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Improving Participation in Colorectal Cancer Screening: a Randomised Controlled Trial of Sequential Offers of Faecal then Blood Based Non-Invasive Tests

  • Symonds, Erin L (Flinders Centre for Innovation in Cancer) ;
  • Pedersen, Susanne (Clinical Genomics Pty Ltd.) ;
  • Cole, Stephen R (Flinders Centre for Innovation in Cancer) ;
  • Massolino, Joseph (East Adelaide Healthcare) ;
  • Byrne, Daniel (Chandlers Hill Surgery) ;
  • Guy, John (Flagstaff Hill Medical Centre) ;
  • Backhouse, Patricia (East Adelaide Healthcare) ;
  • Fraser, Robert J (Flinders Centre for Innovation in Cancer) ;
  • LaPointe, Lawrence (Clinical Genomics Pty Ltd.) ;
  • Young, Graeme P (Flinders Centre for Innovation in Cancer)
  • Published : 2016.01.11

Abstract

Background: Poor participation rates are often observed in colorectal cancer (CRC) screening programs utilising faecal occult blood tests. This may be from dislike of faecal sampling, or having benign bleeding conditions that can interfere with test results. These barriers may be circumvented by offering a blood-based DNA test for screening. The aim was to determine if program participation could be increased by offering a blood test following faecal immunochemical test (FIT) non-participation. Materials and Methods: People were invited into a CRC screening study through their General Practice and randomised into control or intervention (n=600/group). Both groups were mailed a FIT (matching conventional screening programs). Participation was defined as FIT completion within 12wk. Intervention group non-participants were offered a screening blood test (methylated BCAT1/IKZF1). Overall participation was compared between the groups. Results: After 12wk, FIT participation was 82% and 81% in the control and intervention groups. In the intervention 96 FIT nonparticipants were offered the blood test - 22 completed this test and 19 completed the FIT instead. Total screening in the intervention group was greater than the control (88% vs 82%, p<0.01). Of 12 invitees who indicated that FIT was inappropriate for them (mainly due to bleeding conditions), 10 completed the blood test (83%). Conclusions: Offering a blood test to FIT non-participants increased overall screening participation compared to a conventional FIT program. Blood test participation was particularly high in invitees who considered FIT to be inappropriate for them. A blood test may be a useful adjunct test within a FIT program.

Keywords

Colorectal cancer;screening;faecal immunochemical test;methylated blood test;participation;FOBT

