Testing behavioral interventions to optimize participation in a population-based colorectal cancer screening program in Catalonia, Spain.

The aim of the study was to measure the effect of three cost-neutral behavioral interventions on participation compared to the standard invitation letter in a population-based colorectal cancer screening program in 2014. For that purpose, a four-arm randomized field trial was conducted among 5077 individuals aged 50 to 69 years. Over an 8-week period, each week was randomly allocated to the intervention or the control conditions. Individuals assigned to the intervention conditions additionally received a prompt to write down the date to pick up the screening test in a pharmacy. Two of the three intervention groups also included an additional paragraph in the invitation letter on either: 1) the high proportion of individuals participating regularly (social norms condition) or 2) the importance of regular participation (benefit condition). We measured screening participation before and after receiving a reminder letter six weeks after the screening invitation. An overall 8.0 percentage point increase in CRC screening was achieved as a direct result of receiving a reminder letter; however none of the intervention strategies influenced participation. The only significant difference was found for newly invited individuals. There, participation rates decreased from 34.9% to 24.2% when the invitation mailing mentioned the importance of regular participation (OR: 0.60; 95% CI: 0.38-0.95). While none of the intervention strategies improved participation rates we found that praising the benefit of regular screening may discourage individuals who have never been invited before as the continuous behavior may be perceived as a large request. Nevertheless, the reminder letter boosted participation rates independently of the intervention assigned.

Cross-sectional survey on awareness of colorectal cancer and a screening programme for primary health care professionals in Catalonia, Spain.

This study aimed to assess whether primary health care professionals have accurate information regarding colorectal cancer (CRC) screening procedures, surveillance recommendations and referral strategies. This cross-sectional descriptive study was based on a survey conducted among primary health care professionals in Barcelona, Spain. The questionnaire was used to gather information regarding CRC screening procedures as well as demographic and professional characteristics of the study subjects. A CRC and screening awareness score (ranging from 0 to 12) was created based on the survey questions. The response rate was 58.9% (206/305). The estimated mean score (standard deviation) was 8.43 (SD: 1.30). For four questions, more than 60% of the answers were incorrect: one related to risk factors, two concerning follow-up colonoscopy, and one related to surveillance. Only 30.8% of the participants believed that they were responsible for determining the appropriate surveillance intervals and for scheduling colonoscopies. Although the professionals had sufficient knowledge of CRC screening, professional knowledge of some aspects related to the major non-modifiable risk factors for the disease and surveillance colonoscopy procedures could be improved. Frequent communication with professionals is necessary to maintain updated screening-related information. Possible methods for facilitating communication could include continuous briefings, regular message reminders or educational websites.

Interval cancers in a population-based screening program for colorectal cancer in catalonia, Spain.

Objective. To analyze interval cancers among participants in a screening program for colorectal cancer (CRC) during four screening rounds. Methods. The study population consisted of participants of a fecal occult blood test-based screening program from February 2000 to September 2010, with a 30-month follow-up (n = 30,480). We used hospital administration data to identify CRC. An interval cancer was defined as an invasive cancer diagnosed within 30 months of a negative screening result and before the next recommended examination. Gender, age, stage, and site distribution of interval cancers were compared with those in the screen-detected group. Results. Within the study period, 97 tumors were screen-detected and 74 tumors were diagnosed after a negative screening. In addition, 17 CRC (18.3%) were found after an inconclusive result and 2 cases were diagnosed within the surveillance interval (2.1%). There was an increase of interval cancers over the four rounds (from 32.4% to 46.0%). When compared with screen-detected cancers, interval cancers were found predominantly in the rectum (OR: 3.66; 95% CI: 1.51-8.88) and at more advanced stages (P = 0.025). Conclusion. There are large numbers of cancer that are not detected through fecal occult blood test-based screening. The low sensitivity should be emphasized to ensure that individuals with symptoms are not falsely reassured.

Use of text-message reminders to improve participation in a population-based breast cancer screening program.

