attended and were successfully screened. Attendance rates differed by gender, with significantly more women attending an appointment than men (20.7% vs 8.8%, respectively; OR=2.73, 95% CI=1.02-7.35, P=0.05), but not by area (Brent vs Harrow) or area-level deprivation. Of the 30 people who self-referred for an appointment, 27 (90%) indicated a preference for a same-sex practitioner, whereas three (10%) gave no preference. Preference for a same-sex practitioner was higher among women than men (χ(2)=7.78, P<0.05), with only 67% of men (six of nine) requesting a same-sex practitioner, compared with 100% of women (n=21). CONCLUSIONS Sending previous non-responders a 12 months' reminder letter with a brief information leaflet is a feasible and efficacious intervention, which merits further investigation in a randomised controlled trial.
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Affiliation(s)
- Robert S Kerrison
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
| | - Lesley M McGregor
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
| | - Sarah Marshall
- St. Mark's Bowel Cancer Screening Centre, St. Mark's Hospital, Watford Road, Harrow, Middlesex HA1 3UJ, UK
| | - John Isitt
- Resonant Behaviour Change and Social Marketing, Canterbury Court, 1-3 Brixton Road, London, SW9 6DE, UK
| | - Nicholas Counsell
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
| | - Jane Wardle
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
| | - Christian von Wagner
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
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McGregor LM, von Wagner C, Atkin W, Kralj-Hans I, Halloran SP, Handley G, Logan RF, Rainbow S, Smith S, Snowball J, Thomas MC, Smith SG, Vart G, Howe R, Counsell N, Hackshaw A, Morris S, Duffy SW, Raine R, Wardle J. Reducing the Social Gradient in Uptake of the NHS Colorectal Cancer Screening Programme Using a Narrative-Based Information Leaflet: A Cluster-Randomised Trial. Gastroenterol Res Pract 2016; 2016:3670150. [PMID: 27069473 PMCID: PMC4812359 DOI: 10.1155/2016/3670150] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 11/24/2015] [Accepted: 12/09/2015] [Indexed: 12/17/2022] Open
Abstract
Objective. To test the effectiveness of adding a narrative leaflet to the current information material delivered by the NHS English colorectal cancer (CRC) screening programme on reducing socioeconomic inequalities in uptake. Participants. 150,417 adults (59-74 years) routinely invited to complete the guaiac Faecal Occult Blood test (gFOBt) in March 2013. Design. A cluster randomised controlled trial (ISRCTN74121020) to compare uptake between two arms. The control arm received the standard NHS CRC screening information material (SI) and the intervention arm received the standard information plus a supplementary narrative leaflet, which had previously been shown to increase screening intentions (SI + N). Between group comparisons were made for uptake overall and across socioeconomic status (SES). Results. Uptake was 57.7% and did not differ significantly between the two trial arms (SI: 58.5%; SI + N: 56.7%; odds ratio = 0.93; 95% confidence interval: 0.81-1.06; p = 0.27). There was no interaction between group and SES quintile (p = 0.44). Conclusions. Adding a narrative leaflet to existing information materials does not reduce the SES gradient in uptake. Despite the benefits of using a pragmatic trial design, the need to add to, rather than replace, existing information may have limited the true value of an evidence-based intervention on behaviour.
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Affiliation(s)
- Lesley M. McGregor
- Department of Epidemiology and Public Health, University College London, London WC1E 7HB, UK
| | - Christian von Wagner
- Department of Epidemiology and Public Health, University College London, London WC1E 7HB, UK
| | - Wendy Atkin
- Department of Surgery & Cancer, Imperial College London, London SW7 2AZ, UK
| | - Ines Kralj-Hans
- Department of Biostatistics, King's Clinical Trials Unit, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | - Stephen P. Halloran
- NHS Bowel Cancer Screening Southern Programme Hub, Surrey Research Park, Guildford, Surrey GU2 7YS, UK
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey GU2 7TE, UK
| | - Graham Handley
- NHS Bowel Cancer Screening North East Programme Hub, Gateshead Health NHS Foundation Trust, Queen Elizabeth Hospital, Gateshead NE9 6SX, UK
| | - Richard F. Logan
- NHS Bowel Cancer Screening Eastern Programme Hub, Nottingham University Hospitals, Nottingham NG7 2UH, UK
| | - Sandra Rainbow
- NHS Bowel Cancer Screening London Programme Hub, Northwick Park and St Mark's Hospitals, Harrow, Middlesex HA1 3UJ, UK
| | - Steve Smith
- NHS Bowel Cancer Screening Midlands and North West Programme Hub, Hospital of St Cross, Barby Road, Rugby CV22 5PX, UK
| | - Julia Snowball
- NHS Bowel Cancer Screening Southern Programme Hub, Surrey Research Park, Guildford, Surrey GU2 7YS, UK
| | - Mary C. Thomas
- Department of Applied Health Research, University College London, London WC1E 7HB, UK
| | - Samuel G. Smith
- Department of Epidemiology and Public Health, University College London, London WC1E 7HB, UK
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK
| | - Gemma Vart
- Department of Epidemiology and Public Health, University College London, London WC1E 7HB, UK
| | - Rosemary Howe
- Department of Surgery & Cancer, Imperial College London, London SW7 2AZ, UK
| | - Nicholas Counsell
- Cancer Research UK & UCL Cancer Trials Centre, Cancer Institute, University College London, London W1T 4TJ, UK
| | - Allan Hackshaw
- Cancer Research UK & UCL Cancer Trials Centre, Cancer Institute, University College London, London W1T 4TJ, UK
| | - Stephen Morris
- Department of Applied Health Research, University College London, London WC1E 7HB, UK
| | - Stephen W. Duffy
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK
| | - Rosalind Raine
- Department of Applied Health Research, University College London, London WC1E 7HB, UK
| | - Jane Wardle
- Department of Epidemiology and Public Health, University College London, London WC1E 7HB, UK
