title: Improving compliance to colorectal cancer screening using blood and stool based tests in patients refusing screening colonoscopy in Germany.
abstract: BACKGROUND
  Despite strong recommendations for colorectal cancer (CRC) screening, participation rates are low. Understanding factors that affect screening choices is essential to developing future screening strategies. Therefore, this study assessed patient willingness to use non-invasive stool or blood based screening tests after refusing colonoscopy.
  
  
  METHODS
  Participants were recruited during regular consultations. Demographic, health, psychological and socioeconomic factors were recorded. All subjects were advised to undergo screening by colonoscopy. Subjects who refused colonoscopy were offered a choice of non-invasive tests. Subjects who selected stool testing received a collection kit and instructions; subjects who selected plasma testing had a blood draw during the office visit. Stool samples were tested with the Hb/Hp Complex Elisa test, and blood samples were tested with the Epi proColon® 2.0 test. Patients who were positive for either were advised to have a diagnostic colonoscopy.
  
  
  RESULTS
  63 of 172 subjects were compliant to screening colonoscopy (37%). 106 of the 109 subjects who refused colonoscopy accepted an alternative non-invasive method (97%). 90 selected the Septin9 blood test (83%), 16 selected a stool test (15%) and 3 refused any test (3%). Reasons for blood test preference included convenience of an office draw, overall convenience and less time consuming procedure.
  
  
  CONCLUSIONS
  97% of subjects refusing colonoscopy accepted a non-invasive screening test of which 83% chose the Septin9 blood test. The observation that participation can be increased by offering non-invasive tests, and that a blood test is the preferred option should be validated in a prospective trial in the screening setting.
authors.affiliation: Central Interdisciplinary Endoscopy Unit, Department for Internal Medicine with focus on Hepatology, Gastroenterology and Metabolic Diseases, University Hospitals Berlin, Charité-Virchow-Klinikum, Berlin, Germany. andreas.adler@charite.de.
authors.forename: Andreas
authors.initials: A
authors.lastname: Adler
authors.forename: Sebastian
authors.initials: S
authors.lastname: Geiger
authors.forename: Anne
authors.initials: A
authors.lastname: Keil
authors.forename: Harald
authors.initials: H
authors.lastname: Bias
authors.forename: Philipp
authors.initials: P
authors.lastname: Schatz
authors.forename: Theo
authors.initials: T
authors.lastname: deVos
authors.forename: Jens
authors.initials: J
authors.lastname: Dhein
authors.forename: Mathias
authors.initials: M
authors.lastname: Zimmermann
authors.forename: Rudolf
authors.initials: R
authors.lastname: Tauber
authors.forename: Bertram
authors.initials: B
authors.lastname: Wiedenmann
mesh_terms: D000368:Aged; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D004247:DNA / Q000097:blood; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D005858:Germany; D006403:Hematologic Tests; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009780:Occult Blood; D010349:Patient Compliance; D011446:Prospective Studies
chemical_list: D004247:DNA