Does the Flemish colorectal cancer screening programme reach equity in FIT uptake?

Abstract

Background To investigate colorectal cancer (CRC) screening rates by the faecal immunochemical test (FIT) according to sociodemographic characteristics and nationality. Methods Men and women, aged 56–74, invited to participate in the Flemish CRC screening programme in 2013 and 2014 were included in this study. We analysed the association between CRC screening uptake and sex, age, (first and current) nationality and several proxies for socio-economic status (SES). The statistical analysis was based on descriptive analyses and logistic regression models. Results A total of 1 184 426 persons were included in our analysis. The overall screening uptake was 52.3%, uptake varied by sex, age, nationality and SES. Lower participation rates were associated with the youngest and oldest age categories (56–60 and 70–74) and being male. All nationalities other than Belgian or Dutch were significantly less screened. Lower uptake of screening was also associated with several proxy’s for low SES, such as having an allowance for being disabled, not being able to work, being an extended minor and having a social allowance/minimum wage. The descriptive analysis showed a 27% difference in CRC screening uptake between the (early) retired and the people entitled to a minimum wage. Conclusions There is a significant difference between screening uptake and demographic and socio-economic variables in the first 2 years of the population-based screening programme in Flanders. Based on the study results, implementing strategies to improve participation in those subgroups is needed.

Population-Based Data Reveal Factors Associated with Organised and Non-Organised Colorectal Cancer Screening: An Important Step towards Improving Coverage

“…Our study found a lower organised FOBT screening coverage in municipalities with a higher percentage of people with non-Belgian/Dutch nationality. The negative association between non-Belgian/Dutch nationality and organised CRC screening has also been shown in a previous Flemish study at the individual level [8]. Two main reasons for FOBT nonparticipation reported by migrants in Flanders are language issues and embarrassment when talking about CRC screening and stool samples [18].…”

“…Less time for sample collection at home has been reported as a reason for individuals not choosing FOBT as their preferred CRC screening method compared to (hypothetical) blood and saliva sampling [22]. A previous Flemish study at the individual level also found negative associations between organised FOBT screening with wage earners and being self-employed [8]. It was not possible to compare our findings regarding the association between employment and FOBT screening with other countries due to different systems of employment classification [15,16,20].…”

“…An interesting result that we found with the use of data at the municipality level is that more men in the screening population were associated with a higher organised screening coverage. This finding seemed counter-intuitive at first sight, since previous studies have shown that women are more likely to participate in CRC screening than men [8,20,23,[29][30][31]. However, a closer data inspection revealed that in Flanders, within a municipality, the screening coverage in women was higher compared to men, but among municipalities, more men in the screening population were associated with a higher screening coverage in both men and women, leading to a higher overall screening coverage.…”

“…Other variables were measured for the total population of a municipality and were used as a proxy for the characteristics of the target CRC screening population. Current nationality combines Belgian and Dutch because language and cultural barriers seem irrelevant for Dutch people (Dutch is the official language in Flanders) [8]. Municipal average income is calculated by the total net taxable income divided by the number of inhabitants.…”

Occurrence and characteristics of faecal immunochemical screen‐detected cancers vs non–screen‐detected cancers: Results from a Flemish colorectal cancer screening programme

“…Participation in FIT screening in Flanders is 52%, which explains why many CRCs are detected outside the screening programme. Non-participation could be due to symptoms, family history, socioeconomic status 25 or a recent CRC diagnosis (possibly fast growing). The CCD information flyer underscores that individuals with symptoms or CRC family history (increased risk for CRC) should seek advice from their general practitioner instead of participating in the FIT screening.…”