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Decker KM, Demers AA, Nugent Z, Biswanger N, Singh H. Reducing income-related inequities in colorectal cancer screening: lessons learned from a retrospective analysis of organised programme and non-programme screening delivery in Winnipeg, Manitoba. BMJ Open 2016; 6:e009470. [PMID: 26908517 PMCID: PMC4769429 DOI: 10.1136/bmjopen-2015-009470] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE We examined organised colorectal cancer (CRC) screening programme and non-programme faecal occult blood test (FOBT) use from 2008 to 2012 for individuals living in Winnipeg, Manitoba, by area-level income. SETTING Winnipeg, Manitoba, a region with universal healthcare and an organised CRC screening programme. PARTICIPANTS Individuals who had a non-programme FOBT were identified from the Provincial Medical Claims database. Individuals who had a programme FOBT were identified from the provincial screening registry. Census data were used to determine average household income based on area of residence. STATISTICAL ANALYSIS Trends in age-standardised FOBT rates were examined using Joinpoint Regression. Logistic regression was performed to explore the association between programme and non-programme FOBT use and income quintile. RESULTS FOBT use (non-programme and programme) increased from 32.2% in 2008 to 41.6% in 2012. Individuals living in the highest income areas (Q5) were more likely to have a non-programme FOBT compared with those living in other areas. Individuals living in areas with the lowest average income level (Q1) were less likely to have had programme FOBT than those living in areas with the highest average income level (OR 0.80, 95% CI 0.77 to 0.82). There was no difference in programme FOBT use for individuals living in areas with the second lowest income level (Q2) compared with those living in areas with the highest. Individuals living in areas with a moderate-income level (Q3 and Q4) were more likely to have had a programme FOBT compared with those living in an area with the highest income level (OR 1.12, 95% CI 1.09 to 1.15 for Q3 and OR 1.10, 95% CI 1.07 to 1.13 for Q4). CONCLUSIONS Inequities by income observed for non-programme FOBTs were largely eliminated when programme FOBTs were examined. Targeted interventions within organised screening programmes in very low-income areas are needed.
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Affiliation(s)
- Kathleen M Decker
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Alain A Demers
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Zoann Nugent
- Department of Internal Medicine, University of Manitoba, Health Sciences Centre, Winnipeg, Manitoba, Canada
- Medical Oncology and Haematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | | | - Harminder Singh
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Internal Medicine, University of Manitoba, Health Sciences Centre, Winnipeg, Manitoba, Canada
- Medical Oncology and Haematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
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Colorectal Cancer Screening Programme in Spain: Results of Key Performance Indicators After Five Rounds (2000-2012). Sci Rep 2016; 6:19532. [PMID: 26787510 PMCID: PMC4726304 DOI: 10.1038/srep19532] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 12/10/2015] [Indexed: 12/22/2022] Open
Abstract
Effective quality assurance is essential in any screening programme. This article provides a unique insight into key quality indicators of five rounds of the first population-based colorectal cancer screening programme implemented in Spain (2000–2012), providing the results according to the type of screening (prevalent or first screen and incident or subsequent screen) and test (guaiac or immunochemical). The total crude participation rate increased from 17.2% (11,011) in the first round to 35.9% (22,988) in the last one. Rescreening rate was very high (88.6% in the fifth round). Positivity rate was superior with the faecal immunochemical test (6.2%) than with the guaiac-based test (0.7%) (p < 0.0001) and detection rates were also better with the immunochemical test. The most significant rise in detection rate was observed for high risk adenoma in men (45.5 per 1,000 screened). Most cancers were diagnosed at an early stage (61.4%) and there was a statistically significant difference between those detected in first or subsequent screening (52.6% and 70.0% respectively; p = 0.024). The availability of these results substantially improves data comparisons and the exchange of experience between screening programmes.
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Berger BM, Schroy PC, Dinh TA. Screening for Colorectal Cancer Using a Multitarget Stool DNA Test: Modeling the Effect of the Intertest Interval on Clinical Effectiveness. Clin Colorectal Cancer 2015; 15:e65-74. [PMID: 26792032 DOI: 10.1016/j.clcc.2015.12.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 12/01/2015] [Accepted: 12/09/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND A multitarget stool DNA (mt-sDNA) test was recently approved for colorectal cancer (CRC) screening for men and women, aged ≥ 50 years, at average risk of CRC. The guidelines currently recommend a 3-year interval for mt-sDNA testing in the absence of empirical data. We used clinical effectiveness modeling to project decreases in CRC incidence and related mortality associated with mt-sDNA screening to help inform interval setting. MATERIALS AND METHODS The Archimedes model (Archimedes Inc., San Francisco, CA) was used to conduct a 5-arm, virtual, clinical screening study of a population of 200,000 virtual individuals to compare the clinical effectiveness of mt-sDNA screening at 1-, 3-, and 5-year intervals compared with colonoscopy at 10-year intervals and no screening for a 30-year period. The study endpoints were the decrease in CRC incidence and related mortality of each strategy versus no screening. Cost-effectiveness ratios (US dollars per quality-adjusted life year [QALY]) of mt-sDNA intervals were calculated versus no screening. RESULTS Compared with 10-year colonoscopy, annual mt-sDNA testing produced similar reductions in CRC incidence (65% vs. 63%) and related mortality (73% vs. 72%). mt-sDNA testing at 3-year intervals reduced the CRC incidence by 57% and CRC mortality by 67%, and mt-sDNA testing at 5-year intervals reduced the CRC incidence by 52% and CRC mortality by 62%. At an average price of $600 per test, the annual, 3-year, and 5-year mt-sDNA screening costs would be $20,178, $11,313, and $7388 per QALY, respectively, compared with no screening. CONCLUSION These data suggest that screening every 3 years using a multitarget mt-sDNA test provides reasonable performance at acceptable cost.
