Predictive factors for non-participation or partial participation in breast, cervical and colorectal cancer screening programmes†.

BACKGROUND: No study has investigated factors associated with non-participation or partial participation in the different combination patterns of screening programmes for all three cancers, that is, breast, colorectal and cervical cancer. METHODS: In a retrospective cohort study, we sought to describe combinations of cancer screening participation rates among women in the Val-de-Marne area of France and to identify individual and contextual factors associated with non-participation or partial participation. RESULTS: Women aged between 50 and 65 and who were eligible for all three screening programmes (n = 102 219) were analysed in multilevel logistic models, with the individual as the Level 1 variable and the place of residence as the Level 2 variable. The women who did not participate in any of the screening programmes were 34.4%, whereas 30.1%, 24% and 11.5% participated in one, two or all three screening programmes, respectively. Age below 55, a previous false-positive mammography, prior opportunistic mammography only, no previous mammography, membership of certain health insurance schemes (all P < 0.05) and residence in a deprived area (P < 0.001) were independently associated with non-participation or partial participation. We observed a stronger effect of deprivation on non-participation in all three cancers than in combinations of screening programmes. CONCLUSION: Our findings suggest that the health authorities should focus on improving cancer screenings in general rather than screenings for specific types of cancer, especially among younger women and those living in the most socially deprived areas.

Colorectal cancer fecal screening test completion after age 74, sources and outcomes in French program.

BACKGROUND: Elderly patients aged at least 75 years old (Elderly_75), represent 45% of colorectal cancer (CRC) incidence. As others, the French Colorectal Cancer Screening Program (CRCSP) does not include Elderly_75. To date, there is little evidence to justify stopping screening at 74 years of age. AIM: To describe CRC fecal screening test completion after age 74, source (CRCSP/Provider ordered) and outcomes of these tests. METHODS: The study concerned 18704 Elderly_75 residing in eleven French districts (Ain, Doubs, Essonne, Haute-Saone, Hauts-de-Seine, Jura, Seine-Saint-Denis, Territoire-de-Belfort, Val-de-Marne, Val-d'Oise, Yonne), having performed a CRC screening test between January 2008 and December 2017. The tests performed in a circumstance of delayed response to a solicitation (DRS) from the local cancer screening managing center (Managing-Center) were distinguished from the tests non-solicited by the Managing-Center, performed after a recommendation by a General Practitioner (GP) or other provider ordered (RGP). DRS was any test realized by an Elderly_75 following an initial invitation from the Managing-Center with a maximum 24 mo after this invitation. Any Non-DRS test was considered RGP. The outcomes of these tests were described according to the circumstances of test completion. RESULTS: Of 18995 screening-tests were performed at ages: 75 (83.5%), 76-80 (13.4%) and > 80 (3.1%) years old. Elderly_75 performed the screening test in a circumstance of DRS (71.9%) or RGP (28.1%). The proportion of the tests that could not be analyzed and not restarted was 13.2%. For these unanalyzed tests, the reason was age-related in 78.0% of cases, related to the laboratory's refusal to analyze the test of people aged ≥ 77. Reported colonoscopy completion rate was 81.3%. For those 575 people with reported colonoscopy, no complication was listed. 18.0% of the 366 Elderly_75 with lesions had no anteriority in the CRCSP. The neoplasia (124 Low-risk-polyps, 159 High-risk-polyps, 13 Unspecified-polyps and 70 CRCs) detection rate was 19.3/1000 Elderly_75 screened and the CRC detection rate was 3.7/1000 Elderly_75 screened. CONCLUSION: The high rate of colonoscopy completion after a positive test and the high proportion of screened lesions observed suggest that the lengthening of the screening period could allow significant detection of CRC and polyps that occur in Elderly_75 excluded from CRCSP.

Effect of reminders mailed to general practitioners on colorectal cancer screening adherence: a cluster-randomized trial.

