Acceptability of alternative technologies compared with faecal immunochemical test and/or colonoscopy in colorectal cancer screening: A systematic review

Abstract

Objective Colorectal cancer (CRC) is the third most common cancer and the second largest cause of cancer-related death worldwide. Current CRC screening in various countries involves stool-based faecal immunochemical testing (FIT) and/or colonoscopy, yet public uptake remains sub-optimal. This review assessed the literature regarding acceptability of alternative CRC screening modalities compared to standard care in average-risk adults. Method Systematic searches of MEDLINE, EMBASE, CINAHL, Cochrane and Web of Science were conducted up to February 3rd, 2022. The alternative interventions examined were computed tomography colonography, flexible sigmoidoscopy, colon capsule endoscopy and blood-based biomarkers. Outcomes for acceptability were uptake, discomfort associated with bowel preparation, discomfort associated with screening procedure, screening preferences and willingness to repeat screening method. A narrative data synthesis was conducted. Results Twenty-one studies met the inclusion criteria. Differences between intervention and comparison modalities in uptake did not reach statistical significance in most of the included studies. The findings do suggest FIT as being more acceptable as a screening modality than flexible sigmoidoscopy. There were no consistent significant differences in bowel preparation discomfort, screening procedure discomfort, screening preference and willingness to repeat screening between the standard care and alternative modalities. Conclusion Current evidence comparing standard colonoscopy and stool-based CRC screening with novel modalities does not demonstrate any clear difference in acceptability. Due to the small number of studies available and included in each screening comparison and lack of observed differences, further research is needed to explore factors influencing acceptability of alternative CRC modalities that might result in improvement in population uptake within different contexts.

Perceptions of the Impact of Comorbidity on the Bowel Cancer Screening Programme: Qualitative Study With Bowel Screening Participants and Staff

“…Low levels of screening participant tolerance for bowel preparation led to suggestions for alternate methods of screening, such as blood tests. Research into alternative technologies for screening, such as multicancer early detection tests [ 24 , 25 ] and the acceptability of new technologies for bowel cancer (including blood tests and pill‐cameras) [ 26 ] is ongoing elsewhere. These research areas should ensure the representation of people with a variety of health conditions.…”

Advancing Colorectal Cancer Detection With Blood-Based Tests: Qualitative Study and Discrete Choice Experiment to Elicit Population Preferences

“…Aside from the financial aspect, the other downsides of screening, such as patient anxiety and lead-time bias, will all need to be considered seriously. Most of the existing studies examining the attitude and preference for blood-based CRC tests were conducted in Western societies [ 26 , 27 ]. Preference of the technology in Asia is understudied.…”

“…Such profiling efforts can inform the crafting of targeted screening programs to cater to the heterogeneous preferences across different groups. Fourth, many preference studies were done in Western countries and very few were done in Asia [ 26 , 27 ]. Cultural and social norms could influence decision-making and outcomes.…”

Colorectal Cancer: Epidemiology, Risk Factors, and Prevention

“…A recent randomized, controlled trial also reported significant effects of colonoscopy examination in reducing CRC risk (RR = 0.69) and mortality (RR = 0.50) [219]. Colonoscopy may be considered as the only CRC screening modality for specific (high-risk) populations or may be used in combination with other non-invasive modalities in general (average-risk) populations [220][221][222].…”