Nationwide participation in FIT-based colorectal cancer screening in Denmark during the COVID-19 pandemic: An observational study

Abstract

Background: Worldwide, most colorectal cancer screening programmes were paused at the start of the COVID-19 pandemic, whilst the Danish faecal immunochemical test (FIT)-based programme continued without pausing. We examined colorectal cancer screening participation and compliance with subsequent colonoscopy in Denmark throughout the pandemic. Methods: We used data from the Danish Colorectal Cancer Screening Database among individuals aged 50-74 years old invited to participate in colorectal cancer screening from 2018-2021 combined with population-wide registries. Using a generalised linear model, we estimated prevalence ratios (PR) and 95% confidence intervals (CI) of colorectal cancer screening participation within 90 days since invitation and compliance with colonoscopy within 60 days since a positive FIT test during the pandemic in comparison with the previous years adjusting for age, month and year of invitation. Results: Altogether, 3,133,947 invitations were sent out to 1,928,725 individuals and there were 94,373 positive FIT tests (in 92,848 individuals) during the study period. Before the pandemic, 60.7% participated in screening within 90 days. A minor reduction in participation was observed at the start of the pandemic (PR=0.95; 95% CI: 0.94-0.96 in pre-lockdown and PR=0.85; 95% CI: 0.85-0.86 in 1st lockdown) corresponding to a participation rate of 54.9% during pre-lockdown and 53.0% during 1st lockdown. This was followed by a 5-10% increased participation in screening corresponding to a participation rate of up to 64.9%. The largest increase in participation was observed among 55-59 year olds and among immigrants. The compliance with colonoscopy within 60 days was 89.9% before the pandemic. A slight reduction was observed during 1st lockdown (PR=0.96; 95% CI: 0.93-0.98), where after it resumed to normal levels. Conclusions: Participation in the Danish FIT-based colorectal cancer screening programme and subsequent compliance to colonoscopy after a positive FIT result was only slightly affected by the COVID-19 pandemic. Funding: The study was funded by the Danish Cancer Society Scientific Committee (grant number R321-A17417) and the Danish regions.

Nationwide mammography screening participation in Denmark during the COVID-19 pandemic: An observational study

“…This indicates that the restrictions imposed in Denmark may have affected some groups of women disproportionally. A study from Spain Bosch et al, 2022 found that the participation in mammography screening decreased with age and with lower socio-economic level post-COVID-19; this has also been reported for the two other screening programmes in Denmark ( Olesen et al, 2023a ; Olesen et al, 2023b ; this study). The evidence is scarce on participation according to ethnicity throughout the pandemic; however, the lower participation during the pandemic has also been demonstrated for bowel and cervical cancer screening in Denmark ( Olesen et al, 2023a ; Olesen et al, 2023b ; this study).…”

“…A study from Spain Bosch et al, 2022 found that the participation in mammography screening decreased with age and with lower socio-economic level post-COVID-19; this has also been reported for the two other screening programmes in Denmark ( Olesen et al, 2023a ; Olesen et al, 2023b ; this study). The evidence is scarce on participation according to ethnicity throughout the pandemic; however, the lower participation during the pandemic has also been demonstrated for bowel and cervical cancer screening in Denmark ( Olesen et al, 2023a ; Olesen et al, 2023b ; this study). Immigrants may find it more difficult to navigate the healthcare system in Denmark, and possibly this has been exacerbated by the pandemic where the majority of the communication at press conferences and news media were conveyed in Danish, a language that may not be fully comprehensive to all immigrants.…”

“…However, the participation in screening for cervical and bowel cancer in Denmark during the pandemic showed similar patterns, with a decrease in the short term, but to a much lesser extent in the longer term. This indicates that people invited for screening in Denmark more often postponed their participation by a few months, rather than not attending at all ( Olesen et al, 2023a ; Olesen et al, 2023b ; this study).…”

10 A narrative journey into the borderland of patient safety

“…1 In 2021, the COVID-19 project was launched in Denmark to investigate the secondary consequences of the pandemic on various illnesses. [2][3][4][5][6] The study was conducted by the Danish Clinical Quality Program -National Clinical Registries (RKKP) in partnership with medical professionals. The primary goal of the project was to gain insight into how the pandemic affected the following areas: the levels of diagnostic and therapeutic activity for illnesses besides COVID-19, the quality of care for diseases other than COVID-19, social inequality in healthcare, and the lessons learned for managing similar pandemics and catastrophes in the future.…”