Improving compliance to colorectal cancer screening using blood and stool based tests in patients refusing screening colonoscopy in Germany

Abstract

BackgroundDespite strong recommendations for colorectal cancer (CRC) screening, participation rates are low. Understanding factors that affect screening choices is essential to developing future screening strategies. Therefore, this study assessed patient willingness to use non-invasive stool or blood based screening tests after refusing colonoscopy.MethodsParticipants were recruited during regular consultations. Demographic, health, psychological and socioeconomic factors were recorded. All subjects were advised to undergo screening by colonoscopy. Subjects who refused colonoscopy were offered a choice of non-invasive tests. Subjects who selected stool testing received a collection kit and instructions; subjects who selected plasma testing had a blood draw during the office visit. Stool samples were tested with the Hb/Hp Complex Elisa test, and blood samples were tested with the Epi proColon® 2.0 test. Patients who were positive for either were advised to have a diagnostic colonoscopy.Results63 of 172 subjects were compliant to screening colonoscopy (37%). 106 of the 109 subjects who refused colonoscopy accepted an alternative non-invasive method (97%). 90 selected the Septin9 blood test (83%), 16 selected a stool test (15%) and 3 refused any test (3%). Reasons for blood test preference included convenience of an office draw, overall convenience and less time consuming procedure.Conclusions97% of subjects refusing colonoscopy accepted a non-invasive screening test of which 83% chose the Septin9 blood test. The observation that participation can be increased by offering non-invasive tests, and that a blood test is the preferred option should be validated in a prospective trial in the screening setting.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-230X-14-183) contains supplementary material, which is available to authorized users.

Development and Clinical Validation of a Blood Test Based on 29-Gene Expression for Early Detection of Colorectal Cancer

“…Another study reported that of 172 age-eligible individuals who were indicated for colorectal cancer screening by colonoscopy, 63% refused the procedure, whereas 97% of those who refused colonoscopy agreed to be screened by a less invasive test such as a blood test (83%) or a stool test (17%; ref. 10). It is therefore reasonable to expect that a blood test can help convincing average-risk individuals to be tested for colorectal cancer, and in the long term to contribute to reduction of colorectal cancerrelated mortality.…”

“…There is therefore an unmet need for an effective and routine test for asymptomatic average-risk individuals. A blood-based test is highly attractive due to its minimal invasiveness, convenience, and high acceptance by individuals at average risk (9)(10)(11).…”

Screening for Colorectal Cancer Based on the Promoter Methylation Status of the Septin 9 Gene in Plasma Cell Free DNA

“…Blood based testing using the SEPT9 promoter methylation test provides a viable option as reported in two independent trials. In a test choice trial in Germany, 83% of patients who refused a screening colonoscopy chose to be screened with the blood test, and 15% opted for a stool test, for a combined 98% coverage by non-invasive testing [39]. Furthermore in the randomized ADMIT trial in the US described above, 99.5% of patients who had previously not completed screening after at least two recommendations, proceeded to be screened with the blood test [37].…”

Compliance to company based colorectal cancer screening in Germany using fecal immunochemical test (FIT) - Results of Almost Half a Million FIT tests

“…Various studies have found that participation in fecal immunochemical testing is higher than in colonoscopy procedures, which could improve the overall diagnostic yield beyond the mere sensitivity and specificity of the test (9,10,21). The objectives of this study are:…”

“…Adler et al (2014) reported that of the 63% who refused colonoscopy, 97% accepted an alternative non-invasive screening method (FOBT) or a minimally invasive technique (blood test) (9). This refers to both men and women.…”