September 22, 2015
2 min read

Majority declined flexible sigmoidoscopy for CRC screening

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Less than half of people opted to undergo a one-off flexible sigmoidoscopy after being invited as part of the English Bowel Scope Screening program, according to a recent study.

“These are early days for the new bowel scope program — there hasn’t been a publicity campaign about it yet, and bowel screening is generally not as familiar to people as breast-screening mammograms or cervical-screening smear tests,” Christian von Wagner, MD, senior lecturer in behavioral research in early diagnosis of cancer at the Health Behavior Research Centre at University College of London, said in a press release. “With that in mind, we were encouraged by the level of uptake in the pilot areas for a fairly new and invasive test, and we were surprised that more men were willing to have the test than women. What we found worrying was that people living in poorer areas seem less likely to take advantage of this screening.”

The English Bowel Cancer Screening Program began its national roll-out of the Bowel Scope Screening Program by inviting 21,187 people who turned 55 between March 2013 and May 2014 to undergo a one-off flexible sigmoidoscopy at one of six screening centers. To evaluate uptake of the program, researchers used multivariate logistic regression analysis to determine overall uptake and variation based on gender, socioeconomic status, ethnic diversity, screening center and appointment time.

Overall, 43.1% accepted the offer to undergo flexible sigmoidoscopy screening, and men were more likely to do so than women (44.6% vs. 41.5%; OR = 1.136; 95% CI, 1.076-1.199).

The researchers observed a socioeconomic gradient in uptake across centers, with 32.7% uptake in the most socioeconomically deprived quintile compared with 53.2% in the least socioeconomically deprived quintile (OR = 2.344; 95% CI, 2.148-2.557).

Areas with the least ethnic diversity had 44.9% uptake compared with 38.7% in areas with the most ethnic diversity, (OR = 1.292; 95% CI, 1.184-1.409), but no gradient was observed.

Those offered a routine appointment during weekday mornings or afternoons were less likely to attend than those offered an out-of-hours appointment during weekday evenings and Saturday mornings and afternoons (42% vs. 44%; OR = 0.931; 95% CI, 0.882-0.983).

Multivariate analyses confirmed that socioeconomic deprivation, gender and center were independent predictors of uptake, but not ethnic diversity or appointment time.

“There are lots of reasons why people, wherever they live, might not have the test — and these can include practical barriers such as embarrassment about the procedure or problems taking time off work to keep the appointment. We’re doing more research to uncover these reasons and see what can be done to encourage as many eligible people as possible to take part,” von Wagner said.

Julie Sharp, MD, head of health and patient information at Cancer Research UK, expressed confidence that the program would be implemented successfully, with high likelihood of prevention and detection, she said in the press release

“You don't need to have symptoms for this test to be effective, but people can choose whether or not to have it and it's important that they receive clear information so they can decide what's right for them,” Sharp said. “Research like this can identify practical barriers that stop people taking up the test when they would like to have it. We welcome the new ambition from the Independent Cancer Taskforce that uptake for bowel scope should reach 75% in all parts of the country by 2020, as this gives a clear signal that the [National Health Service] should be removing these barriers.”

It is expected that the Bowel Scope Screening program will be fully rolled out across all centers by 2016 and covering the full population by 2018. – by Adam Leitenberger

Disclosures: The researchers report no relevant financial disclosures. Sharp reports she is affiliated with Cancer Research UK.