Gender, having a positive FIT and type of hospital are important factors for colonoscopy experience in colorectal cancer screening – findings from the SCREESCO study

Abstract

Objectives: Assessing the experience of screening procedures is crucial for improving the quality and acceptance of colonoscopy in colorectal cancer screening. The aim of the study was to investigate the colonoscopy experience and associated factors among individuals who underwent a colonoscopy in the Screening of Swedish Colons (SCREESCO) study. Methods: Participants in the Screening of Swedish Colons (SCREESCO; n ¼ 7593) randomized clinical trial (colonoscopy vs. faecal immunochemical test (FIT)) were enrolled. The primary outcome was overall colonoscopy experience measured with a study-specific questionnaire. Secondary endpoints were measured using multiple regression analyses with factors that included sex, randomization group, geographical regions, university hospital, complications, sedation, clean bowel, time to cecum, and presence of polyps or cancer. Results: A total of 6572 (87%) individuals responded to the questionnaire. The majority was satisfied with the information, care and treatment. Women reported more worry, discomfort and pain, but also better information, care and treatment compared with men. The FIT group was more worried and perceived more discomfort and pain than the colonoscopy group. Type of hospital (geographical region; university hospital vs. not university hospital) was also a significant predictor for the colonoscopy experience. Conclusions: Although most participants were satisfied with the colonoscopy experience, the study has highlighted areas for improvement. Important factors for colonoscopy experience were gender, randomization group, and type of hospital and therefore crucial to bear in mind when designing screening programs.

Colorectal cancer screening with fecal immunochemical testing or primary colonoscopy: An analysis of health equity based on a randomised trial

“… 2 , 20 Possible explanations may be that FIT participation is influenced by traditional gender roles in health, while women's embarrassment and worry for pain are more strongly linked to the invasive characteristics of colonoscopy. 2 , 21 Among the test attendees in the FIT × 2 arm, the proportion of test positives was higher among men than among women; this is probably related to biological factors rather than psychosocial/cultural factors. 5 , 20 …”

Gender-specific cut-off levels in colorectal cancer screening with fecal immunochemical test: A population-based study of colonoscopy findings and costs

“…Apart from the risk of complications, a positive FIT with a negative follow-up screening colonoscopy could be associated with emotional distress due to the false positive test-more frequent among women-sometimes persisting for a long time after a negative colonoscopy. 40,41 Other studies, however, have shown an improved quality of life after screening colonoscopy regardless of the colonoscopy findings. 42 For detection of the 28 CRCs in women with FIT 40-79 mg/g of which 15 were stages I and II and 8 were stages III and IV, the estimated costs were 16% higher compared to the cost using gender-equal cut-off levels.…”

Expectations for and challenges in population‐based endoscopic gastric and colorectal cancer screening

“…It may be difficult to apply U.S. methods to Japan due to differences in health insurance systems and other factors; however, Japan should consider introducing TCS during screening. Five randomized controlled trials assessing the effects of TCS in colorectal cancer screening on reducing mortality are currently in progress 7–11 . The Akita pop‐colon trial randomly assigned participants to an initial TCS intervention or a non‐intervention group 8 .…”

“…Five randomized controlled trials assessing the effects of TCS in colorectal cancer screening on reducing mortality are currently in progress. [7][8][9][10][11] The Akita pop-colon trial randomly assigned participants to an initial TCS intervention or a non-intervention group. 8 Although the primary endpoint of this study is colorectal cancer death, it is expected to produce valuable findings regarding population-based TCS screening, including differences between groups in colorectal cancer stage, the incidence of complications, and clinicopathological features of the discovered lesions.…”