Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands.
Int J Cancer. 2012 May 1;130(9):2096-102. doi: 10.1002/ijc.26260. Epub 2011 Aug 16.
Screening programmes based on single modality testing may prevent individuals with a preference for a different test from participating. We conducted a population-based trial to determine whether nonparticipants in flexible sigmoidoscopy (FS) screening were willing to attend faecal immunochemical test (FIT) screening. In total, 8,407 subjects were invited in a primary FS screening programme. Invitees did not know at the time of FS invitation that nonparticipants would be offered FIT screening. A total of 4,407 nonparticipants of FS screening were invited for FIT screening (cut-off 50 ng haemoglobin/ml). The participation rate to FS screening was 31% [95% confidence interval (CI): 30-32%]. Among the FS nonparticipants 25% (CI: 24-26%) did attended FIT screening. The participation rate of the two-stage recruitment for FS and FIT screening was 45% (CI: 44-46%). FIT screenees were older (p = 0.02), more often women (p < 0.001) and had a lower social economic status (p = 0.01) than FS screenees. The detection rate (DR) for advanced adenoma was 3.5% (CI: 2.5-4.8%), and for colorectal cancer (CRC) it was 0.3% (CI: 0.1-0.8%) among participants to FIT screening. The DR of the two-stage recruitment was 6.1% (n = 202) for an advanced adenoma and 0.5% (n = 16) for a CRC. In conclusion, offering FIT screening to nonparticipants in a FS screening programme increases the overall participation rate considerably, as a quarter of nonparticipants of FS screening was willing to attend FIT screening. The participation rate remains lower for primary FIT screening in the same population (62%). Women in the target population were more likely to refuse FS than FIT screening. Countries introducing FS screening should be aware of these preferences.
基于单一检测方法的筛查项目可能会使那些偏好其他检测方法的个体无法参与。我们开展了一项基于人群的试验，旨在确定在接受乙状结肠镜筛查的人群中，那些不参加筛查的人是否愿意参加粪便免疫化学检测（FIT）筛查。共有 8407 名受试者参加了一项初级乙状结肠镜筛查项目。邀请者在进行乙状结肠镜检查邀请时并不知道不参加者将接受 FIT 筛查。共有 4407 名不参加乙状结肠镜筛查的人被邀请参加 FIT 筛查（血红蛋白阈值为 50ng/ml）。乙状结肠镜筛查的参与率为 31%（95%置信区间：30-32%）。在不参加乙状结肠镜筛查的人群中，有 25%（95%置信区间：24-26%）参加了 FIT 筛查。FS 和 FIT 筛查的两阶段招募参与率为 45%（95%置信区间：44-46%）。FIT 筛查者年龄更大（p=0.02），女性更多（p<0.001），社会经济地位更低（p=0.01）。在接受 FIT 筛查的人群中，高级腺瘤的检出率（DR）为 3.5%（95%置信区间：2.5-4.8%），结直肠癌（CRC）的检出率为 0.3%（95%置信区间：0.1-0.8%）。两阶段招募的 DR 为 6.1%（n=202）的高级腺瘤和 0.5%（n=16）的 CRC。总之，在乙状结肠镜筛查项目中为不参加筛查的人提供 FIT 筛查可显著提高总体参与率，因为四分之一不参加乙状结肠镜筛查的人愿意参加 FIT 筛查。在同一人群中，初级 FIT 筛查的参与率仍较低（62%）。目标人群中的女性更有可能拒绝 FS 筛查而不是 FIT 筛查。引入 FS 筛查的国家应意识到这些偏好。
