Factors related to longitudinal adherence in colorectal cancer screening:qualitative research findings

Background: The effectiveness of screening in colorectal cancer prevention depends on sustained participation rates. The objective of this study was to explore factors related to the longitudinal adherence of screening behavior in the context of a biennial population-based cancer screening program. Methods: Eight focus groups were conducted with individuals who were invited two or three consecutive times to a population-based colorectal cancer screening program using a fecal occult blood test and who agreed to participate in the program at least once (n = 45). The criteria used to select the study members included adherence to fecal occult blood test maintenance, factors regarding their initial participation in the colorectal cancer screening, sex, and contextual educational level. Results: The participants expressed a high level of satisfaction with the program; however, they showed a low level of understanding with respect to cancer screening. Consulting a general practitioner was cited by all participants as an important factor that mediated their final decision or influenced their behavior as a whole with regard to the program. Fear played a different role in the screening behavior for regular and irregular adherent participants. In the adherent participants, fear facilitated their continued participation in the screening program, whereas for the irregular participants, fear led them to avoid or refuse further screening. Having a close person diagnosed with colorectal cancer was a facilitator for the regular adherent participants. The irregular adherent participants showed some relaxation with respect to screening after a negative result and considered that further screening was no longer necessary. Conclusion: Considering the importance of primary healthcare professionals in the decision regarding sustained participation, it is important to better engage them with cancer screening programs, as well as improve the communication channels to provide accurate and balanced information for both health professionals and individuals.</p

Impact of organised programs on colorectal cancer screening

<p>Abstract</p> <p>Purpose</p> <p>Colorectal cancer (CRC) screening has been shown to decrease CRC mortality. Organised mass screening programs are being implemented in France. Its perception in the general population and by general practitioners is not well known.</p> <p>Methods</p> <p>Two nationwide observational telephone surveys were conducted in early 2005. First among a representative sample of subjects living in France and aged between 50 and 74 years that covered both geographical departments with and without implemented screening services. Second among General Practionners (Gps). Descriptive and multiple logistic regression was carried out.</p> <p>Results</p> <p>Twenty-five percent of the persons(N = 1509) reported having undergone at least one CRC screening, 18% of the 600 interviewed GPs reported recommending a screening test for CRC systematically to their patients aged 50–74 years. The odds ratio (OR) of having undergone a screening test using FOBT was 3.91 (95% CI: 2.49–6.16) for those living in organised departments (referent group living in departments without organised screening), almost twice as high as impact educational level (OR = 2.03; 95% CI: 1.19–3.47).</p> <p>Conclusion</p> <p>CRC screening is improved in geographical departments where it is organised by health authorities. In France, an organised screening programs decrease inequalities for CRC screening.</p

Trends in screening for prostate cancer

1542 Background: Screening for prostate cancer is still in debate. In France, there is no financial barrier for individuals to be screened with the prostate-specific antigen (PSA) test, and there is no recommendation for mass screening. Methods: Two nationwide observational studies were carried out in France. The first one, EDIFICE 1, was conducted in 2005 among a representative sample of 1504 subjects aged between 40 and 75 years and a representative sample of 600 general practitioners (GPs). The second one, EDIFICE 2, was conducted in 2008 with the same methodology. Results: General population: In 2005, 36% of the interviewed male population aged between 50 and 75 years declared having undergone a screening test, compared to 49% in 2008 (OR = 1.63 CI95% 1.25; 2.12). Prostate cancer screening increased in all age groups, however, the most significant increase can be observed in the population aged between 50 and 54 years: 18% in 2005 versus 35% in 2008 (OR = 2.43 CI95% 1.31; 4.52). This trend for increasing testing will probably be confirmed in the future since 57% of males never screened plan to undergo a test, and only 16% of those who did screening plan to stop. The expected participation in the future will be close to 70%. Physicians: In 2005, 58% of GPs systematically recommended prostate cancer screening for their male consultants ages 50 to 74, in 2008 the figure is 65% (OR = 1.32 CI95%1.04; 1.66). For prostate cancer screening, a GP's gender has no significant impact. Systematic recommendation for both breast and colorectal cancer screening has an impact on recommending prostate cancer screening as well; OR = 2.9 (CI95% 2.0–4.4) and OR = 2.0 (CI95% 1.3–3.2) respectively. The GP's age is not associated with a higher rate of systematic recommendation. Conclusions: We have observed in France a significant growth in prostate cancer screening: more persons screened, more often, at a younger age. Despite the lack of consistent evidence, persons and GPs exposed to mass communication and campaign for breast and colorectal cancer screening might infer that screening is valuable for other conditions. No significant financial relationships to disclose. </jats:p

Trends in screening for colorectal cancer in France

1538 Background: In France, after a pilot population-based screening program in 23 districts (2002–2003), a national organized program was progressively implemented starting in 2005. The EDIFICE 2 survey was conducted in 2008, 3 years after EDIFICE 1, to provide a better understanding of French people's participation in colorectal screening programs and to assess the evolution between the two periods. Methods: This second nationwide observational study, EDIFICE 2, was conducted in January 2008 among a representative sample of 1,801 subjects aged between 40 and 85 years old. The analysis focused on the target population of the national screening program (50–74 years old). Results: In 2008, 38% of subjects between 50 and 74 years (N = 928) had undergone a screening test for colorectal cancer (including fecal test or colonoscopy) versus 25% in 2005 (p &lt; 0.05); 32% of the unscreened population (N = 575) planned to undergo a test. Colorectal cancer screening increased significantly in all age groups, especially between 65 and 69 years, and for both sexes. A most significant increase can be observed in districts with pilot programme (+ 21%). Factors influencing the probability of screening were: being encouraged by the family circle, living in a couple, the existence of a case of cancer (especially colorectal cancer) in the family circle, and fear of colorectal cancer. The main reasons for not performing the screening were: not feeling concerned, no recommendation by the GP, carelessness, no symptoms, and fear of exams or results. Conclusions: The objective rate of participation (50%), can be reached by motivating the unscreened population already planning to perform a test. The results in the pilot districts show the effectiveness of an organization of the screening. This trend of increasing testing will probably be confirmed in the future if the reasons for non-attendance in an organized program are addressed. No significant financial relationships to disclose. </jats:p