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Comparison of uptake of colorectal cancer screening based on faecal immunochemical testing (FIT) in males and females: A systematic review and meta-analysis.

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Presentation on theme: "Comparison of uptake of colorectal cancer screening based on faecal immunochemical testing (FIT) in males and females: A systematic review and meta-analysis."— Presentation transcript:

1 Comparison of uptake of colorectal cancer screening based on faecal immunochemical testing (FIT) in males and females: A systematic review and meta-analysis Nicholas Clarke, Aoife Osborne, Patricia M Kearney, Linda Sharp Irish Cancer Society Funded PhD Scholar

2 Overview Introduction The problem and aims Methods and search Results Discussion Implications

3 Introduction Colorectal cancer  3 rd most common in women worldwide  2 nd most common in men worldwide  Age standardised incidence 44% higher in men (20.6 vs. 14.3) worldwide  Age standardised mortality 45% higher in men (10.0 vs. 6.9) worldwide (GLOBOCAN, 2012)

4 Colorectal cancer screening Reduction in incidence Reduction in mortality Economic benefit in life years saved Improves QOL

5 Colorectal cancer screening Hospital based screening  Colonoscopy  Flexible sigmoidoscopy  Double-contrast barium enema  Computed tomographic (CT) colonography Home or GP based screening  FOBT  FIT Non-invasive  Faecal DNA testing

6 Colorectal cancer screening FOBT screening uptake higher than more invasive tests (Khalid-de Bakker et al, 2011) FIT uptake higher than FOBT (Vart et al, 2012) Men more likely to participate in endoscopic based tests (Evans et al 2005, Meissner et al, 2006, Javanprast et al, 2010) Men less likely to participate in FOBT based screening (von Wagner et al, 2011, Seef et al, 2004)

7 Given: 1) males at greater risk of developing and dying from CRC 2) FIT increasingly recommended (Von Karsa et al, 2013, Levin et al, 2008), is there a differential uptake between males and females in FIT based screening? Problem

8 Aims To conduct a systematic review of studies containing comparisons of male and female participation rates of FIT based colorectal cancer screening. To determine if factors such as age, number of samples, invitation strategy and reminders impact on differences in uptake

9 Methods RCTs & Observational studies Numbers of males and females invited and screened Inclusion PubMed Embase Databases Meta-analysis & subgroup analysis using Revman Analysis RCTs – Cochrane risk of bias tool Observational studies – Newcastle Ottawa Scale Quality Assessment

10 The Search

11 Results 6 RCTs, 12 cross-sectional, 1 cohort 15 population based Study design 4,789,384 invited 1,396,445 screened Excluding Park et al (2011): 382, 684 invited - 185,283 screened Subjects 10.5% (Park et al, 2011) % (Fenocchi et al, 2006) Less than 40% (7 studies) 40-60% (8 studies) Over 60% (4 studies) Uptake rates

12 Study locations

13 Results – Uptake Meta-analysis 0.83 [0.77, 0.90]

14 Results – RCTs Meta analysis 0.83 [0.71, 0.97]

15 Results – Cross sectional studies meta analysis 0.85 [0.78, 0.94]

16 Results Significantly lower uptake in males Lower uptake across sub-group analysis Situations in which there is no difference in uptake:  Low quality studies  Non population based studies  Studies using advance notification invitations  Studies targeting people over 50 years of age with no upper age limit  Contact with medical professional

17 Discussion Uptake similar when there is contact with medical professional Uptake similar in studies with no upper age limit  Older males may be more inclined to participate  Older men report less disability (White et al, 2011)  Older men may be more health conscious

18 Discussion – Males in health care Absence of male targeted healthcare programmes (White et al, 2011) When males more accepting of screening often see themselves as adhering to physician recommendations (Ritvo et al, 2013) Males often procrastinate about screening (Ritvo et al, 2013)  fatalism  preventative/protective elements of screening

19 Summary & Implications Significantly lower male uptake of FIT based CRC screening Need for targeted gender based strategies to improve uptake in FIT based screening

