Randomized Trial of Different Screening Strategies for Colorectal Cancer: Patient Response and Detection Rates

Segnan, Nereo; Senore, Carlo; Andreoni, B.; Arrigoni, Arrigo; Bisanti, Luigi; Cardelli, A; Castiglione, Guido; Crosta, C.; DiPlacido, Roberta; Ferrari, A; Ferraris, R.; Ferrero, Franco; Fracchia, M.; Gasperoni, Stefano; Malfitana, Giuseppe; Recchia, S.; Risio, Mauro; Rizzetto, M.; Saracco, Giorgio Maria; Spandre, M.; Turco, D.; Turco, P. H. N.; Zappa, Marco

doi:10.1093/jnci/dji050

Cited by 171 publications

(172 citation statements)

References 39 publications

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“…Both methods had similar participation rates in what is, to our knowledge, the only large randomized trial comparing different screening strategies. 14 The increased nonparticipation rate among people with a low income observed in our study is well in line the findings in other studies, indicating that socioeconomically disadvantaged people are over-represented among nonparticipants. [15][16][17][18] The sigmoidoscopies in our study were all free of charge.…”

Section: Discussionsupporting

confidence: 93%

Toward understanding nonparticipation in sigmoidoscopy screening for colorectal cancer

Blom

Yin

Lidén

et al. 2008

Intl Journal of Cancer

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Understanding the reasons for nonparticipation in cancer screening may give clues about how to improve compliance. However, limited cooperation has hampered research on nonparticipant profiles. We took advantage of Sweden's comprehensive demographic and health care registers to investigate characteristics of all participants and nonparticipants in a pilot program for colorectal cancer screening with sigmoidoscopy. A population-based sample of 1986 Swedish residents 59-61 years old was invited. Registers provided information on each individual's gender, country of birth, marital status, education, income, hospital contacts, place of residence, distance to screening center and cancer within the family. Odds ratios (ORs) with 95% confidence intervals (CIs), modeled with multivariable logistic regression, estimated the independent associations between each background factor and the propensity for nonparticipation after control for the effects of other factors. All statistical tests were 2-sided. Being male (OR 5 1.27, 95% CI 5 1.03-1.57, relative to female), unmarried or divorced (OR 5 1.69, 95% CI 5 1.23-2.30 and OR 5 1.49, 95% CI 5 1.14-1.95, respectively, relative to married) and having an income in the lowest tertile (OR 5 1.68, 95% CI 5 1.27-2.23, relative to highest tertile) was associated with increased nonparticipation. Living in the countryside or in small communities and having a documented family history of colorectal cancer was associated with better participation. Distance to the screening center did not significantly affect participation, nor did recent hospital care consumption or immigrant status. To increase compliance, invitations must appeal to men, unmarried or divorced people and people with low socioeconomic status. ' 2007 Wiley-Liss, Inc.Key words: mass screening; colorectal neoplasms; sigmoidoscopy; patient participation; registers To be effective on a population level, screening programs have to be widely accepted. To minimize nonparticipation, it is important to understand the reasons for nonattendance and to identify groups that would benefit from extra recruitment efforts. Further, understanding of selection forces is necessary for valid interpretation of the effects of screening.Investigators of nonparticipation, whether in screening, public health campaigns or scientific investigations typically have to resort to interviews or questionnaires. As the motivation among nonparticipants generally is low, such studies are characterized by low response rates and questionable data quality. For example, in a recently published Norwegian study concerning a colorectal cancer screening program, only 11% of the nonparticipants responded to a follow-up questionnaire. 1 To our knowledge, no comprehensive model explaining nonparticipation in cancer screening has yet gained widespread acceptance. The scarcity of unbiased background information among nonparticipants may have contributed to this lack of a firm conceptual basis for the understanding of underlying mechanisms.We took advantage of 8 national ...

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Section: Discussionsupporting

confidence: 93%

Toward understanding nonparticipation in sigmoidoscopy screening for colorectal cancer

Blom

Yin

Lidén

et al. 2008

Intl Journal of Cancer

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“…Numerous strategies exist to improve screening rates for colorectal and breast cancer, 2,3,5,6,[11][12][13][14][15][16][17][18][19][20] but the relative incremental benefit of these interventions have not been compared. 5 Using a pragmatic randomized trial, we examined the incremental benefit of several strategies to augment the effect of a patient reminder letter to improve cancer-screening rates.…”

Section: Discussionmentioning

confidence: 99%

Get Screened: A Randomized Trial of the Incremental Benefits of Reminders, Recall, and Outreach on Cancer Screening

