Screening Status as a Determinant of Choice of Colorectal Cancer Screening Method: A Population-Based Informed Survey

Abstract

Objectives: Fecal blood testing is a noninvasive alternative to colonoscopy for colorectal cancer (CRC) screening and is preferred by a substantial proportion of individuals. However, participant-related determinants of the choice of screening method, particularly up-to-date screening status, remain less studied. We aimed to determine if up-to-date screening status was related to choosing a fecal blood test over colonoscopy. Setting: Participants in the population-based cross-sectional survey study Bus Santé in Geneva, Switzerland – aged 50–69 years. Design: Cross-sectional survey study using mailed questionnaires inquiring about CRC screening method of choice after providing information on advantages and disadvantages of both screening methods. We used multivariable logistic regression models to determine the association between up-to-date CRC screening status and choosing fecal blood testing. Key results: We included 1,227 participants. Thirty-eight percent of participants did not have up-to-date CRC screening. Overall, colonoscopy (54.9%) was preferred to fecal blood testing (45.1%) (p < 0.001) as screening method of choice. However, screening method choices differed between those with (65.6% colonoscopy and 34.4% fecal blood testing) and without up-to-date CRC screening (36.5% colonoscopy and 63.5% fecal blood testing). Not having up-to-date CRC screening was associated with a higher probability of choosing fecal blood testing as screening method (odds ratio = 2.6 [1.9; 3.7], p < 0.001) after adjustment for the aforementioned confounders. Conclusions: Not having up-to-date screening was independently associated with fecal blood testing as the preferred method for CRC screening. Proposing this method to this subpopulation, in a context of shared decision, could potentially increase screening uptake in settings where it is already high.

Colorectal Cancer Screening: Have We Addressed Concerns and Needs of the Target Population?

“…In the same study, regardless of the test chosen based on one's preference, up to 80% of those screened were screened with colonoscopy. The two studies by Palmer et al (2010) [47] and Sandoval et al (2021) [48] also showed that individuals who were adherent to CRC screening were more likely to choose colonoscopy as their preferred test, while those who were non-adherent to CRC screening were more likely to choose stool-based tests. Participants with up-to-date screening were more concerned about test accuracy, unlike participants without up-to-date screening who were more concerned about the risks of colonoscopy and its costs [48].…”

“…There are two prominent trends in population preference for CRC screening tests reported in previous studies: people preferred either the most accurate test (visual or structural test: colonoscopy) [29,31,[41][42][43][44][45][46][47][48][49][50][51] or the least invasive one (stool-based test: fecal occult blood test (FOBT) or stool DNA (sDNA) test) [26,28,[52][53][54][55][56][57][58]. While both tests are highly recommended by international guidelines [5][6][7][8], with colonoscopy recommended as the gold standard test and stool-based test (iFOBT or gFOBT) as the standard firstline test for population-based CRC screening, population preference for colonoscopy and stool-based tests, as well as the other available screening techniques, has not been systematically reviewed.…”

“…Colonoscopy was reported as the most preferred test in almost half of the studies regarding this topic that had been selected (13 studies, 4 countries: USA, South Korea, Jordan and Switzerland) [29,31,[41][42][43][44][45][46][47][48][49][50][51]. In these studies, colonoscopy was offered together with either only one other test (FOBT [42,48], CTC [43], or multi-target stool DNA test [31]), or a group of the available tests including stool-based tests [41] (FOBT [29,[44][45][46][47][49][50][51] or sDNA [46,49]), sigmoidoscopy [44,45,47,[49][50][51], CTC [41,44,46], colon capsule [29,44], barium enema [47,[49][50][51] and FOBT plus barium enema [49]. The percentages of individuals selecting colonoscopy as their first-choice test ranged from 41.1% to 80.6% [29,…”

“…In these studies, colonoscopy was offered together with either only one other test (FOBT [42,48], CTC [43], or multi-target stool DNA test [31]), or a group of the available tests including stool-based tests [41] (FOBT [29,[44][45][46][47][49][50][51] or sDNA [46,49]), sigmoidoscopy [44,45,47,[49][50][51], CTC [41,44,46], colon capsule [29,44], barium enema [47,[49][50][51] and FOBT plus barium enema [49]. The percentages of individuals selecting colonoscopy as their first-choice test ranged from 41.1% to 80.6% [29,31,[41][42][43][44][45][46][47][48][49][50][51].…”

« Médecine de ville et essai clinique dans le parcours de soins : aspects organisationnels, réglementaires, outils »

“…Un bus recherche est utilisé à Genève depuis 1992 pour réaliser des études principalement épidémiologiques, telles que l'étude décrite par Sandoval 2021 [6]. Ces unités mobiles de recherche peuvent avoir des équipements et des fonctions variables et permettent de pallier les espaces insuffisants de nombreux cabinets médicaux, apporter du temps pour le médecin généraliste avec une équipe mobile dotée d'un médecin en capacité d'informer les patients, de recueillir leur consentement,…”