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Affiliation(s)
| | - Paul C Schroy
- Department of Gastroenterology, Boston University School of Medicine, Boston, MA
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Azimafoussé Assogba GF, Jezewski-Serra D, Lastier D, Quintin C, Denis B, Beltzer N, Duport N. Impact of subsequent screening episodes on the positive predictive value for advanced neoplasia and on the distribution of anatomic subsites of colorectal cancer: A population-based study on behalf of the French colorectal cancer screening program. Cancer Epidemiol 2015; 39:964-71. [DOI: 10.1016/j.canep.2015.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 09/14/2015] [Accepted: 09/15/2015] [Indexed: 12/22/2022]
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Baker DW, Brown T, Goldman SN, Liss DT, Kollar S, Balsley K, Lee JY, Buchanan DR. Two-year follow-up of the effectiveness of a multifaceted intervention to improve adherence to annual colorectal cancer screening in community health centers. Cancer Causes Control 2015; 26:1685-90. [PMID: 26337733 DOI: 10.1007/s10552-015-0650-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 08/03/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE We previously found that a multifaceted outreach intervention achieved 82 % annual adherence to colorectal cancer (CRC) screening with fecal occult blood testing (FOBT). This study assessed adherence to FOBT after a second outreach. METHODS We followed 225 patients in community health centers in Chicago, Illinois, who were randomized to the intervention group. Our primary analysis focused on 124 patients who completed FOBT during the first outreach and were due again for annual FOBT; 90% were Latino, 87% preferred to speak Spanish, and 77% were uninsured. Second outreach consisted of (1) a mailed reminder letter, a free fecal immunochemical test (FIT) with postage-paid return envelope, (2) automated phone and text messages, (3) automated reminders 2 weeks later if the FIT was not returned, and (4) a telephone call after 3 months. Our main outcome was completion of FIT within 6 months of the due date. We also analyzed the proportion of the original 225 patients who were fully screened for CRC over the 2-year study period. RESULTS A total of 88.7% of patients completed a FIT within 6 months of their second outreach. Over the 2 years since the first outreach, 71.6% of the 225 patients assigned to the intervention group were fully up to date on CRC screening, another 11.1% had been screened suboptimally, and 17.3% were inadequately screened or not screened. CONCLUSIONS It is possible to achieve high rates of CRC screening over a 2-year period for vulnerable populations using outreach with FIT as a primary strategy.
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Affiliation(s)
- David W Baker
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA. .,Center for Advancing Equity in Clinical Preventive Services, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. .,Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA. .,Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Tiffany Brown
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA. .,Center for Advancing Equity in Clinical Preventive Services, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Shira N Goldman
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA. .,Center for Advancing Equity in Clinical Preventive Services, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - David T Liss
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA. .,Center for Advancing Equity in Clinical Preventive Services, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | | | | | - Ji Young Lee
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA. .,Center for Advancing Equity in Clinical Preventive Services, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Blanks RG, Benson VS, Alison R, Brown A, Reeves GK, Beral V, Patnick J, Green J. Nationwide bowel cancer screening programme in England: cohort study of lifestyle factors affecting participation and outcomes in women. Br J Cancer 2015; 112:1562-7. [PMID: 25742470 PMCID: PMC4453681 DOI: 10.1038/bjc.2015.69] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 01/16/2015] [Accepted: 01/27/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In 2006, the National Health Service Bowel Cancer Screening Programme in England (NHSBCSP) began offering routine population-based biennial faecal occult blood testing (FOBt) at ages 60-69. There is, however, limited information on how characteristics of individuals affect participation and outcomes of screening, and we studied this association by linking NHSBCSP data to a large prospective cohort of women. METHODS Electronic linkage of the NHSBCSP and Million Women Study records identified 899 166 women in the study cohort with at least one invitation for screening. NHSBCSP provided information on screening acceptance, FOBt results, screen-detected colorectal cancer and other outcomes. The Million Women Study provided prospectively collected information on personal and lifestyle factors. Multiple regression was used to estimate relative risks (RRs) of factors associated with acceptance and outcomes of screening. RESULTS Overall, 70% of women (628 976/899 166) accepted their first invitation for bowel cancer screening, of whom 9133 (1.5%) were FOBt-positive, 743 (0.1%) had screen-detected colorectal cancer and 3056 (0.5%) had screen-detected colorectal adenoma. Acceptance was lower in women from the most than the least deprived tertile, in South Asians and in Blacks than in Whites, in current than in never smokers and in obese than in normal weight women: adjusted RRs (95% confidence interval) for acceptance vs not, 0.90 (0.90-0.90); 0.77 (0.75-79); 0.94 (0.92-0.96); 0.78 (0.77-0.78); and 0.88 (0.88-0.89), respectively: P<0.001 for each. These factors were also associated with an increased risk of being FOBt-positive and of having screen-detected adenoma, but were not strongly associated with the risk of screen-detected colorectal cancer. Relative risks for screen-detected adenoma were 1.22 (1.12-1.34), 2.46 (1.75-3.45), 1.61 (1.05-2.48), 1.53 (1.38-1.68) and 1.77 (1.60-1.95), respectively (P<0.001 for all, except for Blacks vs Whites P=0.03). Use of hormone therapy for menopause was associated with reduced risk of screen-detected adenoma, RR ever vs never use, 0.87 (0.81-0.93), P<0.001 and colorectal cancer, 0.78 (0.68-0.91), P=0.001. INTERPRETATION Among women in England, socioeconomic and lifestyle factors strongly affect participation in routine bowel cancer screening, risk of being FOBt-positive and risk of having screen-detected colorectal adenoma. However, screen-detected colorectal cancer risk is not strongly related to these factors.
