title: Improving Participation in Colorectal Cancer Screening: a Randomised Controlled Trial of Sequential Offers of Faecal then Blood Based Non-Invasive Tests.
abstract: BACKGROUND
  Poor participation rates are often observed in colorectal cancer (CRC) screening programs utilising faecal occult blood tests. This may be from dislike of faecal sampling, or having benign bleeding conditions that can interfere with test results. These barriers may be circumvented by offering a blood-based DNA test for screening. The aim was to determine if program participation could be increased by offering a blood test following faecal immunochemical test (FIT) non-participation.
  
  
  METHODS
  People were invited into a CRC screening study through their General Practice and randomised into control or intervention (n=600/group). Both groups were mailed a FIT (matching conventional screening programs). Participation was defined as FIT completion within 12wk. Intervention group non-participants were offered a screening blood test (methylated BCAT1/IKZF1). Overall participation was compared between the groups.
  
  
  RESULTS
  After 12wk, FIT participation was 82% and 81% in the control and intervention groups. In the intervention 96 FIT non- participants were offered the blood test - 22 completed this test and 19 completed the FIT instead. Total screening in the intervention group was greater than the control (88% vs 82%, p<0.01). Of 12 invitees who indicated that FIT was inappropriate for them (mainly due to bleeding conditions), 10 completed the blood test (83%).
  
  
  CONCLUSIONS
  Offering a blood test to FIT non-participants increased overall screening participation compared to a conventional FIT program. Blood test participation was particularly high in invitees who considered FIT to be inappropriate for them. A blood test may be a useful adjunct test within a FIT program.
authors.affiliation: Flinders Centre for Innovation in Cancer, Bedford Park, Australia E-mail : Erin.Symonds@health.sa.gov.au.
authors.forename: Erin L
authors.initials: EL
authors.lastname: Symonds
authors.forename: Susanne
authors.initials: S
authors.lastname: Pedersen
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Cole
authors.forename: Joseph
authors.initials: J
authors.lastname: Massolino
authors.forename: Daniel
authors.initials: D
authors.lastname: Byrne
authors.forename: John
authors.initials: J
authors.lastname: Guy
authors.forename: Patricia
authors.initials: P
authors.lastname: Backhouse
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Fraser
authors.forename: Lawrence
authors.initials: L
authors.lastname: LaPointe
authors.forename: Graeme P
authors.initials: GP
authors.lastname: Young
mesh_terms: D000368:Aged; D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000517:prevention & control*; D003256:Community Participation / Q000706:statistics & numerical data*; D003955:Diagnostic Tests, Routine / Q000379:methods*; D055088:Early Detection of Cancer / Q000379:methods* / Q000706:statistics & numerical data; D005243:Feces / Q000737:chemistry*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007120:Immunochemistry; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D011379:Prognosis