Effect of Gender, Age and Deprivation on Key Performance Indicators in a Fobt-based Colorectal Screening Programme

Abstract

a demonstration pilot of biennial guaiac faecal occult blood test (gFOBT) colorectal screening was carried out in North-East Scotland for all individuals aged 50 -69 years. Methods The relevant populations were subdivided, by gender, into four age groups and into five deprivation categories according to the Scottish Index of Multiple Deprivation (SIMD), and key performance indicators analysed within these groups. Results In all rounds, uptake of the gFOBT increased with age (P , 0.001), decreased with increasing deprivation in both genders (P , 0.001), and was consistently higher in women than in men in all age and all SIMD groups. In addition, increasing deprivation was negatively associated with uptake of colonoscopy in men with a positive gFOBT (P , 0.001) although this effect was not observed in women. Positivity rates increased with age (P , 0.001) and increasing deprivation (P , 0.001) in both genders in all rounds, although they were higher in men than in women for all age and SIMD categories. Cancer detection rates increased with age (P , 0.001), were higher in men than in women in all age and SIMD categories, but were not consistently related to deprivation. In both genders, the positive predictive value (PPV) for cancer increased with age (P , 0.001) and decreased with increasing deprivation (P , 0.001) in all rounds and was consistently higher in men than in women in all age and SIMD categories. Conclusions In this population-based colorectal screening programme gender, age, and deprivation had marked effects on key performance indicators, and this has implications both for the evaluation of screening programmes and for strategies designed to reduce inequalities.

The effect of information about false negative and false positive rates on people's attitudes towards colorectal cancer screening using faecal occult blood testing (FOBt)

“…Completion rates of a second FOBt following a false positive has been recorded at 69.6% [56] which is below the 85.4% completion rate of a second test among all first time completers (regardless of their screening result in the first round of screening) [36], suggesting lower participation in repeat screening in this group. However, such figures do not control for any other differences between the two groups in terms of demographic variables, such as gender and SES, which also affect uptake [57,58] and further research should establish whether FP results adversely affect future screening uptake.…”

Gender Differences in Fecal Immunochemical Test Performance for Early Detection of Colorectal Neoplasia

“…The number needed to screen (NNscreen) was calculated as the number of complete screening tests needed to find one advanced neoplasia or CRC. All test characteristics were calculated separately for cut-off levels of 10,15,20,25,30,35, and 40 mg Hb/g feces, respectively. FIT test characteristics and FIT concentrations were adjusted for age via logistic regression.…”

“…As a consequence, guaiac-based FOBT screening results in a lower positivity and detection rate and may result in a higher proportion of false-positive test results in women. [14][15][16] A Scottish guaiac-based (gFOBT) screening study reported more screen-detected CRCs in men (64.5%) compared with women (35.5%), whereas the number of interval CRCs was similar in both groups (men, 49.8%; women, 50.2%). 17 These data suggest that gFOBT is less sensitive when used in women.…”

Use of a faecal immunochemical test narrows current gaps in uptake for sex, age and deprivation in a bowel cancer screening programme

“…It is well documented that uptake using gFOBT is lower in men than in women, increases with age, and is lower in the most deprived. 13,14 Thus, an aspiration of any bowel screening programme would be to find methods to increase uptake, particularly in men, the young and the deprived. We therefore investigated whether the overall increased uptake we found with FIT as a first-line test was achieving this aim, by comparison with a group from nine NHS Boards for whom we had detailed information on age, sex and deprivation.…”