The Public's Intended Uptake of Hypothetical Esophageal Adenocarcinoma Screening Scenarios: A Nationwide Survey

Abstract

Introduction: Screening for early esophageal adenocarcinoma (EAC) may potentially reduce EAC-related mortality and morbidity. This study aimed to examine the Dutch population’s intended uptake of three hypothetical EAC screening test scenarios and preferences for potential future organization. Methods: A total of 8350 Dutch individuals aged 45-75 years were invited, of whom 2258 completed a web-based survey. Participants were randomly assigned to one of three hypothetical screening test scenarios (i.e., transnasal endoscopy, ingestible cell-collection device, or breath analysis). The primary outcome was intended uptake. Secondary outcomes included acceptance of screening eligibility criteria and preferences regarding invitation, counseling, and diagnostic follow-up. We performed exploratory univariable and multivariable regression analyses to assess which determinants were associated with EAC screening intent. Results: Intended uptake of screening was highest in the breath analysis scenario (95%), followed by conventional upper endoscopy (78%), an ingestible cell-collection device (75%), and transnasal endoscopy (68%) (p<0.001). Anticipating discomfort was most strongly associated with decreased intention to undergo transnasal endoscopy (OR 0.18, 95% CI 0.11-0.29) or swallow a cell-collection device (OR 0.20, 95% CI 0.13-0.32). Cancer worry and high acceptance of test sensitivity/specificity were consistently associated with a positive intention to participate in screening. Inviting persons for screening based on gastro-esophageal reflux disease (GERD) symptoms, age, or the output of a risk prediction model was acceptable to 74%, 69%, and 66%, respectively. Inviting only men was acceptable for only 41% of women. The majority (58%) preferred to be invited by a public health organization and 32% of the participants preferred to discuss their decision to participate with a health care professional. Conclusion: Participants in this study self-selected through a web-based survey, potentially introducing selection bias. Participants generally intended to participate in EAC screening, although the level of intent depends on the discomfort and performance associated with the offered screening test. Determining eligibility based on GERD symptoms, age, or a risk calculator, but not sex, would be acceptable to most individuals.