title: Colorectal cancer screening: factors associated with colonoscopy after a positive faecal occult blood test.
abstract: BACKGROUND
  Contextual socio-economic factors, health-care access, and general practitioner (GP) involvement may influence colonoscopy uptake and its timing after positive faecal occult blood testing (FOBT). Our objectives were to identify predictors of delayed or no colonoscopy and to assess the role for GPs in colonoscopy uptake.
  
  
  METHODS
  We included all residents of a French district with positive FOBTs (n = 2369) during one of the two screening rounds (2007-2010). Multilevel logistic regression analysis was performed to identify individual and area-level predictors of delayed colonoscopy, no colonoscopy, and no information on colonoscopy.
  
  
  RESULTS
  A total of 998 (45.2%) individuals underwent early, 989 (44.8%) delayed, and 102 (4.6%) no colonoscopy; no information was available for 119 (5.4%) individuals. Delayed colonoscopy was independently associated with first FOBT (odds ratio, (OR)), 1.61; 95% confidence interval ((95% CI), 1.16-2.25); and no colonoscopy and no information with first FOBT (OR, 2.01; 95% CI, 1.02-3.97), FOBT kit not received from the GP (OR, 2.29; 95% CI, 1.67-3.14), and socio-economically deprived area (OR, 3.17; 95% CI, 1.98-5.08). Colonoscopy uptake varied significantly across GPs (P=0.01).
  
  
  CONCLUSIONS
  Socio-economic factors, GP-related factors, and history of previous FOBT influenced colonoscopy uptake after a positive FOBT. Interventions should target GPs and individuals performing their first screening FOBT and/or living in socio-economically deprived areas.
authors.affiliation: 1] Université Paris Est Créteil (UPEC), LIC EA 4393 (Laboratoire d'Investigation Clinique), F-94010 Créteil, France [2] Université Paris Est Créteil (UPEC), Faculté de médecine, département de médecine générale, F-94010 Créteil, France.
authors.forename: E
authors.initials: E
authors.lastname: Ferrat
authors.forename: J
authors.initials: J
authors.lastname: Le Breton
authors.forename: K
authors.initials: K
authors.lastname: Veerabudun
authors.forename: S
authors.initials: S
authors.lastname: Bercier
authors.forename: Z
authors.initials: Z
authors.lastname: Brixi
authors.forename: B
authors.initials: B
authors.lastname: Khoshnood
authors.forename: E
authors.initials: E
authors.lastname: Paillaud
authors.forename: C
authors.initials: C
authors.lastname: Attali
authors.forename: S
authors.initials: S
authors.lastname: Bastuji-Garin
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003113:Colonoscopy / Q000191:economics / Q000379:methods*; D015179:Colorectal Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000601:surgery; D055088:Early Detection of Cancer / Q000191:economics / Q000379:methods; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D010342:Patient Acceptance of Health Care; D012189:Retrospective Studies; D012959:Socioeconomic Factors