An industry based approach to colorectal cancer screening in an asymptomatic population

Abstract

The uptake of faecal occult blood testing in a workplace based colorectal cancer screening programme was investigated. Altogether 1828 employees aged 41-65 years at a large British industrial company were invited to receive a free faecal occult blood test (Haemoccult). Faecal occult blood tests were completed on three separate days. Patients with positive results were invited to undergo colonoscopy. The number of employees completing kits was measured and differences in compliance according to age, sex, and occupation were tested with a x 2 test. Compliance was 25.4%, and similar in men (25.0%) and women (32.0%, x 2 = 3.0, not significant). In men, compliance was highest in those aged 51-60 years (30.5% x 2 .11.6, p,0.001). Compliance in women aged 41-50 years, 51-60 years, and 61-65 years was similar (Yates's corrected x 2 ,2.08, not significant). Managers returned more kits than clerical and blue collar workers (28.6% v 23.5%, x 2 = 5.6, p,0.02). One percent of tests were positive and one patient had a tubular adenoma. Compliance in employees aged 51-60 years was comparable to that achieved in one-off British general practice programmes, but less than that in the large randomised trial of screening in general practices in Nottinghamshire. Health education of large numbers of people is easier at the workplace than in the community. Future screening must target older employees and those with clerical and blue collar jobs.C olorectal cancer is a common cause of death from malignant disease resulting in over 19 000 annual deaths in Britain 1 and 57 000 in the United States. 2 The overall five year survival rate is only 30% 3 but for those with limited disease at presentation (Dukes's type A tumours) it is 85%. 4 In the commonest method of screening, that is, faecal occult blood testing, small stool samples are analysed for microscopic traces of blood from asymptomatic cancers and polyps. Three large studies of faecal occult blood testing showed more early tumours (Dukes's A type tumours) and adenomatous polyps in the screened than control group, [5][6][7] which lead to a reduction in mortality of 15%, 18%, and 33% respectively.The World Health Organisation has stated that one of the criteria necessary for a successful screening programme is a high compliance.8 A major problem in colorectal cancer screening trials is encouraging people to participate. A poor compliance means few people benefit and the economic costs are high. This problem of low compliance was identified in the Nottingham trial where only 60% of the test group completed at least one test, with just 38% returning all the follow up tests at two yearly intervals.5 Unfortunately, compliance is also a problem in other smaller community trials in British general practice, where fewer than 50% of the population participated.9-15 An alternative approach to delivering screening, which may raise compliance, is to develop workplace based screening programmes. On-site health education at the workplace, the availability of occupational medical and nursing staff...

A comparative study of faecal occult blood kits in a colorectal cancer screening program in a cohort of healthy construction workers

“…This was confirmed in three other randomised controlled trials [17][18][19]. Population-based programmes also showed a high FIT uptake rate ranging from 17 to 90.1% [20][21][22], whereas gFOBT uptake rate was in the region of 17.2 to 70.8% [23][24][25][26].…”

Opportunistic Screening of Hospital Staff Using Primary Colonoscopy: Participation, Discomfort and Willingness to Repeat the Procedure

“…This might be due to the overall low participation for any CRC screening method in Israel (10–17%) [33]. Participation rates for other CRC screening methods in workplace-based communities vary between 25 and 62% for FOBT [34,35] and between 31 and 53% for sigmoidoscopy [36,37]. …”

Implementation and Process Evaluation of a Workplace Colorectal Cancer Screening Program in Eastern Washington

“…For example, previous interventions have used small media to disseminate information and raise employee awareness of CRC screening. Various small media formats have been used and tested, including letters, pamphlets (Cornfeld et al, 2002; Hart, Eaden, Barnett, de Bono, & Mayberry, 1998; Hart, Glover, Howick-Baker, & Mayberry, 2003; Myers et al, 1997; Tilley et al, 1999), flyers (Hart et al, 2003; Tilley et al, 1999), and newsletters (Tilley et al, 1999). Other interventions have reminded clients to obtain CRC screening through personalized letters mailed to employees’ homes or sent through employers (Cornfeld et al, 2002; Tilley et al, 1999).…”

“…Other interventions have reminded clients to obtain CRC screening through personalized letters mailed to employees’ homes or sent through employers (Cornfeld et al, 2002; Tilley et al, 1999). Previous interventions have also reduced structural barriers, such as location, timing, and convenience, to encourage CRC screening among employees; these interventions allowed screening during work hours or at the worksite, or sent FOBT kits to employees’ homes on request (Hart et al, 1998; Hart et al, 2003; Tilley et al, 1999).…”

“…Additional strategies show potential but more research is needed to demonstrate their effectiveness. For example, reducing out-of-pocket costs effectively increases breast cancer screening, and although some studies have adapted this strategy to promote CRC screening as well (Hart et al, 1998; Hart et al, 2003; Menon et al, 2003; Myers et al, 1997; Tilley et al, 1999), additional research on the strategy is needed (Baron, Rimer, Coates, et al, 2008). Group education is another promising intervention strategy to inform and motivate individuals to screen, and some worksite interventions have used it to increase awareness of CRC screening and encourage employees to consult with their physicians (Greenwald, 2006).…”