Compliance and findings in a Swedish population screened for colorectal cancer with sigmoidoscopy

Blom, Johannes; Lidén, Annika; Jeppsson, Bengt; Holmberg, Lars; Påhlman, Lars

doi:10.1053/ejso.2002.1282

Cited by 18 publications

(17 citation statements)

References 14 publications

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“…13,14 Any difference between the countries in the introduction of screening for colorectal cancer could explain some of the variations detected, but during the study period only smaller clinical trials or pilot projects have taken place in Denmark, 15 Norway, 16 Sweden, 17 and UK, 18 unlikely to affect the present results significantly. However, in the studied years, the effects of surgical training, use of TME, and use of adjuvant radiotherapy and chemotherapy have been widely discussed and potentially heterogeneously taken up in the countries studied.…”

Section: Discussionmentioning

confidence: 84%

Colorectal cancer survival in the Nordic countries and the United Kingdom: Excess mortality risk analysis of 5 year relative period survival in the period 1999 to 2000

Engholm

Kejs

Brewster³

et al. 2007

Intl Journal of Cancer

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A deficit in colorectal cancer survival in Denmark and in the UK compared to Sweden, Norway and Finland was found in the EUROCARE studies. We set out to explore if these differences still exist. Patients diagnosed with colorectal cancer as their first invasive cancer at age 15-89 in the period 1994-2000 were identified using data from 11 cancer registries in the UK and from four Nordic countries. Five-year relative period survival using deaths in 1999-2000 following cancers diagnosed in 1994-2000 was analysed with excess mortality risk modelling. Follow-up time since diagnosis with age as an effect-modifier in the first half year was the most important factor with the highest excess risk of death immediately after diagnosis and with higher age and decreasing with length of follow-up. Variations between countries were bigger in the first half year following diagnosis than in the interval 0.5-5 years with about 30% higher risk in UK and Denmark. The differences between countries are still substantial and the order has not changed, even if the five year relative survival has improved since the EUROCARE studies. Patient management, diagnostics, and comorbidity likely explain the excess deaths in UK and Denmark during the first 6 months. The effect of stage and quality of management and treatment should be examined in population based studies with detailed patient information. Use of more detailed age-intervals than conventionally applied in survival studies proved to be important in statistical modelling and is recommended for future studies. ' 2007 Wiley-Liss, Inc.

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Section: Discussionmentioning

confidence: 84%

Colorectal cancer survival in the Nordic countries and the United Kingdom: Excess mortality risk analysis of 5 year relative period survival in the period 1999 to 2000

Engholm

Kejs

Brewster³

et al. 2007

Intl Journal of Cancer

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“…2,3 Briefly, from the population register, we randomly selected 2,000 men and women 59-61 years of age residing in 2 areas in central and southern Sweden. Thirteen study subjects were excluded because they had moved out of the study areas and one because there was no match in the multiple record linkages owing to an erroneous national registration number (see later).…”

Section: Methodsmentioning

confidence: 99%

Toward understanding nonparticipation in sigmoidoscopy screening for colorectal cancer

