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Patterns of uptake in a biennial faecal occult blood test screening programme for colorectal cancer
Author(s) -
Steele R. J. C.,
McClements P. L.,
Libby G.,
Carey F. A.,
Fraser C. G.
Publication year - 2014
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.12393
Subject(s) - medicine , occult , colorectal cancer , cancer screening , cancer , colorectal cancer screening , population , gastroenterology , oncology , pathology , colonoscopy , alternative medicine , environmental health
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.