title: Participation in colorectal cancer screening trials after first-time                     invitation: a systematic review.
abstract: OBJECTIVE
  Colorectal cancer (CRC) screening is implemented by an increasing number of countries. Participation rates of screening programs influence the health benefit and cost-effectiveness of the applied method. The aim was to systematically review participation rate after first-time invitation for CRC screening with fecal occult blood test (FOBT), sigmoidoscopy, colonoscopy, and/or computed tomography (CT) colonography.
  
  
  METHODS
  A systematic literature search was performed prior to October 1 2009. Prospective CRC screening studies of unselected populations reporting participation rates were included.
  
  
  RESULTS
  After meta-analyses, overall participation rates were found to be 47 % for FOBT, 42 % for fecal immunologic tests (FITs), 35 % for sigmoidoscopy, 41 % for sigmoidoscopy combined with FIT/FOBT, 28 % for colonoscopy, and 22 % for CT colonography. Studies comparing screening methods showed higher participation rates for less invasive methods. Studies comparing invitation methods showed higher participation rates with general practitioner involvement, a more personalized recruitment approach, and reduction of barriers that discourage participation.
  
  
  CONCLUSIONS
  Knowledge of identified factors affecting CRC screening participation can be used to improve screening programs.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Maastricht University Medical Centre, The Netherlands. carolina.khalid@intmed.unimaas.nl
authors.forename: C
authors.initials: C
authors.lastname: Khalid-de Bakker
authors.forename: D
authors.initials: D
authors.lastname: Jonkers
authors.forename: K
authors.initials: K
authors.lastname: Smits
authors.forename: I
authors.initials: I
authors.lastname: Mesters
authors.forename: A
authors.initials: A
authors.lastname: Masclee
authors.forename: R
authors.initials: R
authors.lastname: Stockbrügger
mesh_terms: D000368:Aged; D023881:Colonography, Computed Tomographic; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009780:Occult Blood; D010342:Patient Acceptance of Health Care; D012812:Sigmoidoscopy