References

  1. Benning TM, Dellaert BG, Dirksen CD, et al (2014). Preferences for potential innovations in non-invasive colorectal cancer screening: A labeled discrete choice experiment for a Dutch screening campaign. Acta Oncol, 53, 898-908. https://doi.org/10.3109/0284186X.2013.877159
  2. Bresalier RS, Kopetz S, Brenner DE (2015). Blood-Based Tests for Colorectal Cancer Screening: Do They Threaten the Survival of the FIT Test? Dig Dis Sci, 60, 664-71. https://doi.org/10.1007/s10620-015-3575-2
  3. Cole SR, Gregory T, Whibley A, et al (2012). Predictors of Re-participation in Faecal Occult Blood Test-Based Screening for Colorectal Cancer. Asian Pac J Cancer Prev, 13, 5989-94. https://doi.org/10.7314/APJCP.2012.13.12.5989
  4. Cole SR, Tucker GR, Osborne JM, et al (2013). Shift to earlier stage at diagnosis as a consequence of the National Bowel Cancer Screening Program. Med J Aust, 198, 327-30. https://doi.org/10.5694/mja12.11357
  5. Cole SR, Young GP, Byrne D, et al (2002). Participation in screening for colorectal cancer based on a faecal occult blood test is improved by endorsement by the primary care practitioner. J Med Screen, 9, 147-52. https://doi.org/10.1136/jms.9.4.147
  6. Cole SR, Young GP, Esterman A, et al (2003). A randomised trial of the impact of new faecal haemoglobin test technologies on population participation in screening for colorectal cancer. J Med Screen, 10, 117-22. https://doi.org/10.1258/096914103769011003
  7. Cole SR, Zajac I, Gregory T, et al (2011). Psychosocial variables associated with colorectal cancer screening in South Australia. Int J Behav Med, 18, 302-9. https://doi.org/10.1007/s12529-010-9101-1
  8. Adler A, Geiger S, Keil A, et al (2014). Improving compliance to colorectal cancer screening using blood and stool based tests in patients refusing screening colonoscopy in Germany. BMC Gastroenterol, 14, 183. https://doi.org/10.1186/1471-230X-14-183
  9. AIHW 2014. National Bowel Cancer Screening Program monitoring report: 2012-13., Canberra, Australian Institute of Health and Welfare Canberra.
  10. DeBourcy AC, Lichtenberger S, Felton S, et al (2008). Community-based preferences for stool cards versus colonoscopy in colorectal cancer screening. J Gen Intern Med, 23, 169-74. https://doi.org/10.1007/s11606-007-0480-1
  11. deVos T, Tetzner R, Model F, et al (2009). Circulating methylated SEPT9 DNA in plasma is a biomarker for colorectal cancer. Clin Chem, 55, 1337-46. https://doi.org/10.1373/clinchem.2008.115808
  12. Fox A, Tietze PH, Ramakrishnan K (2014). Anorectal conditions: hemorrhoids. FP Essent, 419, 11-9.
  13. Greiner KA, James AS, Born W, et al (2005). Predictors of fecal occult blood test (FOBT) completion among low-income adults. Prev Med, 41, 676-84. https://doi.org/10.1016/j.ypmed.2004.12.010
  14. Hardcastle JD, Chamberlain JO, Robinson MH, et al (1996). Randomised controlled trial of faecal-occult-blood screening for colorectal cancer. Lancet, 348, 1472-7. https://doi.org/10.1016/S0140-6736(96)03386-7
  15. Hol L, Kuipers EJ, van Ballegooijen M, et al (2012). Uptake of faecal immunochemical test screening among nonparticipants in a flexible sigmoidoscopy screening programme. Int J Cancer, 130, 2096-102. https://doi.org/10.1002/ijc.26260
  16. Mandel JS, Bond JH, Church TR, et al (1993). Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study. N Engl J Med, 328, 1365-71. https://doi.org/10.1056/NEJM199305133281901
  17. Marshall DA, Johnson FR, Phillips KA, et al (2007). Measuring patient preferences for colorectal cancer screening using a choice-format survey. Value Health, 10, 415-30. https://doi.org/10.1111/j.1524-4733.2007.00196.x
  18. Miles A, Rainbow S, von Wagner C (2011). Cancer fatalism and poor self-rated health mediate the association between socioeconomic status and uptake of colorectal cancer screening in England. Cancer Epidemiol Biomarkers Prev, 20, 2132-40. https://doi.org/10.1158/1055-9965.EPI-11-0453
  19. Mitchell SM, Ross JP, Drew HR, et al (2014). A panel of genes methylated with high frequency in colorectal cancer. BMC Cancer, 14.
  20. Osborne J, Wilson C, Moore V, et al (2012). Sample preference for colorectal cancer screening tests: Blood or stool? OJPM, 2, 326-31. https://doi.org/10.4236/ojpm.2012.23047
  21. Pedersen S, Symonds E, Baker R, et al (2015a). Evaluation of an assay for methylated BCAT1 and IKZF1 in plasma for detection of colorectal neoplasia. BMC Cancer, In press.
  22. Pedersen SK, Baker RT, McEvoy A, et al (2015b). A two-gene blood test for methylated DNA sensitive for colorectal cancer. PLoS One, 10, 125041.
  23. Senore C, Ederle A, Benazzato L, et al (2013). Offering people a choice for colorectal cancer screening. Gut, 62, 735-40. https://doi.org/10.1136/gutjnl-2011-301013
  24. Symonds E, Young G, Osborne J, et al (2015). Comparison of a methylated two-gene (BCAT1-IKZF1) blood test to FIT for detection of colorectal neoplasia. Gastroenterology, 148, 746.
  25. van Dam L, Kuipers EJ, Steyerberg EW, et al (2013). The price of autonomy: should we offer individuals a choice of colorectal cancer screening strategies? Lancet Oncol, 14, 38-46. https://doi.org/10.1016/S1470-2045(12)70489-8
  26. Worthley DL, Cole SR, Esterman A, et al (2006). Screening for colorectal cancer by faecal occult blood test: why people choose to refuse. Intern Med J, 36, 607-10. https://doi.org/10.1111/j.1445-5994.2006.01155.x
  27. Zorzi M, Fedeli U, Schievano E, et al (2014). Impact on colorectal cancer mortality of screening programmes based on the faecal immunochemical test. Gut.

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