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Affiliation(s)
- R G Blanks
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - V S Benson
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - R Alison
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - A Brown
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - G K Reeves
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - V Beral
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - J Patnick
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- NHS Cancer Screening Programmes, Public Health England, Fulwood House, Old Fulwood Road, Sheffield S10 3TH, UK
| | - J Green
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Lo SH, Halloran S, Snowball J, Seaman H, Wardle J, von Wagner C. Colorectal cancer screening uptake over three biennial invitation rounds in the English bowel cancer screening programme. Gut 2015; 64:282-91. [PMID: 24812001 PMCID: PMC4316922 DOI: 10.1136/gutjnl-2013-306144] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To examine patterns of colorectal cancer (CRC) screening uptake over three biennial invitation rounds in the National Health Service (NHS) Bowel Cancer Screening Programme (BCSP) in England. METHODS We analysed data from the BCSP's Southern Hub for individuals (n=62,099) aged 60-64 years at the time of first invitation to screening with a follow-up period that allowed for two further biennial invitations. Data on sex, age and a neighbourhood-level measure of socioeconomic deprivation were used in the analysis. Outcomes included uptake of guaiac-based faecal occult blood (gFOB) test screening, inadequate gFOB screening (≥1 test kit(s) returned but failed to complete further gFOB tests needed to reach a conclusive test result), test positivity, compliance with follow-up examinations (usually colonoscopy) and diagnostic outcomes. RESULTS Overall gFOB uptake was 57.4% in the first, 60.9% in the second and 66.2% in third biennial invitation round. This resulted in 70.1% of the initial cohort having responded at least once, 60.7% at least twice and 44.4% three times. Participation in the first round was strongly predictive of participation in the second round ('Previous Responders': 86.6% vs. 'Previous Non-Responders': 23.1%). Participation in the third round was highest among 'Consistent Screeners' (94.5%), followed by 'Late Entrants' (78.0%), 'Dropouts' (59.8%) and 'Consistent Non-Responders' (14.6%). Socioeconomic inequalities in uptake were observed across the three rounds, but sex inequalities decreased over rounds. Inadequate gFOB screening was influenced by screening history and socioeconomic deprivation. Screening history was the only significant predictor of follow-up compliance. CONCLUSIONS Screening history is associated with overall gFOB uptake, inadequate gFOB screening and follow-up compliance. Socioeconomic deprivation is also consistently associated with lower gFOB uptake and inadequate gFOB screening. Improving regular screening among identified 'at-risk' groups is important for the effectiveness of CRC screening programmes.
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Affiliation(s)
- Siu Hing Lo
- Department of Epidemiology and Public Health, Cancer Research UK Health Behaviour Research Centre, University College London, London, UK
| | - Stephen Halloran
- Bowel Cancer Screening Southern Programme Hub, Royal Surrey County Hospital NHS Trust, Guildford, Surrey & University of Surrey, Guildford, Surrey, UK,University of Surrey, Guildford, Surrey, UK,Guildford Undetected Tumour Screening (GUTS) charity, Royal Surrey County Hospital NHS Trust, Guildford, Surrey, UK
| | - Julia Snowball
- Bowel Cancer Screening Southern Programme Hub, Royal Surrey County Hospital NHS Trust, Guildford, Surrey & University of Surrey, Guildford, Surrey, UK
| | - Helen Seaman
- Bowel Cancer Screening Southern Programme Hub, Royal Surrey County Hospital NHS Trust, Guildford, Surrey & University of Surrey, Guildford, Surrey, UK,University of Surrey, Guildford, Surrey, UK,Guildford Undetected Tumour Screening (GUTS) charity, Royal Surrey County Hospital NHS Trust, Guildford, Surrey, UK
| | - Jane Wardle
- Department of Epidemiology and Public Health, Cancer Research UK Health Behaviour Research Centre, University College London, London, UK
| | - Christian von Wagner
- Department of Epidemiology and Public Health, Cancer Research UK Health Behaviour Research Centre, University College London, London, UK
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Resnicow K, Zhou Y, Hawley S, Jimbo M, Ruffin MT, Davis RE, Shires D, Lafata JE. Communication preference moderates the effect of a tailored intervention to increase colorectal cancer screening among African Americans. PATIENT EDUCATION AND COUNSELING 2014; 97:370-5. [PMID: 25224317 PMCID: PMC6208142 DOI: 10.1016/j.pec.2014.08.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 07/04/2014] [Accepted: 08/18/2014] [Indexed: 05/14/2023]
Abstract
OBJECTIVE Test the impact of tailoring CRC screening messages for African Americans (AAs) using novel theoretical variables and to examine moderating effect of communication preferences. METHODS Participants were randomized to receive two minimally tailored or two enhanced tailored print newsletters addressing CRC. The enhanced intervention was tailored on Self-Determination Theory and other novel psychological constructs. Minimal tailoring only used information available in the patient's EHR. The primary outcome was CRC screening based on EHR. Participants were AA members aged 50-74 of an integrated health care delivery system not up to date on CRC screening. RESULTS We enrolled 881 participants. CRC screening participation rates at 1-year follow up were 20.5% and 21.5% in the minimally and enhanced tailored groups, respectively. Communication preferences moderated the impact of the intervention. Specifically, among those with an autonomous communication preference, screening rates in the minimally and enhanced tailored groups were 17.1% and 25.9%, respectively, while no intervention effect was evident among those with a directive preference. CONCLUSION Future research is needed to explore the impact of communication preference tailoring for other health behaviors and among other populations. PRACTICE IMPLICATIONS Tailored communications should consider communication style preference to help guide the content and tone of messages.
