Patient Preferences for Colorectal Cancer Screening Tests in Light of Lowering the Screening Age to 45 Years

Makaroff, Katherine; Shergill, Jaspreet; Lauzon, Marie; Khalil, Carine; Ahluwalia, Sangeeta C.; Spiegel, Brennan M.; Almario, Christopher V.

doi:10.1016/j.cgh.2022.07.012

Cited by 26 publications

(9 citation statements)

References 34 publications

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“…Not surprisingly, investigators using analytic hierarchy processes that deconstruct the higher-level decision (ie, which test to choose) from simpler criteria (eg, whether an individual values test accuracy vs convenience) have found colonoscopy to be the preferred test by individuals most valuing accuracy . Recently, though, a nationwide survey of US adults aged 50 years or older using conjoint analysis found significantly higher preference for annual FIT (77.4%) relative to colonoscopy every 10 years (22.6%; P = .004) . The regional variation we observed may partly be explained by other factors that we could not directly measure.…”

Section: Discussionmentioning

confidence: 66%

Baseline Features and Reasons for Nonparticipation in the Colonoscopy Versus Fecal Immunochemical Test in Reducing Mortality From Colorectal Cancer (CONFIRM) Study, a Colorectal Cancer Screening Trial

et al. 2023

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ImportanceThe Colonoscopy Versus Fecal Immunochemical Test in Reducing Mortality From Colorectal Cancer (CONFIRM) randomized clinical trial sought to recruit 50 000 adults into a study comparing colorectal cancer (CRC) mortality outcomes after randomization to either an annual fecal immunochemical test (FIT) or colonoscopy.ObjectiveTo (1) describe study participant characteristics and (2) examine who declined participation because of a preference for colonoscopy or stool testing (ie, fecal occult blood test [FOBT]/FIT) and assess that preference’s association with geographic and temporal factors.Design, Setting, and ParticipantsThis cross-sectional study within CONFIRM, which completed enrollment through 46 Department of Veterans Affairs medical centers between May 22, 2012, and December 1, 2017, with follow-up planned through 2028, comprised veterans aged 50 to 75 years with an average CRC risk and due for screening. Data were analyzed between March 7 and December 5, 2022.ExposureCase report forms were used to capture enrolled participant data and reasons for declining participation among otherwise eligible individuals.Main Outcomes and MeasuresDescriptive statistics were used to characterize the cohort overall and by intervention. Among individuals declining participation, logistic regression was used to compare preference for FOBT/FIT or colonoscopy by recruitment region and year.ResultsA total of 50 126 participants were recruited (mean [SD] age, 59.1 [6.9] years; 46 618 [93.0%] male and 3508 [7.0%] female). The cohort was racially and ethnically diverse, with 748 (1.5%) identifying as Asian, 12 021 (24.0%) as Black, 415 (0.8%) as Native American or Alaska Native, 34 629 (69.1%) as White, and 1877 (3.7%) as other race, including multiracial; and 5734 (11.4%) as having Hispanic ethnicity. Of the 11 109 eligible individuals who declined participation (18.0%), 4824 (43.4%) declined due to a stated preference for a specific screening test, with FOBT/FIT being the most preferred method (2820 [58.5%]) vs colonoscopy (1958 [40.6%]; P &lt; .001) or other screening tests (46 [1.0%] P &lt; .001). Preference for FOBT/FIT was strongest in the West (963 of 1472 [65.4%]) and modest elsewhere, ranging from 199 of 371 (53.6%) in the Northeast to 884 of 1543 (57.3%) in the Midwest (P = .001). Adjusting for region, the preference for FOBT/FIT increased by 19% per recruitment year (odds ratio, 1.19; 95% CI, 1.14-1.25).Conclusions and RelevanceIn this cross-sectional analysis of veterans choosing nonenrollment in the CONFIRM study, those who declined participation more often preferred FOBT or FIT over colonoscopy. This preference increased over time and was strongest in the western US and may provide insight into trends in CRC screening preferences.