Reminders have been used in various settings, but failed to produce convincing evidence of benefits on patient adherence to colorectal cancer (CRC) screening. The aim of this study was to assess the effectiveness of sending general practitioners (GPs) printed reminders about CRC screening. We conducted a cluster-randomized controlled trial involving 144 GPs in the Val-de-Marne district (France), who provided care for any reason to 20 778 patients eligible for CRC screening between June 2010 and November 2011. Data were collected from the main statutory health-insurance programme and local cancer screening agency. GPs were randomly assigned in a 1 : 1 proportion to the intervention or the control group. Every 4 months, intervention-group GPs received a computer-generated printed list of patients who had not performed scheduled faecal occult blood test (FOBT) screening. The primary outcome was patient adherence to FOBT screening or exclusion from CRC screening for medical reasons. The screening adherence rate was 31.2% [95% confidence interval (CI) 30.3-32.1] in the control group and 32.9% (95% CI 32.0-33.8) in the intervention group [crude relative risk, 1.05 (95% CI 1.01-1.09), P<0.01]. This rate was not significantly different between groups by multilevel modelling accounting for clustering and confounding variables [adjusted relative risk, 1.07 (95% CI 0.95-1.20), P=0.27]. Computer-generated printed reminders sent to GPs did not significantly improve patient adherence to organized CRC screening by the FOBT.

Understanding barriers to organized breast cancer screening in France: women's perceptions, attitudes, and knowledge.

BACKGROUND: The participation rate in organized breast cancer screening in France is lower than recommended. Non-participants either use opportunistic screening or do not use either screening modality. OBJECTIVE: To assess any differences in perceptions, attitudes and knowledge related to breast cancer screening between users of opportunistic screening and non-users of any screening mammograms and to identify potential barriers to participation in organized screening. METHODS: Six focus groups were conducted in May 2010 with 34 French non-participants in organized screening, 15 who used opportunistic screening (OpS group) and 19 who used no screening (NoS group). The guide used for both groups explored perceptions and attitudes related to health, cancer and screening; perceptions of femininity; and knowledge about breast cancer screening. Thematic content analysis was performed. RESULTS: Perceptions, attitudes and knowledge differed between the two groups. Women in the OpS group perceived a high susceptibility to breast cancer, visited their gynaecologist regularly, were unfamiliar with organized screening modalities and had doubts about its quality. NoS women had very high- or low-perceived susceptibility to breast cancer, knew about screening modalities, had doubts about its usefulness and expressed negative opinions of mammograms. CONCLUSIONS: Differences in perceptions and attitudes related to breast cancer screening partially explain why some women choose opportunistic screening or no screening. General practitioners and gynaecologists are in a unique position to provide individually tailored preventative messages to improve participation in organized screening.

Improving participation in colorectal cancer screening: targets for action.

OBJECTIVE: Our aim was to determine whether physician-related factors influenced patient participation in colorectal cancer (CRC) screening programs and to identify patient characteristics associated with lower participation in order to facilitate the development of targeted actions to improve participation. METHOD: A retrospective cohort study was conducted in a French department during its first CRC screening campaign from June 2007 to May 2010. Data for 157,766 patients followed by 903 general practitioners (GPs) were analyzed. Patient participation was assessed using multilevel logistic modeling. RESULTS: The overall participation rate was 30% (95% confidence interval [95% CI], 29.8-30.2) and varied across the 903 GPs from 0% to 75.5% (median, 30; interquartile range, 24-35). Inter-GP variance explained only 5.5% of the participation rate variance. Participation was significantly lower in males (odds ratio [OR], 0.79; 95% CI, 0.78-0.91), the youngest age group (55-59 years, OR, 0.61; 95% CI, 0.58-0.63), and patients living in socioeconomically deprived areas (OR, 0.82; 95% CI, 0.77-0.87). CONCLUSION: Targeted actions to improve CRC screening participation should focus on patients younger than 60 years, males, and individuals living in deprived areas. Actions to enhance the influence of GPs on patient participation should be directed to the overall population of GPs.