Comparing different strategies for colorectal cancer screening in italy: Predictors of patients participation

Carlo Senore, Paola Armaroli, Marco Silvani, Bruno Andreoni, Luigi Bisanti, Luisa Marai, Guido Castiglione, Grazia Grazzini, Serena Taddei, Stefano Gasperoni, Orietta Giuliani, Giuseppe Malfitana, Anna Marutti, Giovanna Genta, Nereo Segnan

Research output: Contribution to journalArticlepeer-review


OBJECTIVES:The objective of this study was to study predictors of patients participation in colorectal cancer (CRC) screening.METHODS:Men and women, aged 55-64 years, were randomized to the following: (i) biennial fecal occult blood test (FOBT) delivered by mail (n2,266); (ii) FOBT delivered by a general practitioner (GP)/screening facility (n5,893); (iii) once-only sigmoidoscopy (FS) (n3,650); (iv) FS followed by FOBT for screenees with negative FS (n10,867); and (v) patient's choice between FS and FOBT (n3,579). A stratified (by screening arm) random sample of attenders and nonattenders was contacted by trained interviewers 4 months after the initial invitation. Subjects giving their consent were administered a questionnaire (available online) investigating perceptions of individual CRC risk, attitudes toward prevention, adoption of health protective behaviors, and reasons for attendance/nonattendance. Adjusted prevalence odds ratios (ORs) were computed by multivariable logistic regression.RESULTS:The response rate was 71.9% (701 of 975) among nonattenders and 88.9% (773 of 870) among attenders. Adjusting for screening arm, center, gender, age, and education, participation was significantly higher among people who consulted their GP before undergoing screening (OR: 4.24; 95% confidence interval (CI): 3.11-5.78), who mentioned one first-degree relative with CRC (OR: 3.62; 95% CI: 2.02-6.49), who reported regular physical activity (OR: 1.85; 95% CI: 1.33-2.55), and who read the mailed information (letter only: OR: 1.85; 95% CI: 1.23-2.78; letterleaflet: OR: 3.18; 95% CI: 2.12-4.76). People who considered screening to be ineffective (OR: 0.12; 95% CI: 0.08-0.19), those who considered it to be effective but reported even moderate levels of anxiety (OR: 0.32; 95% CI: 0.23-0.45), and those who mentioned previous knowledge of CRC screening tests were less likely to accept the invitation (OR: 0.49; 95% CI: 0.34-0.70).CONCLUSIONS:Adoption of health protective behaviors is associated with a higher attendance rate, whereas anxiety represents a strong barrier, even among people who deemed screening to be effective. Increasing the proportion of people who consult their GP when making a decision regarding screening might enhance participation.

Original languageEnglish
Pages (from-to)188-198
Number of pages11
JournalAmerican Journal of Gastroenterology
Issue number1
Publication statusPublished - Jan 2010

ASJC Scopus subject areas

  • Gastroenterology


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