Colonoscopy is the preferred colorectal cancer screening method in a population-based program

 

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Background and study aims: Various screening methods for colorectal cancer (CRC) are promoted by professional societies; however, few data are available about the factors that determine patient participation in screening, which is crucial to the success of population-based programs. This study aimed (i) to identify factors that determine acceptance of screening and preference of screening method, and (ii) to evaluate procedure success, detection of colorectal neoplasia, and patient satisfaction with screening colonoscopy.

Patients and methods: Following a public awareness campaign, the population aged 50 – 80 years was offered CRC screening in the form of annual fecal occult blood tests, flexible sigmoidoscopy, a combination of both, or colonoscopy.

Results: 2731 asymptomatic persons (12.0 % of the target population) registered with and were eligible to take part in the screening program. Access to information and a positive attitude to screening were major determinants of participation. Colonoscopy was the method preferred by 74.8 % of participants. Advanced colorectal neoplasia was present in 8.5 %; its prevalence was higher in males and increased with age. Significant complications occurred in 0.5 % of those undergoing colonoscopy and were associated with polypectomy or sedation. Most patients were satisfied with colonoscopy and over 90 % would choose it again for CRC screening.

Conclusions: In this population-based study, only a small proportion of the target population underwent CRC screening despite an extensive information campaign. Colonoscopy was the preferred method and was safe. The determinants of participation in screening and preference of screening method, together with the distribution of colorectal neoplasia in different demographic categories, provide a rationale for improving screening procedures.

