Koïvogui A, Vincelet C, Ait-Hadad H, Pellissier H, Valibay S, Kaufmanis A, Benamouzig R
CRCDC-IDF, Seine-Saint-Denis site, 41 avenue de Verdun, 93146Bondy, France.
CRCDC-IDF, Yvelines site, 18 avenue Dutartre, BP 120 - 78153 - Le Chesnay Cedex, France.
Rev Epidemiol Sante Publique. 2021 Oct;69(5):265-276. doi: 10.1016/j.respe.2021.06.002. Epub 2021 Aug 1.
Even though theinterest of a Colorectal-Cancer Screening Program has been amply demonstrated, in French departments the participation rate (PR) seldom reaches 45%. In the absence of mass mailing, a strategy (S-1) consisting in mailing a test kit to people having made a request was implemented in 2015. In 2017, another mailing strategy (S-2), which consisted in sending the test kit only to people likely to take the test, was programmed. This study assesses the respective impact of these two strategies as compared to the standard approach (S-0).
The study included 254,113 (S-0), 4,130 (S-1) and 10,887 (S-2) people aged 50-74, targeted during the 2016-2017 campaign in Seine-Saint-Denis (France). S-0 persons received a 2nd reminder without a test-kit, while S-1 persons received, at their request, a mailed test kit. Without having made a request, S-2 persons the mailed test kit according to probability of participation (Proba) which was estimated a priori by the ratio between the sum total of index values (frequency of previous participation, date of most recent participation, age) and a theoretical maximum. Completion rates (test/colonoscopy) were compared 18 months after the last S-2 kit was sent.
PR was highest in S-1 (S-0: 5.8%, S-1: 74.9%, S-2: 31.3%; p < 0.0001). In S-2, PR rose as Proba increased (Proba: ]0-30%], ]30-50%], ]50-75%], ]75-100%]; PR: 21.1%, 23.3%, 36.2%, 52.8% respectively; p < 0.05). Compared to the ≥70 years age-group, the 50-54 years age-group presented a lower PR in S-1 (65.9% vs. 85.1%; p < 0.05) whereas it presented a higher PR in S-0 (4.3% vs. 7.1%; p < 0.05) and in S-2 (23.2% vs. 54.5%; p < 0.05). All in all, colonoscopy completion rates were highest in S-1 (S-0: 62.2%, S-1: 80.0%, S-2: 65.0%; p < 0.001).
Test-kit mailing without spontaneous request does not lead to an optimal level of participation, thereby highlighting a need to give thought to new and improved mobilization methods. The relatively pronounced participation of younger persons, who are not favored by present-day testing specifications, underscores the interest of a specific approach addressed to active people, who are less inclined than elderly individuals to regularly consult their attending physicians.
尽管结直肠癌筛查项目的益处已得到充分证明，但在法国各部门，参与率（PR）很少能达到45%。在没有大规模邮寄的情况下，2015年实施了一项策略（S-1），即向提出请求的人邮寄检测试剂盒。2017年，计划实施另一项邮寄策略（S-2），即仅向可能接受检测的人发送检测试剂盒。本研究评估了这两种策略与标准方法（S-0）相比各自的影响。
该研究纳入了2016 - 2017年在法国塞纳 - 圣但尼地区开展活动期间针对的254,113名（S-0）、4,130名（S-1）和10,887名（S-2）50 - 74岁的人群。S-0组的人收到了第二封不含检测试剂盒的提醒信，而S-1组的人根据其请求收到了邮寄的检测试剂盒。S-2组的人在未提出请求的情况下，根据参与概率（Proba）收到了邮寄的检测试剂盒，该概率通过指数值总和（先前参与频率、最近参与日期、年龄）与理论最大值的比值预先估计得出。在最后一批S-2试剂盒发送18个月后比较完成率（检测/结肠镜检查）。
S-1组的参与率最高（S-0：5.8%，S-1：74.9%，S-2：31.3%；p < 0.0001）。在S-2组中，参与率随着Proba的增加而上升（Proba：]0 - 30%]、]30 - 50%]、]50 - 75%]、]75 - 100%]；参与率分别为21.1%、23.3%、36.2%、52.8%；p < 0.05）。与70岁及以上年龄组相比，50 - 54岁年龄组在S-1组中的参与率较低（65.9%对85.1%；p < 0.05），而在S-0组（4.3%对7.1%；p < 0.05）和S-2组（23.2%对54.5%；p < 0.05）中则较高。总体而言，S-1组的结肠镜检查完成率最高（S-0：62.2%，S-1：80.0%，S-2：65.0%；p < 0.001）。
未经自发请求就邮寄检测试剂盒并不能带来最佳参与水平，从而凸显出需要思考新的、改进的动员方法。相对明显的是，目前检测规范不太青睐的年轻人参与度较高，这突出了针对活跃人群采用特定方法的益处，这些人比老年人更不愿意定期咨询他们的主治医生。