Blom

Yin

Lidén

et al. 2008

Intl Journal of Cancer

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Understanding the reasons for nonparticipation in cancer screening may give clues about how to improve compliance. However, limited cooperation has hampered research on nonparticipant profiles. We took advantage of Sweden's comprehensive demographic and health care registers to investigate characteristics of all participants and nonparticipants in a pilot program for colorectal cancer screening with sigmoidoscopy. A population-based sample of 1986 Swedish residents 59-61 years old was invited. Registers provided information on each individual's gender, country of birth, marital status, education, income, hospital contacts, place of residence, distance to screening center and cancer within the family. Odds ratios (ORs) with 95% confidence intervals (CIs), modeled with multivariable logistic regression, estimated the independent associations between each background factor and the propensity for nonparticipation after control for the effects of other factors. All statistical tests were 2-sided. Being male (OR 5 1.27, 95% CI 5 1.03-1.57, relative to female), unmarried or divorced (OR 5 1.69, 95% CI 5 1.23-2.30 and OR 5 1.49, 95% CI 5 1.14-1.95, respectively, relative to married) and having an income in the lowest tertile (OR 5 1.68, 95% CI 5 1.27-2.23, relative to highest tertile) was associated with increased nonparticipation. Living in the countryside or in small communities and having a documented family history of colorectal cancer was associated with better participation. Distance to the screening center did not significantly affect participation, nor did recent hospital care consumption or immigrant status. To increase compliance, invitations must appeal to men, unmarried or divorced people and people with low socioeconomic status. ' 2007 Wiley-Liss, Inc.Key words: mass screening; colorectal neoplasms; sigmoidoscopy; patient participation; registers To be effective on a population level, screening programs have to be widely accepted. To minimize nonparticipation, it is important to understand the reasons for nonattendance and to identify groups that would benefit from extra recruitment efforts. Further, understanding of selection forces is necessary for valid interpretation of the effects of screening.Investigators of nonparticipation, whether in screening, public health campaigns or scientific investigations typically have to resort to interviews or questionnaires. As the motivation among nonparticipants generally is low, such studies are characterized by low response rates and questionable data quality. For example, in a recently published Norwegian study concerning a colorectal cancer screening program, only 11% of the nonparticipants responded to a follow-up questionnaire. 1 To our knowledge, no comprehensive model explaining nonparticipation in cancer screening has yet gained widespread acceptance. The scarcity of unbiased background information among nonparticipants may have contributed to this lack of a firm conceptual basis for the understanding of underlying mechanisms.We took advantage of 8 national ...

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“…The screening study has been described previously (4,5). Briefly, from the population register, we randomly selected 2,000 men and women ages 59 to 61 years residing in two areas in central (Uppsala) and southern (Lund) Sweden.…”

Section: Methodsmentioning

confidence: 99%

“…The other half of the invitees were not told to make an appointment themselves but were called up by a nurse, who made the arrangements. Compliance did not differ significantly between these two modes of invitation (4). All sigmoidoscopies were free of charge for the invitees and performed on an outpatient basis at two hospitals, one in each area.…”

Section: Methodsmentioning

confidence: 99%

A 9-Year Follow-up Study of Participants and Nonparticipants in Sigmoidoscopy Screening: Importance of Self-Selection

Blom

Yin

Lidén

et al. 2008

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background: Self-selection may compromise cost-effectiveness of screening programs. We hypothesized that nonparticipants have generally higher morbidity and mortality than participants. Methods: A Swedish population-based random sample of 1,986 subjects ages 59 to 61 years was invited to sigmoidoscopy screening and followed up for 9 years by means of multiple record linkages to health and population registers. Gender-adjusted cancer incidence rate ratio (IRR) and overall and disease group-specific and mortality rate ratio (MRR) with 95% confidence intervals (95% CI) were estimated for nonparticipants relative to participants. Cancer and mortality rates were also estimated relative to the age-matched, gendermatched, and calendar period-matched Swedish population using standardized incidence ratios and standardized mortality ratios. Results: Thirty-nine percent participated. The incidence of colorectal cancer (IRR, 2.2; 95% CI, 0.8-5.9), other gastrointestinal cancer (IRR, 2.7; 95% CI, 0.6-

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Compliance and findings in a Swedish population screened for colorectal cancer with sigmoidoscopy

Cited by 18 publications

References 14 publications

Colorectal cancer survival in the Nordic countries and the United Kingdom: Excess mortality risk analysis of 5 year relative period survival in the period 1999 to 2000

Colorectal cancer survival in the Nordic countries and the United Kingdom: Excess mortality risk analysis of 5 year relative period survival in the period 1999 to 2000

Toward understanding nonparticipation in sigmoidoscopy screening for colorectal cancer

A 9-Year Follow-up Study of Participants and Nonparticipants in Sigmoidoscopy Screening: Importance of Self-Selection

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