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Section: Discussionmentioning

confidence: 66%

Baseline Features and Reasons for Nonparticipation in the Colonoscopy Versus Fecal Immunochemical Test in Reducing Mortality From Colorectal Cancer (CONFIRM) Study, a Colorectal Cancer Screening Trial

et al. 2023

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“…However, with the expansion of screening options and recent alterations to the screening recommendations (e.g., lowering the screening age to 45), preferences may change. A novel conjoint analysis study of individuals aged 40 and older found that, if given the option between five different CRC screening tests (annual FIT, stool DNA-FIT every 3 years, capsule endoscopy every 5 years, CTC every 5 years, or colonoscopy every 10 years), approximately one-third of respondents expressed preference for a stool DNA-FIT test every three years, and this preference did not differ by age groups (45-49 years versus ≥50 years) ( 6 ). However, a separate study showed that preference for a stool-based test was either less or no different than colonoscopy ( 7 ).…”

Section: Opportunities To Improve Colorectal Cancer Screening Adheren...mentioning

confidence: 99%

The utility of liquid biopsy-based methylation biomarkers for colorectal cancer detection

Loomans-Kropp

2024

Front. Oncol.

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Colorectal cancer (CRC) is one of the most prevalent cancers and the second leading cause of cancer-related deaths in the United States. It is also one of the few cancers with established screening guidelines, however these methods have significant patient burden (e.g., time, invasive). In recent years, the development of liquid biopsy-based screening methods for biomarker detection have emerged as alternatives to traditional screening. Methylation biomarkers are of particular interest, and these markers can be identified and measured on circulating tumor and cell-free DNA. This perspective summarizes the current state of CRC screening and the potential integration of DNA methylation markers into liquid biopsy-based techniques. Finally, I discuss limitations to these methods and strategies for improvement. The continued development and implementation of liquid biopsy-based cancer screening approaches may provide an acceptable alternative to individuals unwilling to be screened by traditional methods.

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“…Cologuard has demonstrated high sensitivity in detecting CRC and advanced adenomas, providing valuable opportunities for early detection [4,6,7]. Nevertheless, it is plagued by a high false-positive rate and low positive predictive value (PPV), occasionally resulting in unnecessary follow-up interventions [4,8].…”

Section: Introductionmentioning

confidence: 99%

Inappropriate Multi-Target Stool DNA Use for Colorectal Cancer Screening: Risks, Compliance, and Outcomes

Lazar,

Khreisat,

AlKloub

et al. 2023

Cureus

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BackgroundInappropriate or "off-label" use of multi-target stool DNA (mt-sDNA) tests refers to their use in patients for whom colonoscopy or no testing at all is warranted. Examples include a positive family history of colorectal cancer, a history of inflammatory bowel disease, or medical issues necessitating diagnostic colonoscopy, among others. Current understanding of off-label mt-sDNA use for colorectal cancer screening, its associated risks, and outcomes is lacking. We examined off-label mt-sDNA prescription and compliance with testing in an outpatient setting in southeast Michigan.

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Patient Preferences for Colorectal Cancer Screening Tests in Light of Lowering the Screening Age to 45 Years

Cited by 26 publications

References 34 publications

Baseline Features and Reasons for Nonparticipation in the Colonoscopy Versus Fecal Immunochemical Test in Reducing Mortality From Colorectal Cancer (CONFIRM) Study, a Colorectal Cancer Screening Trial

Baseline Features and Reasons for Nonparticipation in the Colonoscopy Versus Fecal Immunochemical Test in Reducing Mortality From Colorectal Cancer (CONFIRM) Study, a Colorectal Cancer Screening Trial

The utility of liquid biopsy-based methylation biomarkers for colorectal cancer detection

Inappropriate Multi-Target Stool DNA Use for Colorectal Cancer Screening: Risks, Compliance, and Outcomes

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