References

• 1 Lieberman D A, Atkin W. Review article: balancing the ideal versus the practical-considerations of colorectal cancer prevention and screening.  Aliment Pharmacol Ther. 2004;  19 (Suppl 1) 71-76
  CrossrefPubMedGoogle Scholar
• 2 Rex D K, Johnson D A, Lieberman D A. et al . Colorectal cancer prevention 2000: screening recommendations of the American College of Gastroenterology.  Am J Gastroenterol. 2000;  95 868-877
  PubMedGoogle Scholar
• 3 Smith R A, Cokkinides V, Eyre H J. American Cancer Society guidelines for the early detection of cancer, 2004.  CA Cancer J Clin. 2004;  54 41-52
  CrossrefPubMedGoogle Scholar
• 4 Winawer S, Fletcher R, Rex D. et al . Colorectal cancer screening and surveillance: clinical guidelines and rationale – update based on new evidence.  Gastroenterology. 2003;  124 544-560
  CrossrefPubMedGoogle Scholar
• 5 Winawer S J, Fletcher R H, Miller L. et al . Colorectal cancer screening: clinical guidelines and rationale.  Gastroenterology. 1997;  112 594-642
  CrossrefPubMedGoogle Scholar
• 6 American Joint Committee on Cancer .AJCC Cancer Staging Manual, 5th ed. Philadelphia, PA; Lippincott-Raven 1997: 83-90
  Google Scholar
• 7 UK Flexible Sigmoidoscopy Screening Trial Investigators . Single flexible sigmoidoscopy screening to prevent colorectal cancer: baseline findings of a UK multicentre randomised trial.  Lancet. 2002;  359 1291-1300
  CrossrefPubMedGoogle Scholar
• 8 UK Colorectal Cancer Screening Pilot Group . Results of the first round of a demonstration pilot of screening for colorectal cancer in the United Kingdom.  BMJ. 2004;  329 133
  CrossrefPubMedGoogle Scholar
• 9 Berry D P, Clarke P, Hardcastle J D, Vellacott K D. Randomized trial of the addition of flexible sigmoidoscopy to faecal occult blood testing for colorectal neoplasia population screening.  Br J Surg. 1997;  84 1274-1276
  CrossrefPubMedGoogle Scholar
• 10 Betes M, Munoz-Navas M A, Duque J M. et al . Use of colonoscopy as a primary screening test for colorectal cancer in average risk people.  Am J Gastroenterol. 2003;  98 2648-2654
  PubMedGoogle Scholar
• 11 Faivre J, Dancourt V, Lejeune C. et al . Reduction in colorectal cancer mortality by fecal occult blood screening in a French controlled study.  Gastroenterology. 2004;  126 1674-1680
  CrossrefPubMedGoogle Scholar
• 12 Segnan N, Senore C, Andreoni B. et al . Comparing attendance and detection rate of colonoscopy with sigmoidoscopy and FIT for colorectal cancer screening.  Gastroenterology. 2007;  132 2304-2312
  CrossrefPubMedGoogle Scholar
• 13 Schoepfer A, Marbet U A. Colonoscopic findings of symptomatic patients aged 50 to 80 years suggest that work-up of tumour suspicious symptoms hardly reduces cancer-induced mortality.  Swiss Med Wkly. 2005;  135 679-683
  PubMedGoogle Scholar
• 14 Farraye F A, Wong M, Hurwitz S. et al . Barriers to endoscopic colorectal cancer screening: are women different from men?.  Am J Gastroenterol. 2004;  99 341-349
  CrossrefPubMedGoogle Scholar
• 15 Ioannou G N, Chapko M K, Dominitz J A. Predictors of colorectal cancer screening participation in the United States.  Am J Gastroenterol. 2003;  98 2082-2091
  CrossrefPubMedGoogle Scholar
• 16 Pignone M, Harris R, Kinsinger L. Videotape-based decision aid for colon cancer screening. A randomized, controlled trial.  Ann Intern Med. 2000;  133 761-769
  CrossrefPubMedGoogle Scholar
• 17 Seeff L C, Nadel M R, Klabunde C N. et al . Patterns and predictors of colorectal cancer test use in the adult US population.  Cancer. 2004;  100 2093-2103
  CrossrefPubMedGoogle Scholar
• 18 Subramanian S, Klosterman M, Amonkar M M, Hunt T L. Adherence with colorectal cancer screening guidelines: a review.  Prev Med. 2004;  38 536-550
  CrossrefPubMedGoogle Scholar
• 19 Klabunde C N, Frame P S, Meadow A. A national survey of primary care physicians’ colorectal cancer screening recommendations and practices.  Prev Med. 2003;  36 352-362
  CrossrefPubMedGoogle Scholar
• 20 Sharma V K, Vasudeva R, Howden C W. Colorectal cancer screening and surveillance practices by primary care physicians: results of a national survey.  Am J Gastroenterol. 2000;  95 1551-1556
  CrossrefPubMedGoogle Scholar
• 21 Zack D L, DiBaise J K, Quigley E M, Roy H K. Colorectal cancer screening compliance by medicine residents: perceived and actual.  Am J Gastroenterol. 2001;  96 3004-3008
  CrossrefPubMedGoogle Scholar
• 22 Cokkinides V E, Chao A, Smith R A. et al . Correlates of underutilization of colorectal cancer screening among US adults, age 50 years and older.  Prev Med. 2003;  36 85-91
  CrossrefPubMedGoogle Scholar
• 23 Lemon S, Zapka J, Puleo E. et al . Colorectal cancer screening participation: comparisons with mammography and prostate-specific antigen screening.  Am J Public Health. 2001;  91 1264-1272
  CrossrefPubMedGoogle Scholar
• 24 Shapiro J A, Seeff L C, Nadel M R. Colorectal cancer-screening tests and associated health behaviors.  Am J Prev Med. 2001;  21 132-137
  CrossrefPubMedGoogle Scholar
• 25 McGregor S E, Hilsden R J, Li F X. et al . Low uptake of colorectal cancer screening 3 yr after release of national recommendations for screening.  Am J Gastroenterol. 2007;  102 1727-1735
  CrossrefPubMedGoogle Scholar
• 26 Ling B S, Moskowitz M A, Wachs D. et al . Attitudes toward colorectal cancer screening tests.  J Gen Intern Med. 2001;  16 822-830
  CrossrefPubMedGoogle Scholar
• 27 Ristvedt S L, McFarland E G, Weinstock L B. et al . Patient preferences for CT colonography, conventional colonoscopy, and bowel preparation.  Am J Gastroenterol. 2003;  98 578-585
  CrossrefPubMedGoogle Scholar
• 28 Zubarik R, Ganguly E, Benway D. et al . Procedure-related abdominal discomfort in patients undergoing colorectal cancer screening: a comparison of colonoscopy and flexible sigmoidoscopy.  Am J Gastroenterol. 2002;  97 3056-3061
  CrossrefPubMedGoogle Scholar
• 29 Imperiale T F, Wagner D R, Lin C Y. et al . Risk of advanced proximal neoplasms in asymptomatic adults according to the distal colorectal findings.  N Engl J Med. 2000;  343 169-174
  CrossrefPubMedGoogle Scholar
• 30 Lieberman D A, Weiss D G, Bond J H. et al . Use of colonoscopy to screen asymptomatic adults for colorectal cancer. Veterans Affairs Cooperative Study Group 380.  N Engl J Med. 2000;  343 162-168
  CrossrefPubMedGoogle Scholar
• 31 Nelson D B, McQuaid K R, Bond J H. et al . Procedural success and complications of large-scale screening colonoscopy.  Gastrointest Endosc. 2002;  55 307-314
  CrossrefPubMedGoogle Scholar
• 32 Rex D K, Bond J H, Winawer S. et al . Quality in the technical performance of colonoscopy and the continuous quality improvement process for colonoscopy: recommendations of the US Multi-Society Task Force on Colorectal Cancer.  Am J Gastroenterol. 2002;  97 1296-1308
  CrossrefPubMedGoogle Scholar
• 33 Schoenfeld P, Cash B, Flood A. et al . Colonoscopic screening of average-risk women for colorectal neoplasia.  N Engl J Med. 2005;  352 2061-2068
  CrossrefPubMedGoogle Scholar
• 34 Barclay R L, Vicari J J, Doughty A S. et al . Colonoscopic withdrawal times and adenoma detection during screening colonoscopy.  N Engl J Med. 2006;  355 2533-2541
  CrossrefPubMedGoogle Scholar
• 35 Imperiale T F, Wagner D R, Lin C Y. et al . Using risk for advanced proximal colonic neoplasia to tailor endoscopic screening for colorectal cancer.  Ann Intern Med. 2003;  139 959-965
  CrossrefPubMedGoogle Scholar
• 36 Regula J, Rupinski M, Kraszewska E. et al . Colonoscopy in colorectal-cancer screening for detection of advanced neoplasia.  N Engl J Med. 2006;  355 1863-1872
  CrossrefPubMedGoogle Scholar
• 37 Soon M S, Kozarek R A, Ayub K. et al . Screening colonoscopy in Chinese and Western patients: a comparative study.  Am J Gastroenterol. 2005;  100 2749-2755
  CrossrefPubMedGoogle Scholar

F. Delcò, MD MPH 

Division of Gastroenterology
Department of Internal Medicine
University Hospital of Zürich

Raemistrasse 100
8091 Zürich
Switzerland

Fax: +41-44-2554503

Email: Fabiola.Delco@eoc.ch