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Nicholas Clarke, Aoife Osborne, Patricia M Kearney, Linda Sharp

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. Overview. Introduction

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Nicholas Clarke, Aoife Osborne, Patricia M Kearney, Linda Sharp

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  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 • 3rd most common in women worldwide • 2nd 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 CRC2) 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

  10. The Search

  11. Results

  12. Study locations 9 3 3 1 3

  13. Results – UptakeMeta-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):1572-9  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):191-9. 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):147-52. 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):117-22. 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):384-90. 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):37-43. GLOBOCAN (2012) IARC Section of Cancer Information (Cited:(04/03/2014). Available at: http://globocan.iarc.fr Gregory TA, Wilson C, Duncan A, Turnbull D, Cole SR, Young G. (2011) Demographic, social cognitive and social ecological predictors of intention and uptake in screening for colorectal cancer. BMC Public Health;11:38. doi: 10.1186/1471-2458-11-38. Gupta S., Halm E.A., Rockey D.C., Hammons M., Koch M., Carter E., Valdez L., Tong L., Ahn C., Kashner M., Argenbright K., Tiro J., Geng Z., Pruitt S., Skinner C.S. (2013) Comparative effectiveness of fecal immunochemical test outreach, colonoscopy outreach, and usual care for boosting colorectal cancer screening among the underserved a randomized clinical trial. JAMA Internal Medicine; 173 (18): 1725-1732 Hol L, Kuipers EJ, van Ballegooijen M, van Vuuren AJ, Reijerink JC, Habbema DJ, van Leerdam ME. (2012) Uptake of faecal immunochemical test screening among nonparticipants in a flexible sigmoidoscopy screening programme. Int J Cancer;130(9):2096-102. Javanprast S, Ward P, Young G, Wilson C, Carter S, Misan G, Cole S, Jiwa M, Tsourtos G, Martini A, Gill T, Baratiny G, Ah Matt M. (2010) How equitable are colorectal cancer screening programs which include FOBTs? A review of qualitative and quantitative studies. Preventive Medicine; 50: 165-172 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):e512-21. 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): 1059-1086 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, 2008-2009. Prev Chronic Dis; 9:E77. Levin B, Lieberman DA, McFarland B, et al. 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  21. Acknowledgement This research has been funded by an Irish Cancer Society scholarship grant

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