Patients prefer FIT over blood test for CRC screening
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When given a choice, participants preferred fecal immunochemical test-based screening for colorectal cancer compared with a blood test, according to research presented at Digestive Disease Week.
“Suboptimal participation is common in CRC screening programs; few studies have directly targeted non-participants to test strategies that might be effective in engaging them. Barriers include accessing healthcare systems, belief in the value of screening, exposure to trusted advocates, distaste for certain types of testing and the inconvenience of undertaking the screening system itself,” Graeme Young, MD, FRACP, Flinders Centre for Innovation in Cancer, Flinders University, said. “Our prior studies have demonstrated an overwhelming preference for a blood test over FIT for two-step screening. Thus, a blood test with screening might improve participation, especially in non-participants previously offered FIT.”
To determine participation rates, predictors for screening and reasons for test choice in previous non-participants in FIT-based screening, researchers randomized 875 non-participants at an average risk for CRC to receive either an FIT kit, directions to arrange a blood screening test or the choice of either screening modality. Following a 12-week screening participation assessment, non-participants completed a survey that evaluated the cognitive and attitudinal variables related to participation and screening choice.
The overall participation rate was 12.5% with similar rates between the FIT group (12%; 95% CI, 8.7-16.3), blood test group (13.3%; 95% CI,9.8-17.7) and choice group (13.4%; 95% CI,6.8-13.6). Within the choice group, researchers noted higher FIT participation compared with blood test participation (9.7%, 95% CI, 6.8-13.6 vs. 3.8%; 95% CI, 2.1-6.7) with participants aged 71 years to 75 years (compared with 50-55 years: RR = 3.4; 95% CI, 1.4-8.3) and participants least socially disadvantaged more likely to favor FIT (RR = 2; 95% CI, 1.1-3.7). Cognitive and attitude assessments revealed FIT participants chose FIT because it saved time while blood test participants chose that screening modality to avoid the ‘unpleasantness’ of fecal sampling.
“It should be noted that providing choice did not help in this challenging group, this is consistent with previous studies that have not shown choice to provide an obvious advantage in overall participation,” Young concluded. “Demographic and attitudinal predictors of participation vary between the two test types; when attempting to rescue non-participants, tailoring invitations based on these variables will improve the outcomes.”
Perspective
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The ideal screening modality in those non-adherent to CRC screening is not known. Young and colleagues randomly assigned 875 non-participants at average risk for CRC to receive either a FIT kit, directions to arrange a blood-based screening test or a choice between the two.
Participation was similar in the FIT, blood test and choice group at about 12% to 13%. In the choice group, FIT was preferred over blood test. These results show that many factors other than choice of test play a role in bringing non-participants to screening. It should be noted that the effect of being offered a home-based blood draw or choice of a colonoscopy is not known.
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Young G, et al. Abstract 689. Presented at: Digestive Disease Week; May 21-23, 2021 (virtual meeting).
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