et al. 2013

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BACKGROUND:Rates of breast cancer (BC) and colorectal cancer (CRC) screening are particularly low among poor and minority patients. Multifaceted interventions have been shown to improve cancer-screening rates, yet the relative impact of the specific components of these interventions has not been assessed. Identifying the specific components necessary to improve cancer-screening rates is critical to tailor interventions in resource limited environments. OBJECTIVE: To assess the relative impact of various components of the reminder, recall, and outreach (RRO) model on BC and CRC screening rates within a safety net practice. DESIGN: Pragmatic randomized trial. PARTICIPANTS: Men and women aged 50-74 years past due for CRC screen and women aged 40-74 years past due for BC screening. INTERVENTIONS: We randomized 1,008 patients to one of four groups: (1) reminder letter; (2) letter and automated telephone message (Letter + Autodial); (3) letter, automated telephone message, and point of service prompt (Letter + Autodial + Prompt); or (4) letter and personal telephone call (Letter + Personal Call). MAIN MEASURES: Documentation of mammography or colorectal cancer screening at 52 weeks following randomization. KEY RESULTS: Compared to a reminder letter alone, Letter + Personal Call was more effective at improving screening rates for BC (17.8 % vs. 27.5 %; AOR 2.2, 95 % CI 1.2-4.0) and CRC screening (12.2 % vs. 21.5 %; AOR 2.0, 95 % CI 1.1-3.9). Compared to letter alone, a Letter + Autodial + Prompt was also more effective at improving rates of BC screening (17.8 % vs. 28.2 %; AOR 2.1, 95 % CI 1.1-3.7) and CRC screening (12.2 % vs. 19.6 %; AOR 1.9, 95 % CI 1.0-3.7). Letter + Autodial was not more effective than a letter alone at improving screening rates. CONCLUSIONS:The addition of a personal telephone call or a patient-specific provider prompt were both more effective at improving mammogram and CRC screening rates compared to a reminder letter alone. The use of automated telephone calls, however, did not provide any incremental benefit to a reminder letter alone.KEY WORDS: cancer screening; colorectal cancer; breast cancer; outreach; inreach.

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“…The way to reduce the incidence of advanced CRC and cancer-related mortality is to screen for it. The current international practice guidelines and expert consensus statements recommend CRC screening for average-risk people aged ≥ 50 years (Segnan et al, 2005;Taber et al, 2010). Although there are many options for CRC screening, the most effective way is colonoscopy.…”

Section: Introductionmentioning

confidence: 99%

“…The adenoma detection rate (ADR) were reported to be about 30-40% and 1.7% respectively (Segna et al, 2005;Liou et al, 2007;Sanaka et al, 2009;Wilkins et al, 2009;Taber et al, 2010). The CRC detection rate could be as high as 4% if patients underwent colonoscopy because of positive fecal occult blood test (Segnan et al, 2005). In contrast, screening colonoscopy in Taiwanese revealed the ADR of 9.9%.…”

Section: Introductionmentioning

confidence: 99%

Screening Colonoscopy from a Large Single Center of Thailand - Something Needs to be Changed?

Aswakul

Prachayakul²,

Lohsiriwat³

et al. 2012

Asian Pacific Journal of Cancer Prevention

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Background: Results of screening colonoscopy from Western countries reported adenoma detection rates (ADRs) of 30-40% while those from Asia had ADR as low as 10%. There have been limited data regarding screening colonoscopy in Thailand. The objectives of this study were therefore to determine polyp and adenoma detection rates in Thai people, to evaluate the incidence of colorectal cancer detected during screening colonoscopy and to determine the endoscopic findings of the polyps which might have some impact on endoscopists to perform polypectomy. Materials & Methods: This study was a retrospective electronic chart review of asymptomatic Thai adults who underwent screening colonoscopy in our endoscopic center from June 2007 to October 2010.Results: A total of 1,594 cases were reviewed. The patients had an average age of 58.3±10.5 years (range 27-82) and 55.5% were female. Most of the cases (83.8%) were handled by staff who were endoscopists. A total of 488 patients (30.6%) were reported to have colonic polyps. Left-sided colon was the most common site (45.1%), followed by right-sided colon (36.5%) and the rectum (18%). Those polyps were removed in 97.5% of cases and 88.5 % of the polyps were sent for histopathology (data lost 11.5%). Two hundred and sixty three cases had adenomatous polyps, accounting for 16.5 % ADR. Advanced adenomas were detected in 43 cases (2.6%). Hyperplastic polyps were mainly located distal to the splenic flexure of the colon whereas adenomas were found throughout the large intestine. Ten cases (0.6%) were found to have colorectal cancer. Four advanced adenomas and two malignant polyps were reported in lesions ≤ 5 mm. Conclusion: The polyp detection rate, adenoma detection rate, advanced adenoma detection rate and colorectal cancer detection rate in the screening colonoscopy of Thai adults were 30.9%, 16.5%, 2.6% and 0.6% respectively. Malignant transformation was detected regardless of the size and location of the polyps. Therefore, new technology would play an important role indistinguishing polyps.

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Randomized Trial of Different Screening Strategies for Colorectal Cancer: Patient Response and Detection Rates

Abstract: The participation rates were similar for sigmoidoscopy and FOBT. The detection rate for advanced neoplasia was three times higher following screening by sigmoidoscopy than by FOBT.

Cited by 171 publications

References 39 publications

Toward understanding nonparticipation in sigmoidoscopy screening for colorectal cancer

Toward understanding nonparticipation in sigmoidoscopy screening for colorectal cancer

Get Screened: A Randomized Trial of the Incremental Benefits of Reminders, Recall, and Outreach on Cancer Screening

Screening Colonoscopy from a Large Single Center of Thailand - Something Needs to be Changed?

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