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Affiliation(s)
- Ken Resnicow
- University of Michigan School of Public Health, Department of Health Behavior & Health Education, Ann Arbor, USA.
| | - Yan Zhou
- University of Michigan, Ann Arbor, USA
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Tinmouth J, Patel J, Austin PC, Baxter NN, Brouwers MC, Earle C, Levitt C, Lu Y, Mackinnon M, Paszat L, Rabeneck L. Increasing participation in colorectal cancer screening: Results from a cluster randomized trial of directly mailed gFOBT kits to previous nonresponders. Int J Cancer 2014; 136:E697-703. [DOI: 10.1002/ijc.29191] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 08/18/2014] [Accepted: 08/21/2014] [Indexed: 12/23/2022]
Affiliation(s)
- Jill Tinmouth
- Sunnybrook Health Sciences Centre; Toronto ON Canada
- Institute of Health Policy; Management and Evaluation, University of Toronto; Toronto ON Canada
- Institute for Clinical Evaluative Sciences; Toronto ON Canada
- Cancer Care Ontario; Toronto ON Canada
| | - Jigisha Patel
- Sunnybrook Health Sciences Centre; Toronto ON Canada
| | - Peter C. Austin
- Institute of Health Policy; Management and Evaluation, University of Toronto; Toronto ON Canada
- Institute for Clinical Evaluative Sciences; Toronto ON Canada
| | - Nancy N. Baxter
- Institute of Health Policy; Management and Evaluation, University of Toronto; Toronto ON Canada
- Institute for Clinical Evaluative Sciences; Toronto ON Canada
- Department of Surgery and Li Ka Shing Knowledge Institute; St. Michael's Hospital; Toronto ON Canada
| | | | - Craig Earle
- Sunnybrook Health Sciences Centre; Toronto ON Canada
- Institute of Health Policy; Management and Evaluation, University of Toronto; Toronto ON Canada
- Institute for Clinical Evaluative Sciences; Toronto ON Canada
| | - Cheryl Levitt
- Department of Family Medicine; McMaster University; Hamilton ON Canada
| | - Yan Lu
- Institute for Clinical Evaluative Sciences; Toronto ON Canada
| | | | - Lawrence Paszat
- Sunnybrook Health Sciences Centre; Toronto ON Canada
- Institute of Health Policy; Management and Evaluation, University of Toronto; Toronto ON Canada
- Institute for Clinical Evaluative Sciences; Toronto ON Canada
- Dalla Lana School of Public Health; University of Toronto; Toronto ON Canada
| | - Linda Rabeneck
- Institute of Health Policy; Management and Evaluation, University of Toronto; Toronto ON Canada
- Institute for Clinical Evaluative Sciences; Toronto ON Canada
- Cancer Care Ontario; Toronto ON Canada
- Dalla Lana School of Public Health; University of Toronto; Toronto ON Canada
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Kearns B, Whyte S, Chilcott J, Patnick J. Guaiac faecal occult blood test performance at initial and repeat screens in the English Bowel Cancer Screening Programme. Br J Cancer 2014; 111:1734-41. [PMID: 25180767 PMCID: PMC4453729 DOI: 10.1038/bjc.2014.469] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 07/23/2014] [Accepted: 07/26/2014] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In many countries, screening for colorectal cancer (CRC) relies on repeat testing using the guaiac faecal occult blood test (gFOBT). This study aimed to compare gFOBT performance measures between initial and repeat screens. METHODS Data on screening uptake and outcomes from the English Bowel Cancer Screening Programme (BCSP) for the years 2008 and 2011 were used. An existing CRC natural history model was used to estimate gFOBT sensitivity and specificity, and the cost-effectiveness of different screening strategies. RESULTS The gFOBT sensitivity for CRC was estimated to decrease from 27.35% at the initial screen to 20.22% at the repeat screen. Decreases were also observed for the positive predictive value (8.4-7.2%) and detection rate for CRC (0.19-0.14%). Assuming equal performance measures for both the initial and repeat screens led to an overestimate of the cost effectiveness of gFOBT screening compared with the other screening modalities. CONCLUSIONS Performance measures for gFOBT screening were generally lower in the repeat screen compared with the initial screen. Screening for CRC using gFOBT is likely to be cost-effective; however, the use of different screening modalities may result in additional benefits. Future economic evaluations of gFOBT should not assume equal sensitivities between screening rounds.
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Affiliation(s)
- B Kearns
- School of Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK
| | - S Whyte
- School of Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK
| | - J Chilcott
- School of Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK
| | - J Patnick
- Public Health England, Sheffield S10 3TH, UK
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Palmer CK, Thomas MC, von Wagner C, Raine R. Reasons for non-uptake and subsequent participation in the NHS Bowel Cancer Screening Programme: a qualitative study. Br J Cancer 2014; 110:1705-11. [PMID: 24619071 PMCID: PMC3974074 DOI: 10.1038/bjc.2014.125] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 02/07/2014] [Accepted: 02/17/2014] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Screening for bowel cancer using the guaiac faecal occult blood test offered by the NHS Bowel Cancer Screening Programme (BCSP) is taken up by 54% of the eligible population. Uptake ranges from 35% in the most to 61% in the least deprived areas. This study explores reasons for non-uptake of bowel cancer screening, and examines reasons for subsequent uptake among participants who had initially not taken part in screening. METHODS Focus groups with a socio-economically diverse sample of participants were used to explore participants' experience of invitation to and non-uptake of bowel cancer screening. RESULTS Participants described sampling faeces and storing faecal samples as broaching a cultural taboo, and causing shame. Completion of the test kit within the home rather than a formal health setting was considered unsettling and reduced perceived importance. Not knowing screening results was reported to be preferable to the implications of a positive screening result. Feeling well was associated with low perceived relevance of screening. Talking about bowel cancer screening with family and peers emerged as the key to subsequent participation in screening. CONCLUSIONS Initiatives to normalise discussion about bowel cancer screening, to link the BCSP to general practice, and to simplify the test itself may lead to increased uptake across all social groups.
