Darvishian Maryam, Moustaqim-Barrette Amina, Awadalla Philip, Bhatti Parveen, Broet Philippe, McDonald Kelly, Murphy Rachel A, Skead Kimberly, Urquhart Robin, Vena Jennifer, Dummer Trevor J B
Cancer Control Research, British Columbia (BC) Cancer, Vancouver, BC, Canada.
School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
Front Oncol. 2023 Jun 16;13:1113907. doi: 10.3389/fonc.2023.1113907. eCollection 2023.
Although colorectal cancer (CRC) screening program is proven to reduce CRC incidence and mortality, understanding patterns and predictors of suboptimal adherence in screening program requires further investigation in Canada.
We used self-reported data from five regional cohorts of the Canadian Partnership for Tomorrow's Health (CanPath), namely the BC Generations Project (BCGP), Alberta's Tomorrow Project (ATP), the Ontario Health Study (OHS), Quebec's CARTaGENE, and the Atlantic Partnership for Tomorrow's Health Study (Atlantic PATH). We stratified participants into the following four risk categories: 1) age 50-74 years, 2) family history in a first-degree relative, 3) personal history of chronic inflammatory bowel disease and/or polyps, and 4) co-existence of personal risk and family history. Multivariable logistic regression was used to identify predictors of adherence to the screening guidelines.
Adherence to CRC screening varied considerably between regions, ranging from 16.6% in CARTaGENE to 47.7% in OHS. Compared to the largest cohort OHS, the likelihood of non-adherence to CRC screening was significantly higher in BCGP (OR 1.15, 95% CI 1.11-1.19), the Atlantic PATH (OR 1.90, 95% CI 1.82-1.99) and CARTaGENE (OR 5.10, 95% CI 4.85-5.36). Low physical activity, current smoking, presence of personal risk, family history of CRC significantly reduced the likelihood of adherence to screening recommendations.
DISCUSSION/CONCLUSION: Compared to the national target of ≥ 60% for participation in CRC screening, adherence to regular CRC screening was suboptimal in this cohort of Canadians and varied by region. Further efforts are needed to identify the specific barriers to screening adherence in different provinces and across risk categories.
尽管结直肠癌（CRC）筛查项目已被证明可降低结直肠癌的发病率和死亡率，但在加拿大，了解筛查项目中依从性欠佳的模式和预测因素仍需进一步研究。
我们使用了来自加拿大明日健康伙伴关系（CanPath）五个区域队列的自我报告数据，即不列颠哥伦比亚省世代项目（BCGP）、艾伯塔省明日项目（ATP）、安大略省健康研究（OHS）、魁北克省CARTaGENE以及大西洋明日健康伙伴关系研究（大西洋PATH）。我们将参与者分为以下四个风险类别：1）50 - 74岁，2）一级亲属有家族病史，3）有慢性炎症性肠病和/或息肉的个人病史，4）个人风险与家族病史并存。采用多变量逻辑回归来确定遵循筛查指南的预测因素。
各地区对CRC筛查的依从性差异很大，从CARTaGENE的16.6%到OHS的47.7%不等。与最大的队列OHS相比，BCGP（比值比1.15，95%置信区间1.11 - 1.19）、大西洋PATH（比值比1.90，95%置信区间1.82 - 1.99）和CARTaGENE（比值比5.10，95%置信区间4.85 - 5.36）中不遵守CRC筛查的可能性显著更高。低体力活动、当前吸烟、存在个人风险、CRC家族病史显著降低了遵循筛查建议的可能性。
讨论/结论：与加拿大全国≥60%的CRC筛查参与率目标相比，该组加拿大人对定期CRC筛查的依从性欠佳，且因地区而异。需要进一步努力确定不同省份和不同风险类别中筛查依从性的具体障碍。
