Agreement between self-reported and registered colorectal cancer screening: a meta-analysis

Abstract

This random-effects meta-analysis investigates the accuracy of self-reported colorectal cancer screening history as a function of screening mode (colonoscopy, flexible sigmoidoscopy, faecal occult blood testing - FOBT, double-contrast barium enema - DCBE) and survey mode (written, telephone, face-to-face). Summary estimates of sensitivity, specificity, positive predictive value (PPV) and area under the receiver operating characteristic curve (AUC) were calculated. Medical record data were used as reference. We included 23 studies comprising 11,592 subjects. Colonoscopy yielded higher AUC [0.948, 95% confidence interval (CI) = 0.918, 0.968] than flexible sigmoidoscopy (0.883, 95% CI = 0.849, 0.911) and FOBT (0.869, 95% CI = 0.833, 0.898). Colonoscopy showed the highest sensitivity (0.888, 95% CI = 0.835, 0.931), whereas specificity was comparable between screening modes (ranging from 0.802 for FOBT to 0.904 for DCBE). AUC was not significantly different between survey modes. Prevalence of screening history correlated positively with sensitivity and negatively with specificity, possibly because of errors in the medical records. In conclusion, the accuracy of self-reported cancer screening is generally moderate, and higher for colonoscopy than for sigmoidoscopy and FOBT.

Testing the effectiveness of a general practice intervention to improve uptake of colorectal cancer screening: a randomised controlled trial

“…Self‐report of CRC screening was used to determine CRC screening for the usual care group. While this is not considered gold‐standard, a meta‐analysis found high levels of agreement between self‐report and medical records 36 . The effectiveness of our intervention may have been increased with a longer follow‐up time point.…”

Geographic and population-level disparities in colorectal cancer testing: A multilevel analysis of Medicaid and commercial claims data

“…General limitations of analyses using claims data include: limited ability to assess patient-provider decision making, incomplete timeframes needed to validate some CRC testing modalities (e.g., colonoscopy) to determine up-to-date screening status, potential for under-ascertainment of low-cost tests such as FOBT, and inability to understand screening patterns in uninsured and non-continuously enrolled populations (Schenck et al, 2007; Schenck et al, 2008). However, use of claims data overcomes many of the challenges related to patient recall and social desirability bias in self-reported data (Dodou and de Winter, 2015; Bradbury et al, 2005). Second, our analysis was limited to those who turned 50 during the observation period and met stringent inclusion criteria.…”

“…The National Institutes of Health (NIH) recently cited a need for more population data sources for measurement of CRC testing, particularly for the medically underserved (Steinwachs et al, 2010; Gupta et al, 2013a). In contrast to patient self-reported cancer screening practices, which may be unreliable or inaccurate due to recall bias and social desirability bias, claims data can provide an objective assessment of cancer screening behaviors in a specific population (Schenck et al, 2007; Dodou and de Winter, 2015; Bradbury et al, 2005). …”

Prevalence of appropriate colorectal cancer screening and preferences for receiving screening advice among people attending outpatient clinics

“…Self-reported screening may be affected by recall bias, however, a recent meta-analysis of the accuracy of self-report of FOBT and colonoscopy compared to medical records found good to excellent accuracy of selfreport (area under the curve 0.87 and 0.95 respectively). 36 The sample representativeness may be limited as participants were recruited from one regional hospital. Self-reported sigmoidoscopy data was not collected, however, due to the low rates of sigmoidoscopy found in previous Australian research (<1%), 12,37 it is unlikely that this would affect our results.…”