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Affiliation(s)
- C K Palmer
- Department of Applied Health Research, University College London, 1-19 Torrington Place (Room 112), London WC1E 7HB, UK
| | - M C Thomas
- Department of Applied Health Research, University College London, 1-19 Torrington Place (Room 112), London WC1E 7HB, UK
| | - C von Wagner
- Department of Epidemiology and Public Health, Cancer Research UK Health Behaviour Research Centre, University College London, 1-19 Torrington Place, London WC1E 6BT, UK
| | - R Raine
- Department of Applied Health Research, University College London, 1-19 Torrington Place (Room 112), London WC1E 7HB, UK
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44
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Bulliard JL, Garcia M, Blom J, Senore C, Mai V, Klabunde C. Sorting out measures and definitions of screening participation to improve comparability: The example of colorectal cancer. Eur J Cancer 2014; 50:434-46. [DOI: 10.1016/j.ejca.2013.09.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 09/25/2013] [Accepted: 09/26/2013] [Indexed: 12/20/2022]
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Steele RJC, McClements PL, Libby G, Carey FA, Fraser CG. Patterns of uptake in a biennial faecal occult blood test screening programme for colorectal cancer. Colorectal Dis 2014; 16:28-32. [PMID: 24034143 DOI: 10.1111/codi.12393] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Accepted: 06/28/2013] [Indexed: 02/04/2023]
Abstract
AIM The patterns of response in faecal occult blood test (FOBT) screening were studied. METHOD A total of 251,578 people invited three times for faecal occult blood testing were categorized according to how they responded to the invitations, as follows: YNN, NYN, NNY, NYY, YNY, YYN, YYY or NNN (Y = response; N = no response). RESULTS Overall, 163,038 (64.8%) responded at least once, and of those the biggest category was YYY (98,494, 60.4%). Of 1927 cancers diagnosed in the age group eligible for screening, there were 405 screen-detected cancers, 529 interval cancers and 993 cancers arising in people who had not been screened for over 2 years (i.e. falling outside the interval cancer category). In the YYY group, 79 screen-detected cancers would have been missed had the members of this group responded YNN and 65 had they responded YYN. In the YYN group, 104 screening cancers would have been missed if they had followed the YNN pattern. In most cases, the screen-detected cancers were diagnosed at the last invitation accepted, indicating that, after a diagnosis of cancer, further screening invitations were rarely accepted. Accordingly, the numbers of screen-detected and interval cancers were adjusted for likely pattern of response according to the proportion of the whole population falling into each pattern. With this adjustment, 40.9% of the cancers in the YYY group were screen detected compared with 29.3% in the YYN group and 20.7% in the YNN group (P < 0.001). Among those who responded once, twice and three times, the stage distribution of screen-detected cancers was similar, indicating that the prognosis of screen-detected cancer is unlikely to be poorer if not detected at the first screen. CONCLUSION This study is the first to examine patterns of response to screening invitations and confirms the importance to individuals of continuing to accept repeated screening invitations.
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Affiliation(s)
- R J C Steele
- Department of Surgery, University of Dundee, Dundee, UK; Scottish Bowel Screening Centre, Dundee, UK; Bowel Screening Research Unit, Scottish Bowel Screening Centre, Dundee, UK
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Hall NJ, Rubin GP, Dobson C, Weller D, Wardle J, Ritchie M, Rees CJ. Attitudes and beliefs of non-participants in a population-based screening programme for colorectal cancer. Health Expect 2013; 18:1645-57. [PMID: 24268129 DOI: 10.1111/hex.12157] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2013] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Uptake of colorectal cancer screening programmes needs to be improved or at least maintained in order to achieve projected reductions in mortality and morbidity. Understanding the origins of non-participation in screening is therefore important. OBJECTIVE To explore the beliefs and experiences of individuals who had not responded either to their screening invitation or reminder. DESIGN A qualitative study using in-depth interviews with non-participants from England's population-based colorectal cancer screening programme. Data collection and analysis were carried out using a grounded theory approach, with an emphasis on the constant comparison method, and continued until saturation (27 interviews). FINDINGS The interviews provided an in-depth understanding of a range of reasons and circumstances surrounding non-participation in screening, including contextual and environmental influences as well as factors specific to the screening test. Non-participation in screening was not necessarily associated with negative attitudes towards screening or a decision to not return a kit. Reasons for non-participation in screening included not feeling that participation is personally necessary, avoiding or delaying decision making, and having some degree of intention to take part but failing to do so because of practicalities, conflicting priorities or external circumstances. Beliefs, awareness and intention change over time. DISCUSSION AND CONCLUSIONS A range of approaches may be required to improve screening uptake. Some non-participants may already have a degree of intention to take part in screening in the future, and this group may be more responsive to interventions based on professional endorsement, repeat invitations, reminders and aids to making the test more practical.
