Colorectal cancer screening in Australia: a community-level perspective.
ABSTRACT To determine current colorectal cancer (CRC) screening rates and the level of adherence to screening guidelines @a community level.
A cross-sectional cohort of at-risk people aged 56-88 years randomly selected from the Hunter Community Study (HCS), Australia.
Proportion ever reporting undertaking any CRC testing; current screening rates for each CRC screening modality; level of screening in accordance with national screening guidelines.
Of the 1117 participants (70%) who returned a questionnaire, 777 were deemed asymptomatic and eligible for analysis. Overall, 63% of respondents had ever received any CRC testing. Forty-three per cent had ever had a faecal occult blood test (20% screened in the previous 2 years); 30% had ever had a colonoscopy (16% screened in the previous 5 years); and 7% had ever had a sigmoidoscopy (1% screened in the previous 5 years). Rates of adherence to screening guidelines were 21% for respondents who were @or slightly above average risk, and 45% for respondents who were @moderately increased or potentially high risk.
Rates of CRC screening remain low. The screening rate for colonoscopy was particularly high among people who were @or slightly above average risk, despite such screening not being endorsed in the guidelines. Effective strategies to improve rates of CRC screening and appropriate use of colonoscopy are required across the entire at-risk population.
- [show abstract] [hide abstract]
ABSTRACT: Australia has one of the highest incidences of colorectal cancer (CRC) in the world. In 2006, the federal government introduced a screening program consisting of a one-off fecal occult blood test offered to people turning 50, 55, or 65 years. We conducted a population-based study to estimate CRC screening practices existing outside the current program. A total of 1887 unaffected subjects categorized "at or slightly above average risk" of CRC were selected from the Australasian Colorectal Cancer Family Registry. We calculated the proportions of participants that reported appropriate, under- and over-screening according to national guidelines. We performed a logistic regression analysis to evaluate associations between over-screening and a set of socio-demographic factors. Of 532 participants at average risk of CRC, eligible for screening, 4 (0.75 %) reported appropriate screening, 479 (90 %) reported never having been screened, 18 (3 %) reported some but less than appropriate screening, and 31 (6 %) reported over-screening. Of 412 participants aged 50 years or over, slightly above average risk of CRC, 1 participant (0.25 %) reported appropriate screening, 316 (77 %) reported no screening, and 11 (3 %) reported some but less than appropriate screening. Among participants under age 50 years, 2 % of those at average risk and 10 % of those slightly above average risk reported over-screening. Middle-aged people, those with a family history of CRC and those with a university degree, were more likely to be over-screened. Overall, the level of CRC screening participation was low and the vast majority of screening tests undertaken were inappropriate in terms of timing, modality, or frequency.Cancer Causes and Control 09/2012; 23(11):1853-64. · 3.20 Impact Factor
- [show abstract] [hide abstract]
ABSTRACT: BACKGROUND: The aim of this study was to determine the proportions and predictors of first-degree relatives (FDRs) of colorectal cancer (CRC) patients (i) ever receiving any CRC testing and (ii) receiving CRC screening in accordance with CRC screening guidelines. METHODS: Colorectal cancer patients and their FDRs were recruited through the population-based Victorian Cancer Registry, Victoria, Australia. Seven hundred and seven FDRs completed telephone interviews. Of these, 405 FDRs were deemed asymptomatic and eligible for analysis. RESULTS: Sixty-nine percent of FDRs had ever received any CRC testing. First-degree relatives of older age, those with private health insurance, siblings and FDRs who had ever been asked about family history of CRC by a doctor were significantly more likely than their counterparts to have ever received CRC testing. Twenty-five percent of FDRs "at or slightly above average risk" were adherent to CRC screening guidelines. For this group, adherence to guideline-recommended screening was significantly more likely to occur for male FDRs and those with a higher level of education. For persons at "moderately increased risk" and "potentially high risk", 47% and 49% respectively adhered to CRC screening guidelines. For this group, guideline-recommended screening was significantly more likely to occur for FDRs who were living in metropolitan areas, siblings, those married or partnered and those ever asked about family history of CRC. CONCLUSIONS: A significant level of non-compliance with screening guidelines was evident among FDRs. Improved CRC screening in accordance with guidelines and effective systematic interventions to increase screening rates among population groups experiencing inequality are needed.Australian and New Zealand Clinical Trial Registry: ACTRN12609000628246.BMC Cancer 01/2013; 13(1):13. · 3.33 Impact Factor
- [show abstract] [hide abstract]
ABSTRACT: We conducted a systematic review and a meta-analysis of observational studies to identify and summarise the level of colorectal cancer (CRC) screening participation for people at increased risk due to family history of the disease. Medline, Cinhal, Embase and PsychInfo databases were comprehensively searched between January 1995 and May 2012 to identify relevant articles. To be included, studies had to report on screening for people who had at least one first-degree relative with CRC and no previous personal diagnosis of the disease. Pooled screening participation levels were calculated for each screening modality. Seventeen studies, accounting for a total of 13,269 subjects with a family history of CRC met the inclusion criteria. Seven studies, including a total of 6,901 subjects had a pooled faecal occult blood testing screening participation (at least once) of 25 % (95 % CI 12-38). Five studies including a total of 5,091 subjects had a pooled sigmoidoscopy-based screening participation (at least once) of 16 % (95 % CI 7-27). Seven studies including a total of 9,965 subjects had pooled participation colonoscopy-based screening (at least once) of 40 % (95 % CI 26-54). There was a significant level of screening heterogeneity between studies. This review identified a substantial underuse of CRC screening for people at increased risk of developing the disease. It highlights the potential opportunity that exists for increasing screening participation among this segment of the population and the need to adjust the current CRC screening policies towards that objective.Familial Cancer 05/2013; · 1.94 Impact Factor