title: Screening for colorectal cancer: comparison of perceived test burden of guaiac-based faecal occult blood test, faecal immunochemical test and flexible sigmoidoscopy.
abstract: BACKGROUND
  Perceived burden of colorectal cancer (CRC) screening is an important determinant of participation in subsequent screening rounds and therefore crucial for the effectiveness of a screening programme. This study determined differences in perceived burden and willingness to return for a second screening round among participants of a randomised population-based trial comparing a guaiac-based faecal occult blood test (gFOBT), a faecal immunochemical test (FIT) and flexible sigmoidoscopy (FS) screening.
  
  
  METHODS
  A representative sample of the Dutch population (aged 50-74years) was randomised to be invited for gFOBT, FIT and FS screening. A random sample of participants of each group was asked to complete a questionnaire about test burden and willingness to return for CRC screening.
  
  
  RESULTS
  In total 402/481 (84%) gFOBT, 530/659 (80%) FIT and 852/1124 (76%) FS screenees returned the questionnaire. The test was reported as burdensome by 2.5% of gFOBT, 1.4% of FIT and 12.9% of FS screenees (comparing gFOBT versus FIT p=0.05; versus FS p<0.001). In total 94.1% of gFOBT, 94.0% of FIT and 83.8% of FS screenees were willing to attend successive screening rounds (comparing gFOBT versus FIT p=0.84; versus FS p<0.001). Women reported more burden during FS screening than men (18.2% versus 7.7%; p<0.001).
  
  
  CONCLUSIONS
  FIT slightly outperforms gFOBT with a lower level of reported discomfort and overall burden. Both FOBTs are better accepted than FS screening. All three tests have a high level of acceptance, which may affect uptake of subsequent screening rounds and should be taken into consideration before implementing a CRC screening programme.
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands. l.hol.1@erasmusmc.nl
authors.forename: L
authors.initials: L
authors.lastname: Hol
authors.forename: V
authors.initials: V
authors.lastname: de Jonge
authors.forename: M E
authors.initials: ME
authors.lastname: van Leerdam
authors.forename: M
authors.initials: M
authors.lastname: van Ballegooijen
authors.forename: C W N
authors.initials: CW
authors.lastname: Looman
authors.forename: A J
authors.initials: AJ
authors.lastname: van Vuuren
authors.forename: J C I Y
authors.initials: JC
authors.lastname: Reijerink
authors.forename: J D F
authors.initials: JD
authors.lastname: Habbema
authors.forename: M L
authors.initials: ML
authors.lastname: Essink-Bot
authors.forename: E J
authors.initials: EJ
authors.lastname: Kuipers
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000523:psychology; D017281:Cost of Illness; D055088:Early Detection of Cancer / Q000379:methods / Q000523:psychology*; D005260:Female; D006138:Guaiac; D006801:Humans; D007159:Immunologic Tests / Q000379:methods; D007202:Indicators and Reagents; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009780:Occult Blood; D010146:Pain / Q000209:etiology; D017060:Patient Satisfaction; D012752:Shame; D012812:Sigmoidoscopy / Q000379:methods / Q000523:psychology
chemical_list: D007202:Indicators and Reagents; D006138:Guaiac