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Affiliation(s)
- Nicola J Hall
- School of Medicine, Pharmacy and Health, Durham University, Stockton on Tees, UK
| | - Greg P Rubin
- School of Medicine, Pharmacy and Health, Durham University, Stockton on Tees, UK
| | - Christina Dobson
- School of Medicine, Pharmacy and Health, Durham University, Stockton on Tees, UK
| | - David Weller
- Cancer Research Centre, University of Edinburgh, Edinburgh, UK
| | - Jane Wardle
- Health Behaviour Research Centre, University College London, London, UK
| | - Mary Ritchie
- South of Tyne NHS Bowel Cancer Screening Centre, Gateshead, UK
| | - Colin J Rees
- South Tyneside NHS Foundation Trust, South Shields, UK
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Forster AS, Forbes A, Dodhia H, Connor C, Du Chemin A, Sivaprasad S, Mann S, Gulliford MC. Changes in detection of retinopathy in type 2 diabetes in the first 4 years of a population-based diabetic eye screening program: retrospective cohort study. Diabetes Care 2013; 36:2663-9. [PMID: 23620476 PMCID: PMC3747895 DOI: 10.2337/dc13-0130] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Annual diabetic eye screening has been implemented in England since 2008. This study aimed to estimate changes in the detection of retinopathy in the first 4 years of the program. RESEARCH DESIGN AND METHODS Participants included 32,340 patients with type 2 diabetes resident in three London boroughs with one or more screening records between 2008 and 2011. Data for 87,570 digital images from 2008 to 2011 were analyzed. Frequency of sight-threatening diabetic retinopathy (STDR) was estimated by year of screen for first screens and for subsequent screens according to retinopathy status at first screen. RESULTS Among 16,621 first-ever screens, the frequency of STDR was 7.1% in 2008, declining to 6.4% in 2011 (P = 0.087). The proportion with a duration of diabetes of <1 year at first screen increased from 18.7% in 2008 to 48.6% in 2011. Second or later screens were received by 26,308 participants. In participants with mild nonproliferative retinopathy at first screen, the proportion with STDR at second or later screen declined from 21.6% in 2008 to 8.4% in 2011 (annual change -2.2% [95% CI -3.3 to -1.0], P < 0.001). In participants with no retinopathy at first screen, STDR declined from 9.2% in 2008 to 3.2% in 2011 (annual change -1.8% [-2.0 to -1.7], P < 0.001). Declining trends were similar in sociodemographic subgroups. CONCLUSIONS After the inception of population-based diabetic eye screening, patients at lower risk of STDR contribute an increasing proportion to the eligible population, and the proportion detected with STDR at second or subsequent screening rounds declines rapidly.
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Affiliation(s)
- Alice S Forster
- Department of Primary Care and Public Health Sciences, King's College London, London, UK.
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Socioeconomic variation in uptake of colonoscopy following a positive faecal occult blood test result: a retrospective analysis of the NHS Bowel Cancer Screening Programme. Br J Cancer 2012; 107:765-71. [PMID: 22864455 PMCID: PMC3425978 DOI: 10.1038/bjc.2012.303] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Bowel cancer is a serious health burden and its early diagnosis improves survival. The Bowel Cancer Screening Programme (BCSP) in England screens with the Faecal Occult Blood test (FOBt), followed by colonoscopy for individuals with a positive test result. Socioeconomic inequalities have been demonstrated for FOBt uptake, but it is not known whether they persist at the next stage of the screening pathway. The aim of this study was to assess the association between colonoscopy uptake and area socioeconomic deprivation, controlling for individual age and sex, and area ethnic diversity, population density, poor self-assessed health, and region. Methods: Logistic regression analysis of colonoscopy uptake using BCSP data for England between 2006 and 2009 for 24 180 adults aged between 60 and 69 years. Results: Overall colonoscopy uptake was 88.4%. Statistically significant variation in uptake is found between quintiles of area deprivation (ranging from 86.4 to 89.5%), as well as age and sex groups (87.9–89.1%), quintiles of poor self-assessed health (87.5–89.5%), non-white ethnicity (84.6–90.6%) and population density (87.9–89.3%), and geographical regions (86.4–90%). Conclusion: Colonoscopy uptake is high. The variation in uptake by socioeconomic deprivation is small, as is variation by subgroups of age and sex, poor self-assessed health, ethnic diversity, population density, and region.
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Morris EJA, Whitehouse LE, Farrell T, Nickerson C, Thomas JD, Quirke P, Rutter MD, Rees C, Finan PJ, Wilkinson JR, Patnick J. A retrospective observational study examining the characteristics and outcomes of tumours diagnosed within and without of the English NHS Bowel Cancer Screening Programme. Br J Cancer 2012; 107:757-64. [PMID: 22850549 PMCID: PMC3425974 DOI: 10.1038/bjc.2012.331] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background: Colorectal cancer is common in England and, with long-term survival relatively poor, improving outcomes is a priority. A major initiative to reduce mortality from the disease has been the introduction of the National Health Service (NHS) Bowel Cancer Screening Programme (BCSP). Combining data from the BCSP with that in the National Cancer Data Repository (NCDR) allows all tumours diagnosed in England to be categorised according to their involvement with the BCSP. This study sought to quantify the characteristics of the tumours diagnosed within and outside the BCSP and investigate its impact on outcomes. Methods: Linkage of the NCDR and BCSP data allowed all tumours diagnosed between July 2006 and December 2008 to be categorised into four groups; screen-detected tumours, screening-interval tumours, tumours diagnosed in non-participating invitees and tumours diagnosed in those never invited to participate. The characteristics, management and outcome of tumours in each category were compared. Results: In all, 76 943 individuals were diagnosed with their first primary colorectal cancer during the study period. Of these 2213 (2.9%) were screen-detected, 623 (0.8%) were screening-interval cancers, 1760 (2.3%) were diagnosed in individuals in non-participating invitees and 72 437 (94.1%) were diagnosed in individuals not invited to participate in the programme due to its ongoing roll-out over the time period studied. Screen-detected tumours were identified at earlier Dukes’ stages, were more likely to be managed with curative intent and had significantly better outcomes than tumours in other categories. Conclusion: Screen-detected cancers had a significantly better prognosis than other tumours and this would suggest that the BCSP should reduce mortality from colorectal cancer in England.
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Affiliation(s)
- E J A Morris
- Colorectal Cancer Epidemiology Group, Leeds Institute of Molecular Medicine, University of Leeds, Level 6, Bexley Wing, St James's Institute of Oncology, St James's Hospital, Leeds LS9 7TF, UK.
