Changes in colorectal cancer screening use after introduction of alternative screening offer in Germany: Prospective cohort study

Abstract

In October 2002, screening colonoscopy was added to the German colorectal cancer (CRC) screening program as an alternative to fecal occult blood test (FOBT). We aimed to evaluate the change in CRC screening use after introduction of the dual screening offer and to assess determinants of screening use. Data were drawn from a population‐based cohort study initiated during 2000–2002 in Germany (n = 5,845, age range at recruitment: 50–75 years). We conducted both cross‐sectional and longitudinal analyses to obtain uptake rates of CRC screening based on four waves of data. Age‐group specific proportions of participants having had FOBT within 2 years remained essentially unchanged at 61–67% between 2000 and 2002 (1st wave) and 2005–2007 (3rd wave). The proportions of participants having undergone screening colonoscopy within 10 years increased from 23–29% to 46–57%, leading to a substantial overall increase in being up‐to‐date with CRC screening from 66–68% to 77–80%. In 2008–2010 (4th wave), FOBT use declined and colonoscopy use continued to increase. Obesity was significantly associated with lower prevalence of being up‐to‐date with FOBT (odds ratio [OR] at 8‐year follow‐up 0.68; 95% confidence interval [CI], 0.58–0.80) and screening colonoscopy (OR, 0.73; 95% CI, 0.62–0.86). Also, smokers were less likely to have ever used FOBT (OR, 0.54; 95% CI, 0.40–0.75) or colonoscopy (OR, 0.75; 95% CI, 0.63–0.90) compared to nonsmokers. After the introduction of dual screening offer, the overall adherence to CRC screening steeply increased, mainly due to an increase in screening colonoscopy uptake. Screening tests kept being underused by obese people and smokers who are at elevated CRC risk.

<p>The Association Between Inflammation, Epithelial Mesenchymal Transition and Stemness in Colorectal Carcinoma</p>

“…43 These data likely reflect the overall increased proportion of advanced cancer cases in the population, paralleling the reported low compliance (only 9.6% in 2013) with the population-based colorectal cancer screening in Latvia. 44 In other European countries, the participation rates in screening programs for colorectal cancer range from 77 to 80% in Germany, 45 68.2% in the Netherlands, 19.9% in Croatia and 22.7% in the Czech Republic. The acceptable minimum participation rate is 45% but the desired target is more than 65%, thus screening in our population cannot be considered efficient.…”

Effects of Screening for Colorectal Cancer: Development and Validation of a Multistate Markov Model

“…We extracted the CRC incidence rates for the years 2001, 2006, 2011, and 2016, i.e. one year before the introduction of the population-based colonoscopy screening offer in Germany in 2002, and then in steps of five years to allow for detecting effects of the successive uptake of the colonoscopy screening offer (Supplementary Table 1) [28].…”

“…For comparison, we derived corresponding estimates for modelled populations of each 100,000 German men and women with levels of 2% and 6% annual colonoscopy use. These utilization levels were chosen as the estimated use of colonoscopy for any reason within 10 years in Germany was 24.3% and 63.9% for the periods 2000-2002 and 2008-2010, respectively, reflecting the increase triggered by the introduction of the colonoscopy screening offer in 2002 [28].…”

“…a selective population without or only negative prior fecal testing or (diagnostic) colonoscopy, we discounted adenoma and preclinical cancer prevalences at model start by 30%. This was considered reasonable in order to increase comparability to the German general population given that, already in the period 2000-2002, approximately 66% of 55-59 year-olds had either fecal testing within two years or colonoscopy within ten years [28].…”

“…Model-derived incidences for 55-69 and 60-74-year-olds tended to slightly overestimate the registry-derived incidences. A likely explanation is that we assumed constant annual utilization patterns over time for the sake of simplicity, which does not consider that, in the period 2000-2002, older age groups were more likely to make use of colonoscopy than younger ones [28]. Furthermore, a certain degree of deviation was to be expected given the complexity of CRC epidemiology and CRC screening, and considering that the analyses were based on aggregated data.…”