A demonstration pilot trial for colorectal cancer screening in the United Kingdom: a new concept in the introduction of healthcare strategies

Steele, Robert; Parker, R.; Patnick, Julietta; Warner, Jon; Fraser, Callum G.; Mowat, N. A. G.; Wilson, J. A.; Alexander, Freda E.; Paterson, James H.

doi:10.1136/jms.8.4.197

Cited by 56 publications

(40 citation statements)

References 24 publications

(22 reference statements)

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“…6 The proof of efficacy, in an experimental setting, must be confirmed by the assessment of effectiveness in a public health setting. 25 A major concern for the reduction in effectiveness of screening programmes is low levels of compliance. 25,26 The characteristics of the available tests for CRC screening, in the opinion of several authors, can reduce compliance, and the choice of the primary screening test must take into consideration the population compliance to dietary restrictions.…”

Section: Discussionmentioning

confidence: 99%

“…25 A major concern for the reduction in effectiveness of screening programmes is low levels of compliance. 25,26 The characteristics of the available tests for CRC screening, in the opinion of several authors, can reduce compliance, and the choice of the primary screening test must take into consideration the population compliance to dietary restrictions. 10 Our study design allowed us to demonstrate that the type of FOBT determines compliance, and consequently this information should be taken into account in the planning of screening programmes.…”

Section: Discussionmentioning

confidence: 99%

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The immunochemical faecal occult blood test leads to higher compliance than the guaiac for colorectal cancer screening programmes: a cluster randomized controlled trial

et al. 2005

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Introduction: We conducted a cluster-randomized trial aimed at assessing the effect of the type of faecal occult blood, guaiac or immunochemical test on screening compliance. Methods: We sampled 130 general practitioners (GPs) who consented to participate in the trial. We randomly allocated half of them to the guaiac (Hemo-Fec) and half to the immunochemical test (OCHemodia). We sampled 2/10 of the GPs' 50 -75-year-old patients (n ¼ 7332) and randomly divided this population into half. One half was invited to be screened at the GP's office and the other to the nearest gastroenterology ward. The principal outcome was the percentage of returned tests. Results: The immunochemical test had a compliance of 35.8% and the guaiac of 30.4% (relative risk [RR] 1.20; 95% confidence interval [CI] 1.02-1.44). The difference was mostly due to a higher probability of returning the sample: 93.8% and 88.6% for immunochemical and guaiac, respectively (RR 1.06; 95% CI 1.02-1.10). The guaiac test had a higher prevalence of positives (10.3% versus 6.3%, RR 0.603; 95% CI 0.433-0.837). There was a higher variability in the results obtained with the guaiac test compared with the immunochemical (F[1, 12] ¼ 16.25; P ¼ 0.0017). Conclusions: Compliance is more likely with the immunochemical than the guaiac test, independent of the provider. Guaiac tests show a higher variability of the results among centres. The successful implementation of a screening programme requires a period of standardization of the test reading in order to avoid unexpected work overload for colonscopy services.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The immunochemical faecal occult blood test leads to higher compliance than the guaiac for colorectal cancer screening programmes: a cluster randomized controlled trial

et al. 2005

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“…5 In response to the research evidence, the United Kingdom Departments of Health commissioned a demonstration pilot to test the feasibility of introducing a screening programme into the National Health Service. 6 This pilot was carried out in two areas, one in Scotland and one in England, 7 and the results were used to inform the introduction of national screening programmes throughout the United Kingdom. 8,9 In Scotland the pilot consisted of three biennial rounds of screening carried out between 2000 and 2006.…”

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confidence: 99%

Effect of Gender, Age and Deprivation on Key Performance Indicators in a Fobt-based Colorectal Screening Programme

et al. 2010

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a demonstration pilot of biennial guaiac faecal occult blood test (gFOBT) colorectal screening was carried out in North-East Scotland for all individuals aged 50 -69 years. Methods The relevant populations were subdivided, by gender, into four age groups and into five deprivation categories according to the Scottish Index of Multiple Deprivation (SIMD), and key performance indicators analysed within these groups. Results In all rounds, uptake of the gFOBT increased with age (P , 0.001), decreased with increasing deprivation in both genders (P , 0.001), and was consistently higher in women than in men in all age and all SIMD groups. In addition, increasing deprivation was negatively associated with uptake of colonoscopy in men with a positive gFOBT (P , 0.001) although this effect was not observed in women. Positivity rates increased with age (P , 0.001) and increasing deprivation (P , 0.001) in both genders in all rounds, although they were higher in men than in women for all age and SIMD categories. Cancer detection rates increased with age (P , 0.001), were higher in men than in women in all age and SIMD categories, but were not consistently related to deprivation. In both genders, the positive predictive value (PPV) for cancer increased with age (P , 0.001) and decreased with increasing deprivation (P , 0.001) in all rounds and was consistently higher in men than in women in all age and SIMD categories. Conclusions In this population-based colorectal screening programme gender, age, and deprivation had marked effects on key performance indicators, and this has implications both for the evaluation of screening programmes and for strategies designed to reduce inequalities.

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“…This is also obvious in British National Polyp Study from 1993, which showed 90 % decline of CC incidence in a group of 1500 patients who underwent polypectomy and were followed up for 6-8 years [5] . There are different problems regarding colorectal screening in old age: (1) The problem of performing screening or not seems that consensus was reached that different panel group and association have agreed that the answer was YES [7][8][9][10][11][12][13][14][15]17] ; (2) Recently there were more references that supported colonoscopy as a choice [11,12,16,17] ; (3) Are there any age limits for the colorectal screening procedure? There were two opposed opinions: No limits, or regarding biological age, and individual limit as consequence of the personal expected survival, on average, 75 to 80 y [19] ; (4) What about national programs, accepted by the national authority supported by health funds?…”

Section: Discussionmentioning

confidence: 99%

Problems in screening colorectal cancer in the elderly

Davidović¹

2003

WJG

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AIM:To explore the problems in the screening of colorectal carcinoma in the elderly. METHODS:Three models of colorectal cancer prevention were examined: standard screening, active check-up of suspected cases and summons to have endoscopic checkup for previously diagnosed colorectal polyps. The study was performed among three groups of elderly individuals: Group 1 (167 cases), hospitalized asymptomatic individuals without symptoms in large intestines. Group 2 (612 cases): old individuals at home for the aged, out of which 32 showed symptoms of colon disorders; Group 3 (44 cases): elderly people with diagnosed polyps. As a result of 1788 rectosigmoidoscopies, we identified 61 individuals with polyps, out of which 44 patients were over 65 years old. However, only 9 of these 44 individuals agreed to have the endoscopy performed again.

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A demonstration pilot trial for colorectal cancer screening in the United Kingdom: a new concept in the introduction of healthcare strategies

Cited by 56 publications

References 24 publications

The immunochemical faecal occult blood test leads to higher compliance than the guaiac for colorectal cancer screening programmes: a cluster randomized controlled trial

The immunochemical faecal occult blood test leads to higher compliance than the guaiac for colorectal cancer screening programmes: a cluster randomized controlled trial

Effect of Gender, Age and Deprivation on Key Performance Indicators in a Fobt-based Colorectal Screening Programme

Problems in screening colorectal cancer in the elderly

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