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Groth S, Krause H, Behrendt R, Hill H, Börner M, Bastürk M, Plathner N, Schütte F, Gauger U, Riemann JF, Altenhofen L, Rösch T. Capsule colonoscopy increases uptake of colorectal cancer screening. BMC Gastroenterol 2012; 12:80. [PMID: 22734948 PMCID: PMC3407015 DOI: 10.1186/1471-230x-12-80] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 06/26/2012] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Screening colonoscopy effectiveness is hampered by limited adherence by the general population. The present prospective study was performed to evaluate whether adding capsule colonoscopy to the endoscopic screening options increases uptake. METHODS Invitation letters were sent to 2150 persons above the age of 55 insured with a German medical insurance company in the area of Rinteln, Lower Saxony with a baseline spontaneous annual screening colonoscopy uptake of 1 %. Both capsule or conventional colonoscopy were offered. Interested persons were given information about the two screening options by four local gastroenterologists and examinations were then performed according to screenees' final choice. RESULTS 154 persons sought further information, and 34 and 90 underwent conventional and capsule colonoscopy, respectively. Colonoscopy uptake was thus increased by the invitation process by 60 % (1.6 % vs. 1 %; p = 0.075), while the option of capsule endoscopy led to a fourfold increase of screening uptake (4.2 % vs. 1 %, p < 0.001). Despite similar age distribution in both sex groups, uptake in men was significantly higher (5.6 % vs. 2.8 %, p = 002). However, overall adenoma yield was not different in both groups. CONCLUSIONS The present study suggests that offering the option of capsule colonoscopy increases uptake of endoscopic colorectal cancer screening. However, capsule endoscopy sensitivity for adenoma detection needs to be improved.
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Affiliation(s)
- Stefan Groth
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Regional Hospital, Hamburg, Germany
- Private Gastroenterology Offices Rinteln, BKK 24 Medical Insurance, Obernkirchen, LebensBlicke Foundation for the Prevention of Colon Cancer, Ludwigshafen, Central Research Institute of Ambulatory Health Care, Berlin, Germany
| | - Horst Krause
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Regional Hospital, Hamburg, Germany
- Private Gastroenterology Offices Rinteln, BKK 24 Medical Insurance, Obernkirchen, LebensBlicke Foundation for the Prevention of Colon Cancer, Ludwigshafen, Central Research Institute of Ambulatory Health Care, Berlin, Germany
| | - Rainer Behrendt
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Regional Hospital, Hamburg, Germany
- Private Gastroenterology Offices Rinteln, BKK 24 Medical Insurance, Obernkirchen, LebensBlicke Foundation for the Prevention of Colon Cancer, Ludwigshafen, Central Research Institute of Ambulatory Health Care, Berlin, Germany
| | - Helge Hill
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Regional Hospital, Hamburg, Germany
- Private Gastroenterology Offices Rinteln, BKK 24 Medical Insurance, Obernkirchen, LebensBlicke Foundation for the Prevention of Colon Cancer, Ludwigshafen, Central Research Institute of Ambulatory Health Care, Berlin, Germany
| | - Michael Börner
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Regional Hospital, Hamburg, Germany
- Private Gastroenterology Offices Rinteln, BKK 24 Medical Insurance, Obernkirchen, LebensBlicke Foundation for the Prevention of Colon Cancer, Ludwigshafen, Central Research Institute of Ambulatory Health Care, Berlin, Germany
| | - Murat Bastürk
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Regional Hospital, Hamburg, Germany
- Private Gastroenterology Offices Rinteln, BKK 24 Medical Insurance, Obernkirchen, LebensBlicke Foundation for the Prevention of Colon Cancer, Ludwigshafen, Central Research Institute of Ambulatory Health Care, Berlin, Germany
| | - Nora Plathner
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Regional Hospital, Hamburg, Germany
- Private Gastroenterology Offices Rinteln, BKK 24 Medical Insurance, Obernkirchen, LebensBlicke Foundation for the Prevention of Colon Cancer, Ludwigshafen, Central Research Institute of Ambulatory Health Care, Berlin, Germany
| | - Friedrich Schütte
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Regional Hospital, Hamburg, Germany
- Private Gastroenterology Offices Rinteln, BKK 24 Medical Insurance, Obernkirchen, LebensBlicke Foundation for the Prevention of Colon Cancer, Ludwigshafen, Central Research Institute of Ambulatory Health Care, Berlin, Germany
| | - Ulrich Gauger
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Regional Hospital, Hamburg, Germany
- Private Gastroenterology Offices Rinteln, BKK 24 Medical Insurance, Obernkirchen, LebensBlicke Foundation for the Prevention of Colon Cancer, Ludwigshafen, Central Research Institute of Ambulatory Health Care, Berlin, Germany
| | - Jürgen Ferdinand Riemann
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Regional Hospital, Hamburg, Germany
- Private Gastroenterology Offices Rinteln, BKK 24 Medical Insurance, Obernkirchen, LebensBlicke Foundation for the Prevention of Colon Cancer, Ludwigshafen, Central Research Institute of Ambulatory Health Care, Berlin, Germany
| | - Lutz Altenhofen
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Regional Hospital, Hamburg, Germany
- Private Gastroenterology Offices Rinteln, BKK 24 Medical Insurance, Obernkirchen, LebensBlicke Foundation for the Prevention of Colon Cancer, Ludwigshafen, Central Research Institute of Ambulatory Health Care, Berlin, Germany
| | - Thomas Rösch
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Regional Hospital, Hamburg, Germany
- Private Gastroenterology Offices Rinteln, BKK 24 Medical Insurance, Obernkirchen, LebensBlicke Foundation for the Prevention of Colon Cancer, Ludwigshafen, Central Research Institute of Ambulatory Health Care, Berlin, Germany
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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