To analyze the effect of a cell text message reminder service on participation in a mammogram screening program in Catalonia, Spain. A quasi-experimental design was used with women aged 50 to 69 years who had been scheduled mammogram appointments in June or July 2011. Women were personally invited by letter to attend to the breast cancer screening program (n = 12,786). Prior to the invitation, 3,719 (29.1 %) of them had provided their cell telephone number to the National Health Service. These women received a text message reminder 3 days before their scheduled appointment. Logistic regression models were used to analyze whether the text message reminder was associated with participation in screening. Cost-effectiveness of adding a text message reminder to the invitation letter was also analyzed. The overall rate of participation in breast cancer screening was 68.4 %. The participation rate was significantly higher in the text messaging group, with an age-adjusted OR of 1.56 (95 %CI: 1.43-1.70). A detailed analysis showed that the increase in participation related to the text message reminder was higher among women without previous screening who lived in areas where access to postal mail was limited (OR=2.85; 95 %CI: 2.31-3.53) compared to those who lived in areas of easier postal mail access (OR=1.66; 95 %CI: 1.36-2.02). The invitation letter+text message reminder was a cost-effective strategy. Text message reminders are an efficient cost-effective approach to improve participation in difficult-to-reach populations, such as rural areas and newly developed suburbs.

Factors associated with initial participation in a population-based screening for colorectal cancer in Catalonia, Spain: a mixed-methods study.

OBJECTIVE: To identify barriers and facilitators associated with participation in the first round of a population-based program for colorectal cancer (CRC) in Catalonia, Spain and to identify strategies for motivating and supporting behavioral change. MATERIAL AND METHODS: A two-part, mixed-methods design was used. In first place, a prospective study of individuals aged 50-69 years (n=1961) was conducted in 2006-2007. Secondly, focus groups were undertaken with participants and non-participants of the CRC screening, in 2008. RESULTS: Intention to participate was an important determinant of participation (82.9% vs 65.9%, OR=2.56, 95%CI:1.95-3.36) in addition to knowledge about CRC and its early detection. Respondents who reported that CRC may be asymptomatic in early stages enrolled in the screening program more frequently than those who thought CRC is always symptomatic (49.4% vs 44.8%, OR:1.82; 95%CI:1.3-2.6). Barriers for participation mentioned in focus groups were competing perceived for other health problems and other demands as well as misunderstanding about personal relevance of the screening. CONCLUSION: Individuals' perceptions of CRC are amenable to change through education-based interventions. Increasing public knowledge related to the burden of CRC and its preventive potential may be an effective way for improving participation in a population-based screening program.

Colorectal cancer screening: strategies to select populations with moderate risk for disease.

OBJECTIVE: to analyse the association between rectal bleeding or a family history of colorectal cancer (CRC) and the results obtained in two rounds of a CRC screening pilot programme performed in L Hospitalet, Barcelona, Spain. SUBJECTS: males and females (50-69 years) were the target population. Together with the invitation letter, they received a questionnaire in which they were asked about rectal bleeding, family history of CRC and related neoplasms. The screening test was a guaiac-based faecal occult blood test (FOBT), and colonoscopy for positive tests. RESULTS: 25,829 FOBT were performed in 18,405 individuals. Information on rectal bleeding and a family history of CRC were obtained for 9,849 and 9,865 cases, respectively. Male sex (OR = 1.32), 60-69 years of age (OR = 1.48), rectal bleeding (OR = 1.84) and history of CRC (OR = 1.54) were independent predictors of positive FOBT. With regard to colonoscopy, a greater risk of diagnosing advanced neoplasm was observed among men (OR = 2.47) and subjects with a family history of CRC (OR = 1.98). CONCLUSIONS: CRC screening programmes must have instruments that make it possible to select the candidate population and the possibility of offering a study suited to the risk of individuals who are not susceptible to population screening by means of FOBT.

[Colonoscopic findings from a pilot screening study for colorectal cancer in Catalonia]. / Hallazgos colonoscópicos del estudio piloto de cribado de cáncer colorrectal realizado en Cataluña.

