Herbert C, Launoy G, Thezee Y, Maurel J, Richir B, Reaud J M, Ollivier V, Pegulu L, Valla A, Gignoux M
Registre des Tumeurs Digestives du Calvados, Equipe associée INSERM-DGS, Faculté de Médecine CHU Côte de Nacre, Caen, France.
Prev Med. 1995 Sep;24(5):498-502. doi: 10.1006/pmed.1995.1079.
Participation by the target population is clearly a key element in the success of mass screening programs for colorectal cancer. In France, involvement of general practitioners in test distribution is essential to reach a satisfactory participation rate, but other forms of recruitment also have to be organized. The aim of this study was to determine the influence of demographic characteristics such as sex, age, and place of residence on the participation rate in a French mass screening according to different recruitment methods.
The Hemoccult IIR test was proposed in three consecutive ways: spontaneously by general practitioners and occupational doctors during appointments (phase 1), by postal invitation (phase 2), and finally by direct mailing of the test (phase 3). The target population consisted of 11,947 people between 45 and 74 years of age, living in a district of the French county of Calvados, between March 1991 and April 1993.
The overall participation rate was 51.3%. Forty-nine percent of all the tests were done during phase 1, 31% during phase 2, and 20% during phase 3. The overall participation rate varied essentially according to the place of residence, from 65.5% in urban areas and 48.9% in intermediate areas to 27.7% in rural areas. The overall participation rate was also higher for females (57%) than for males (45%) and for those 60 years and older (53.9%) than for those below this age (49.2%). The proportion of tests done during phase 1 was lowest among the youngest and the oldest age groups (37.5% in the 45- to 49-year class and 45.2% in the 70- to 74-year class) and among people living in the rural environment (respectively 55.3%, 45.5%, and 35.9% in urban, intermediate, and rural areas).
This study shows that place of residence strongly influences the global participation rate in mass screening for colorectal cancer in France, whereas sex and age have little influence. Recruitment methods complementary to distribution by general practitioners must be organized, especially for the youngest and oldest age groups (45-49 years and 70-74 years) and above all for people living in rural areas. The social, cultural, and psychological reasons for these differences remain to be investigated, with the aim of adapting mass screening strategies to the different population groups.
目标人群的参与显然是结直肠癌大规模筛查项目成功的关键因素。在法国，全科医生参与检测分发对于达到令人满意的参与率至关重要，但也必须组织其他形式的招募。本研究的目的是根据不同的招募方法，确定性别、年龄和居住地点等人口统计学特征对法国大规模筛查参与率的影响。
连续三次采用不同方式提供隐血IIR检测：在预约期间由全科医生和职业医生自发提供（第1阶段）、通过邮寄邀请（第2阶段），最后通过直接邮寄检测（第3阶段）。目标人群为1991年3月至1993年4月期间居住在法国卡尔瓦多斯县一个区的11947名45至74岁的人。
总体参与率为51.3%。所有检测中，49%在第1阶段完成，31%在第2阶段完成，20%在第3阶段完成。总体参与率主要因居住地点而异，城市地区为65.5%，中间地区为48.9%，农村地区为27.7%。女性总体参与率（57%）高于男性（45%），60岁及以上人群（53.9%）高于该年龄以下人群（49.2%）。在最年轻和最年长年龄组以及农村地区人群中，第1阶段完成的检测比例最低（45至49岁年龄组为37.5%，70至74岁年龄组为45.2%），农村地区人群分别为55.3%、45.5%和35.9%（城市、中间和农村地区）。
本研究表明，居住地点对法国结直肠癌大规模筛查的总体参与率有强烈影响，而性别和年龄影响较小。必须组织与全科医生分发互补的招募方法，特别是针对最年轻和最年长年龄组（45至49岁和70至74岁），尤其是针对农村地区居民。这些差异的社会、文化和心理原因仍有待研究，目的是使大规模筛查策略适应不同人群。