20 References Cai SR, Zhang SZ, Zhu HH, Huang YQ, Li QR, Ma XY, Yao KY, Zheng S. (2011) Performance of a colorectal cancer screening protocol in an economically and medically underserved population. Cancer Prev Res; 4(10): Chen LS, Liao CS, Chang SH, Lai HC, Chen TH. (2007) Cost-effectiveness analysis for determining optimal cut-off of immunochemical faecal occult blood test for population-based colorectal cancer screening (KCIS 16). J Med Screen; 14(4): Cole SR, Young GP, Byrne D, Guy JR, Morcom J. (2002) Uptake in screening for colorectal cancer based on a faecal occult blood test is improved by endorsement by the primary care practitioner. J Med Screen; 9(4): Cole SR, Young GP, Esterman A, Cadd B, Morcom J. (2003)A randomised trial of the impact of new faecal haemoglobin test technologies on population uptake in screening for colorectal cancer. Med Screen;10(3): Crotta S, Castiglione G, Grazzini G, Valle F, Mosconi S, Rosset R. (2004) Feasibility study of colorectal cancer screening by immunochemical faecal occult blood testing: results in a northern Italian community. Eur J Gastroenterol Hepatol;16(1):33-7. Fenocchi E, Martínez L, Tolve J, Montano D, Rondán M, Parra-Blanco A, Eishi Y. (2006) Screening for colorectal cancer in Uruguay with an immunochemical faecal occult blood test. Eur J Cancer Prev;15(5): Ferrari Bravo M, De Conca V, Devoto GL, Sironi M, Mele R, Fumagalli A, Rimassa P, Rossi G, Zampogna A, Sticchi C, Gabutti G (2012) Medical Screening Program Group. Colorectal cancer screening in LHU4 Chiavarese, Italy: ethical, methodological and outcome evaluations at the end of the first round. J Prev Med Hyg;53 (1): GLOBOCAN (2012) IARC Section of Cancer Information (Cited:(04/03/2014). Available at: of Cancer Informationhttp://globocan.iarc.fr Gregory TA, Wilson C, Duncan A, Turnbull D, Cole SR, Young G. 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(2010) How equitable are colorectal cancer screening programs which include FOBTs? A review of qualitative and quantitative studies. Preventive Medicine; 50: Kelley L, Swan N, Hughes DJ. (2013) An analysis of the duplicate testing strategy of an Irish immunochemical faecal occult blood test colorectal cancer screening programme. Colorectal Dis.;15(9):e Khalid-de Bakker C, Jonkers D, Smits K, Masclee A, Stockbrügger R. (2011) Uptake in colorectal cancer screening trials after first-time invitation: a systematic review. Endoscopy; 43 (12): Kluhsman BC, Lengerich EJ, Fleisher L, Paskett ED, Miller-Halegoua SM, Balshem A, Bencivenga MM, Spleen AM, Schreiber P, Dignan MB. (2012) A pilot study for using fecal immunochemical testing to increase colorectal cancer screening in Appalachia, Prev Chronic Dis; 9:E77. Levin B, Lieberman DA, McFarland B, et al. (2008)Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. Gastroenterology; 134: 1570– 1595 Levy BT, Daly JM, Luxon B, Merchant ML, Xu Y, Levitz CE, Wilbur JK. (2010) The Iowa get screened" colon cancer screening program." J Prim Care Community Health; 1(1):43-9 McDonald P.J., Strachan J.A., Digby J., Steele R.J.C., Fraser C.G. (2012) Faecal haemoglobin concentrations by gender and age: Implications for population-based screening for colorectal cancer. Clinical Chemistry and Laboratory Medicine: 50 (5): ). Parente F, Marino B, DeVecchi N, Moretti R; Lecco Colorectal Cancer Screening Group, Ucci G, Tricomi P, Armellino A, Redaelli L, Bargiggia S, Cristofori E, Masala E, Tortorella F, Gattinoni A, Odinolfi F, Pirola ME. 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21 Acknowledgement This research has been funded by an Irish Cancer Society scholarship grant


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