OBJECTIVE: to evaluate lesions detected in two screening rounds performed in a pilot screening programme for colorectal cancer in Catalonia, Spain. MATERIAL AND METHODS: a colorectal cancer screening programme was initiated in 2000. The target population included men and women aged 50-69 years. Screening consisted of biennial guaiac-based fecal occult blood testing (FOBT), and colonoscopy for participants with a positive FOBT. Any polyps found were removed, and biopsies were performed for any masses. RESULTS: colonoscopies were performed in 442 of 495 people with positive FOBT. In 213 (48.2%), 36 invasive cancers, 121 high-risk adenomas, 29 low-risk adenomas, and 27 hyperplastic polyps were diagnosed. Lesion size was smaller than 10 mm in 25.8% of cases. Most detected lesions (37.2%) were located in the distal colon, followed by the proximal colon (5.7%) and both locations (5.2%). Advanced neoplasm was significantly associated with male gender and distal location. The prevalence of advanced proximal neoplasms among patients with no distal polyps was 5.1%. CONCLUSIONS: the most common lesions detected by colonoscopy were high-risk adenomas located in the distal colon. FOBT is a suitable method for detecting small precancer lesions during population screening, and is thus a key factor in reducing the incidence of colorectal cancer.

Hallazgos colonoscópicos del estudio piloto de cribado de cáncer colorrectal realizado en Cataluña / No disponible

Objetivo: evaluar las lesiones detectadas en las dos rondas yafinalizadas del Programa Piloto de Cribado en Cáncer Colorrectal(CCR) llevado a cabo en L’Hospitalet de Llobregat (Barcelona).Material y métodos: el programa de cribado de CCR se inicióen el año 2000. La población, comprendida entre 50 y 69años residentes en el área, fue invitada a participar a través de ladeterminación bienal de sangre oculta en heces mediante el testguaiaco y colonoscopia en los participantes con test positivo. Serealizó polipectomía de las lesiones detectadas o biopsias cuandono era posible la extirpación. Los pólipos se clasificaron según criteriosde la Organización Mundial de la Salud.Resultados: se realizaron 442 colonoscopias de los 495 testpositivos. En 213 individuos, se detectaron: 36 cánceres invasivos,121 adenomas de alto riesgo, 29 adenomas de bajo riesgo y27 pólipos hiperplásicos. En el 25,8% de los casos, el tamaño delos adenomas fue < 10 mm. La mayoría de las lesiones diagnosticadas(37,2%) estaban localizadas en el colon distal, el 5,7% a nivelproximal y ambas localizaciones en el 5,2%. Las neoplasiasavanzadas se asociaron significativamente al sexo masculino y lalocalización distal. La prevalencia de neoplasias avanzadas a nivelproximal entre los pacientes sin pólipos distales fue del 5,1%.Conclusiones: los adenomas de alto riesgo de localizacióndistal han sido las lesiones detectadas con mayor frecuencia. Elcribado poblacional mediante la determinación de sangre ocultaen heces es un método factible para detectar pequeñas lesionesprecancerosas, factor clave para disminuir la incidencia de CCR

Objective: to evaluate lesions detected in two screeningrounds performed in a pilot screening program for colorectal cancerin Catalonia, Spain.Material and methods: a colorectal cancer screening programwas initiated in 2000. The target population included menand women aged 50-69 years. Screening consisted of biennialguaiac-based fecal occult blood testing (FOBT), and colonoscopyfor participants with a positive FOBT. Any polyps found were removed,and biopsies were performed for any masses.Results: Colonoscopies were performed in 442 of 495 peoplewith positive FOBT. In 213 (48.2%), 36 invasive cancers, 121high-risk adenomas, 29 low-risk adenomas, and 27 hyperplasticpolyps were diagnosed. Lesion size was smaller than 10 mm in25.8% of cases. Most detected lesions (37.2%) were located in thedistal colon, followed by the proximal colon (5.7%) and both locations(5.2%). Advanced neoplasm was significantly associated withmale gender and distal location. The prevalence of advancedproximal neoplasms among patients with no distal polyps was5.1%.Conclusions: the most common lesions detected bycolonoscopy were high-risk adenomas located in the distal colon.FOBT is a suitable method for detecting small precancer lesionsduring population screening, and is thus a key factor in reducingthe incidence of colorectal cancer