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Effectiveness of an organized colorectal cancer screening program on increasing adherence in asymptomatic average-risk Canadians.

Charters TJ, Strumpf EC, Sewitch MJ - BMC Health Serv Res (2013)

Bottom Line: The difference-in-differences analysis shows that ColonCancerCheck increased FOBT screening in the average risk population by 5.2 percentage points (95% CI [3.2, 7.2]), an increase of 33% relative to pre-program screening rates.The program had no observed effect on endoscopy screening and we found no evidence that ColonCancerCheck differentially altered the screening practices of population sub-groups.Our findings suggest ColonCancerCheck has been successful at increasing use of FOBT in the asymptomatic average risk population.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Purvis Hall 41, 1020 Pine Ave, West, Montreal, QC H3A 1A2, Canada. thomas.charters@mcgill.ca.

ABSTRACT

Background: Colorectal cancer (CRC) is the third most commonly diagnosed cancer and second highest cause of cancer-related mortality in Canada. Despite the availability of screening services and establishment of guidelines, utilization of colorectal cancer screening in Canada remains low. In 2008, the province of Ontario launched ColonCancerCheck, an organized colorectal cancer screening program aimed at increasing CRC screening adherence. In this study, we adopt a quasi-experimental approach to estimate and describe the impact of ColonCancerCheck on screening behavior in the asymptomatic average risk population.

Methods: Annual screening rates from the target population were estimated using five cycles of the Canadian Community Health Survey, a cross-sectional nationally representative survey of health status, healthcare use, and determinants of health in the Canadian population. We used a difference-in-differences design to measure the overall impact of ColonCancerCheck on past-year fecal occult blood testing (FOBT) and endoscopy in Ontario relative to the rest of Canada. Several verification tests validated the suitability of our model specification.

Results: The difference-in-differences analysis shows that ColonCancerCheck increased FOBT screening in the average risk population by 5.2 percentage points (95% CI [3.2, 7.2]), an increase of 33% relative to pre-program screening rates. The program had no observed effect on endoscopy screening and we found no evidence that ColonCancerCheck differentially altered the screening practices of population sub-groups.

Conclusions: Our findings suggest ColonCancerCheck has been successful at increasing use of FOBT in the asymptomatic average risk population.

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Related in: MedlinePlus

Past Year CRC Screening in Canada.
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Related In: Results  -  Collection

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Figure 1: Past Year CRC Screening in Canada.

Mentions: Comparisons between the intervention and control groups in the pre-intervention period generally show similarities across a range of measures, indicating the appropriateness of the control group. Notable differences include urban geography, ethnic diversity, flu shot uptake, and screening adherence (Table 2). Figure 1 indicates FOBT screening trends in Ontario rose more consistently than those in the control group, and jumped from 15.7% to 21.9% from 2007 to 2008. FOB testing trends in the control group are fairly similar to those in Ontario overall, despite an uncharacteristic decrease in 2005. FOBT use in the control group decreases from 12.4% in 2007 to 10.6% in 2008. Rates of past year endoscopy screening rose gradually in both groups, with little indication of a change in trajectory in 2008.


Effectiveness of an organized colorectal cancer screening program on increasing adherence in asymptomatic average-risk Canadians.

Charters TJ, Strumpf EC, Sewitch MJ - BMC Health Serv Res (2013)

Past Year CRC Screening in Canada.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4231607&req=5

Figure 1: Past Year CRC Screening in Canada.
Mentions: Comparisons between the intervention and control groups in the pre-intervention period generally show similarities across a range of measures, indicating the appropriateness of the control group. Notable differences include urban geography, ethnic diversity, flu shot uptake, and screening adherence (Table 2). Figure 1 indicates FOBT screening trends in Ontario rose more consistently than those in the control group, and jumped from 15.7% to 21.9% from 2007 to 2008. FOB testing trends in the control group are fairly similar to those in Ontario overall, despite an uncharacteristic decrease in 2005. FOBT use in the control group decreases from 12.4% in 2007 to 10.6% in 2008. Rates of past year endoscopy screening rose gradually in both groups, with little indication of a change in trajectory in 2008.

Bottom Line: The difference-in-differences analysis shows that ColonCancerCheck increased FOBT screening in the average risk population by 5.2 percentage points (95% CI [3.2, 7.2]), an increase of 33% relative to pre-program screening rates.The program had no observed effect on endoscopy screening and we found no evidence that ColonCancerCheck differentially altered the screening practices of population sub-groups.Our findings suggest ColonCancerCheck has been successful at increasing use of FOBT in the asymptomatic average risk population.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Purvis Hall 41, 1020 Pine Ave, West, Montreal, QC H3A 1A2, Canada. thomas.charters@mcgill.ca.

ABSTRACT

Background: Colorectal cancer (CRC) is the third most commonly diagnosed cancer and second highest cause of cancer-related mortality in Canada. Despite the availability of screening services and establishment of guidelines, utilization of colorectal cancer screening in Canada remains low. In 2008, the province of Ontario launched ColonCancerCheck, an organized colorectal cancer screening program aimed at increasing CRC screening adherence. In this study, we adopt a quasi-experimental approach to estimate and describe the impact of ColonCancerCheck on screening behavior in the asymptomatic average risk population.

Methods: Annual screening rates from the target population were estimated using five cycles of the Canadian Community Health Survey, a cross-sectional nationally representative survey of health status, healthcare use, and determinants of health in the Canadian population. We used a difference-in-differences design to measure the overall impact of ColonCancerCheck on past-year fecal occult blood testing (FOBT) and endoscopy in Ontario relative to the rest of Canada. Several verification tests validated the suitability of our model specification.

Results: The difference-in-differences analysis shows that ColonCancerCheck increased FOBT screening in the average risk population by 5.2 percentage points (95% CI [3.2, 7.2]), an increase of 33% relative to pre-program screening rates. The program had no observed effect on endoscopy screening and we found no evidence that ColonCancerCheck differentially altered the screening practices of population sub-groups.

Conclusions: Our findings suggest ColonCancerCheck has been successful at increasing use of FOBT in the asymptomatic average risk population.

Show MeSH
Related in: MedlinePlus