Association Between Socioeconomic Status and Participation in Colonoscopy Screening Program in First Degree Relatives of Colorectal Cancer Patients

Pattern of Participation in Colorectal Cancer Screening from a Population-Based Screening Program in Iran

BACKGROUND

In Isfahan, the fecal immunochemical test (FIT) has been used since January 2016 as part of the Iran's Package of Essential Non-communicable Diseases (IraPEN) program for colorectal cancer (CRC) screening. The test is recommended for people who are 50-70 years old. Then, those with positive results would be referred for colonoscopy. This study aims to describe the uptake of the program and its outcome.

METHODS

A retrospective observational study was performed by collecting data from Isfahan Vice-Chancellor for Health database for this study purpose. The number of participators, the number of positive FIT, and the number of detected polyps or cancers were determined.

RESULTS

Between 2016 and 2019, the number of participants in the program reached 345 207 individuals (nearly 40% of the eligible population of 874 674). Totally, 21 264 participants (6.1%) had positive tests, of whom about 20% underwent the recommended colonoscopy with available reports, and 971 (24%) and 110 (3%) patients were diagnosed with polyps and CRC, respectively.

CONCLUSION

Over four years of screening with FIT in Isfahan, 40% of the eligible population participated. Among those with positive FIT results, 20% underwent colonoscopy, and approximately 26% of these individuals were identified as having polyps or cancer. This study provides valuable insights into the uptake and outcomes of a population-based CRC screening program in Isfahan, Iran. The findings highlight the need for targeted interventions to increase participation rates and improve the detection of polyps and CRC cases.

Barriers to colorectal cancer screening in the Eastern Mediterranean Region: a scoping review using the theoretical domains framework

Background

Colorectal cancer screening plays a key role in mitigating morbidity and mortality associated with the disease. Regions such as the Eastern Mediterranean Region experience a particularly large burden of colorectal cancer. While trends have been described at the country level within the region, it is important to understand what barriers exist to colorectal cancer screening, so that more effective interventions can be conceptualized and implemented.

Methods

A scoping review was conducted by applying the Theoretical Domains Framework. The search strategy was conceptualized and implemented by searching two online databases (Scopus and PubMed) that identified papers published between 2000 and 2021 that were available in English and related to colorectal cancer screening in the Eastern Mediterranean Region. Duplicates were removed both automatically by EndNote and manually for those that remained by two members of the research team. Two data collection matrices, constructed according to the Theoretical Domains Framework, were used to extract data on multi-level barriers to screening as perceived by the at-risk population and providers.

Results

Barriers related to colorectal cancer screening were evident at the individual, public, provider, and health system levels. The most noted barriers among both matrices pertained to the domains of knowledge, emotion, environmental context and resources, and beliefs about consequences. At the individual level, knowledge was the most-cited barrier. At the provider and health system levels, knowledge and environmental context and resources were the most-cited barriers, respectively.

Conclusions

In understanding barriers at the individual, provider, and health system levels, more effective interventions can be developed to promote screening and early detection for colorectal cancer.

Colonoscopy Screening Behaviour and Associated Factors Amongst First-Degree Relatives of People with Colorectal Cancer in China: Testing the Health Belief Model Using a Cross-Sectional Design

Colonoscopy is the best screening choice for at-risk persons, because it offers prevention through the removal of preneoplastic lesions in addition to early detection. This study aims to report the participation rate of colonoscopy screening and examine its associated factors amongst Chinese first-degree relatives of people with colorectal cancer based on the health belief model (HBM). A cross-sectional study was conducted in Shenzhen, China from March to May 2019. Demographic characteristics, family history, variables derived from the HBM and colonoscopy screening behaviours were measured through online surveys as the independent variables of interest. A total of 186 online surveys were returned, with a final response rate of 57.0%. The participation rate of colonoscopy was 15.6%. Univariate analysis (independent t-test/chi-square test/Fisher test) was applied first to identify the candidate independent variables. Then, multivariate logistic regression was used to examine the association between independent variables and uptake of colonoscopy. Perceived barriers and cues to action were identified as factors associated with undergoing colonoscopy. The participation rate of colonoscopy in the study population was low. Health communication to promote colonoscopy screening for the Chinese at-risk population should include components in reducing barriers to colonoscopy tests, family history information and health professional recommendations on screening. Future studies with large sample size are suggested to examine perceived susceptibility, fatalism and other characteristics considering family history (treatment and outcome of patients) and their potential impacts on cancer screening behaviours for Chinese at-risk populations due to family history.

Determination of effective factors on geographic distribution of the incidence of colorectal cancer in Tehran using geographically weighted Poisson regression model

Background: This study aimed to determine effective factors on geographic distribution of the Incidence of Colorectal Cancer (CRC) in Tehran, Iran using Geographically Weighted Poisson Regression Model. Methods: This ecological study was carried out at neighborhood level of Tehran in 2017-2018. Data for CRC incidence was extracted from the population-based cancer registry data of Iran. The socioeconomic variables, risk factors and health costs were extracted from the Urban HEART Study in Tehran. Geographically weighted Poisson regression model was used for determination of the association between these variables with CRC incidence. GWR 4, Stata 14 and ArcGIS 10.3 software systems were used for statistical analysis. Results: The total number of incident CRC cases were 2815 in Tehran from 2008 to 2011, of whom, 2491 cases were successfully geocoded to the neighborhood. The median IRR for local variables were : unemployed people over 15 year old (median IRR: 1.17), women aged 17 years or older with university education (median IRR: 1.17), women head of household (median IRR: 1.06), people without insurance coverage (median IRR: 1.10), households without daily consumption of milk (median IRR: 0.85), smoking households (median IRR: 1.07), household's health expenditure (median IRR: 1.39), disease diagnosis costs (median IRR: 1.03), medicines costs of households (median IRR: 1.05), cost of the hospital (median IRR: 1.09), cost of medical visits (median IRR: 1.27). Conclusion: The spatial variability was observed for most socioeconomic variables, risk factors and health costs that had effects on CRC incidence in Tehran. Spatial variability is necessary when interpreting the results and utterly helpful for implementation of prevention programs.