A randomised trial of the impact of new faecal haemoglobin test technologies on population participation in screening for colorectal cancer.
OBJECTIVE
To investigate the effect on participation in colorectal cancer screening of testing for blood products in faeces using technologies that remove dietary restrictions (i.e. immunochemical tests) and simplify faecal sampling (i.e. tests that use brush sampling).


METHODS



METHODS
Urban residents (n=1818) of Adelaide, Australia, aged between 50 and 69 years, randomly selected from the electoral roll.


METHODS
Three randomised cohorts of 606 invitees were offered a screening test by mail in 2001. The Hemoccult SENSA and FlexSure OBT cohorts were instructed to sample three stools using a spatula while the InSureTM cohort sampled two stools using a brush. The Hemoccult SENSA cohort was asked to restrict certain (high-peroxidase) foods and drugs.


METHODS
Participation (i.e. return of completed sample kits within 12 weeks) and generalised linear modelling (GLM) of relationships between participation, test technologies and demographic variables.


RESULTS
Participation was 23.4%, 30.5% and 39.6% for the Hemoccult, FlexSure and InSure cohorts, respectively (chi(2)=37.1, p<0.00001). GLM demonstrated that participation was increased by 28% by removal of restrictions (p=0.01) and by 30% by simplification of sampling (p=0.001); both together increased participation by 66% (p<0.001). The differences in participation between tests occurred in the first three weeks. Socio-economic status, gender or age did not significantly influence technology-based improvements in participation.


CONCLUSIONS
The brush-sampling faecal immunochemical test for haemoglobin (InSure) achieves the best participation rates by simplifying sampling and removing the need for restrictions of diet and drugs. Because participation in screening is vital to detection, this new technology should contribute to better detection of neoplasia at the population level.
Cole
S R
SR
Bowel Health Service, Repatriation General Hospital Daw Park, SA, Australia.
Young
G P
GP
Esterman
A
A
Cadd
B
B
Morcom
J
J
D000368:Aged; D001315:Australia; D015179:Colorectal Neoplasms / Q000737:chemistry / Q000175:diagnosis* / Q000453:epidemiology; D003710:Demography; D004032:Diet; D005243:Feces / Q000737:chemistry; D005260:Female; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009780:Occult Blood; D010349:Patient Compliance; D018579:Patient Selection; D011933:Reagent Kits, Diagnostic; D012680:Sensitivity and Specificity
D006454:Hemoglobins; D011933:Reagent Kits, Diagnostic