Factors influencing colorectal cancer screening participation rates in 2016

Abstract

Introduction: EDIFICE surveys set out to improve insight into the behavior of the French population with regard to participation in cancer screening programs. The colorectal cancer (CRC) screening program has been in place since 2009 and targets the 50-74-year age group. In 2015, a fecal immunochemical test was implemented, replacing the guaiac fecal occult blood test. By analyzing the latest data on participation rates we sought to determine whether anxiety related to colorectal cancer itself or to the actual screening process are factors that influence participation in the program. Methods: The 5th nationwide observational survey was conducted by phone interviews using the quota method. A representative sample of 1501 individuals (age, 50-75 years) was interviewed between November 22 and December 7, 2016. The present analysis concerns 1299 individuals with no personal history of cancer (age, 50-74 years). Results: In 2016, 64% of the respondents declared having undergone at least one test in their lifetime for CRC screening, compared to 60% in 2014 (difference was not statistically significant, NS). The increase was most striking among younger people (50-54 years, 50% vs. 38% in 2014, P=0.01). Between 2014 and 2016, the proportion of participants who reported having undergone a screening test (fecal immunochemical test or guaiac fecal occult blood test) in the past two years, i.e., as recommended by the guidelines in France, increased significantly (33% in 2014 vs 38% in 2016, P=0.03); once again, this increase was more notable in the 50-54-year age group. The highest proportion of individuals having undergone screening (72%) was found to be amongst those who reported feeling reassured by screening and anxious about CRC (39% of the total population). Comparatively, this proportion was lower (65%, P=0.01) among respondents who reported feeling reassured by screening and not anxious about CRC (47% of the total population). Figures were even lower (57%), though not significantly, among those who were not reassured by screening but who were anxious about colorectal cancer (2% of the total population). The lowest proportion of individuals screened (35% vs 72%, P<0.01) were those who reported not feeling reassured by screening and not anxious about CRC (9% of the total population). Conclusion: The rate of participation in the national CRC screening program in France showed a rising trend between 2014 and 2016. This trend was particularly notable in the 50-54-year age group. Overall, participants were not anxious about CRC, nor about screening. Higher participation rates were however associated with anxiety regarding the disease and reassurance in the screening procedure.