title: Repeat participation in colorectal cancer screening utilizing fecal occult blood testing: a community-based project in a rural setting.
abstract: OBJECTIVE
  To investigate participation in a second round of colorectal cancer screening using a fecal occult blood test (FOBT) in an Australian rural community, and to assess the demographic characteristics and individual perspectives associated with repeat screening.
  
  
  METHODS
  Potential participants from round 1 (50-74 years of age) were sent an intervention package and asked to return a completed FOBT (n = 3406). Doctors of participants testing positive referred to colonoscopy as appropriate. Following screening, 119 participants completed qualitative telephone interviews. Multivariable logistic regression models evaluated the association between round-2 participation and other variables.
  
  
  RESULTS
  Round-2 participation was 34.7%; the strongest predictor was participation in round 1. Repeat participants were more likely to be female; inconsistent screeners were more likely to be younger (aged 50-59 years). The proportion of positive FOBT was 12.7%, that of colonoscopy compliance was 98.6%, and the positive predictive value for cancer or adenoma of advanced pathology was 23.9%. Reasons for participation included testing as a precautionary measure or having family history/friends with colorectal cancer; reasons for non-participation included apathy or doctors' advice against screening.
  
  
  CONCLUSIONS
  Participation was relatively low and consistent across rounds. Unless suitable strategies are identified to overcome behavioral trends and/or to screen out ineligible participants, little change in overall participation rates can be expected across rounds.
authors.affiliation: School of Public Health, Queensland University of Technology, Brisbane, Queensland, Australia. m.janda@qut.edu.au
authors.forename: Monika
authors.initials: M
authors.lastname: Janda
authors.forename: Karen L
authors.initials: KL
authors.lastname: Hughes
authors.forename: Josephine F
authors.initials: JF
authors.lastname: Auster
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Leggett
authors.forename: Beth M
authors.initials: BM
authors.lastname: Newman
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009780:Occult Blood; D011793:Queensland / Q000453:epidemiology; D012189:Retrospective Studies; D012424:Rural Population; D012680:Sensitivity and Specificity