Departments of Gastroenterology and Hepatology, Erasmus MC, University Medical Centre, 's-Gravendijkwal 230, Rotterdam, The Netherlands.
Br J Cancer. 2010 Mar 16;102(6):972-80. doi: 10.1038/sj.bjc.6605566. Epub 2010 Mar 2.
Guidelines underline the role of individual preferences in the selection of a screening test, as insufficient evidence is available to recommend one screening test over another. We conducted a study to determine the preferences of individuals and to predict uptake for colorectal cancer (CRC) screening programmes using various screening tests.
A discrete choice experiment (DCE) questionnaire was distributed among naive subjects, yet to be screened, and previously screened subjects, aged 50-75 years. Subjects were asked to choose between scenarios on the basis of faecal occult blood test (FOBT), flexible sigmoidoscopy (FS), total colonoscopy (TC) with various test-specific screening intervals and mortality reductions, and no screening (opt-out).
In total, 489 out of 1498 (33%) screening-naïve subjects (52% male; mean age+/-s.d. 61+/-7 years) and 545 out of 769 (71%) previously screened subjects (52% male; mean age+/-s.d. 61+/-6 years) returned the questionnaire. The type of screening test, screening interval, and risk reduction of CRC-related mortality influenced subjects' preferences (all P<0.05). Screening-naive and previously screened subjects equally preferred 5-yearly FS and 10-yearly TC (P=0.24; P=0.11), but favoured both strategies to annual FOBT screening (all P-values <0.001) if, based on the literature, realistic risk reduction of CRC-related mortality was applied. Screening-naive and previously screened subjects were willing to undergo a 10-yearly TC instead of a 5-yearly FS to obtain an additional risk reduction of CRC-related mortality of 45% (P<0.001).
These data provide insight into the extent by which interval and risk reduction of CRC-related mortality affect preferences for CRC screening tests. Assuming realistic test characteristics, subjects in the target population preferred endoscopic screening over FOBT screening, partly, due to the more favourable risk reduction of CRC-related mortality by endoscopy screening. Increasing the knowledge of potential screenees regarding risk reduction by different screening strategies is, therefore, warranted to prevent unrealistic expectations and to optimise informed choice.
指南强调了个体偏好在筛选测试选择中的作用，因为目前还没有足够的证据推荐一种筛选测试优于另一种。我们进行了一项研究，以确定个人的偏好，并使用各种筛选测试来预测结直肠癌（CRC）筛选计划的参与率。
我们向尚未接受筛查的初筛对象和已接受过筛查的对象发放了基于粪便潜血试验（FOBT）、柔性乙状结肠镜检查（FS）、全结肠镜检查（TC）和不同筛查间隔及死亡率降低的不同筛查测试的离散选择实验（DCE）问卷。
共收回 1498 名初筛对象中 489 份（33%；男性占 52%；平均年龄+/-标准差 61+/-7 岁）和 769 名已筛查对象中 545 份（71%；男性占 52%；平均年龄+/-标准差 61+/-6 岁）的问卷。筛选测试的类型、筛查间隔和 CRC 相关死亡率的降低均影响了对象的偏好（均 P<0.05）。初筛对象和已筛查对象对 5 年 FS 和 10 年 TC 同样偏好（P=0.24；P=0.11），但如果基于文献应用现实的 CRC 相关死亡率降低，他们更喜欢每年 FOBT 筛查而非上述两种策略（所有 P 值<0.001）。初筛对象和已筛查对象愿意接受 10 年 TC 而非 5 年 FS，以获得 CRC 相关死亡率额外降低 45%（P<0.001）。
这些数据深入了解了 CRC 相关死亡率的降低和筛查间隔对 CRC 筛查测试偏好的影响程度。在考虑到现实的测试特征的情况下，目标人群中的对象更喜欢内镜筛查而非 FOBT 筛查，部分原因是内镜筛查降低 CRC 相关死亡率的效果更有利。因此，有必要增加潜在筛查对象对不同筛查策略的风险降低的了解，以防止不切实际的期望，并优化知情选择。
