Colorectal cancer (CRC) screening has been part of a nationally organized program in France since 2009. In 2015, a fecal immunochemical test (FIT) replaced the previously used guaiac test. Nevertheless, the target participation rate has still not been reached. In this context, it is important to have a clear insight into the characteristics of individuals who remain refractory to screening.
The French nationwide observational survey EDIFICE 6 was conducted online from 26 June to 28 July 2017 on 12 046 individuals (age, 18-69 years). Representativeness was ensured by quota sampling on age, gender, profession, and stratification by geographical area and type of urban district. Multivariate stepwise logistic regression analysis was conducted to identify factors likely to explain non-uptake of CRC screening. The present analysis focused on the 4300 individuals (age, 50-69 years) with no history of cancer.
Of those who were in the target population for CRC screening, 38% (N = 1625) had never taken part in the CRC screening program. Compared to individuals who had undergone at least one screening test in their life time, those who had never been screened were more likely to be younger (58±6 yrs vs 60±6 yrs, P<0.05), current smokers (30% vs 21%, P<0.05) or socially vulnerable (47% vs 36%, P<0.05). In multivariate analysis, items associated with not undergoing screening included belonging to the socio-professional category of skilled manual workers and supervisory or clerical workers (OR=1.83, 95% CI [1.24 – 2.70]), considering that prevention does not provide effective protection from CRC (OR=1.76 [1.48–2.08]), being a current smoker (OR=1.45 [1.25–1.69]) and being socially vulnerable (OR=1.29, [1.13-1.47]). The most frequently cited reasons for not being screened were "I don't feel concerned" (37%), “individual negligence/not a priority” (32%), fear of the examination/results (29%), and a reason related to the physician (i.e., he didn't suggest screening) (23%).
Medical skepticism for CRC prevention efficiency and vulnerability are social indicators of non-participation in a CRC screening program. Likewise, current smoking—which is already acknowledged as a behavioral risk factor for CRC—is also an indicator of non-uptake of CRC screening.
Clinical trial identification
Medical writing assistance was provided by Potentiel d’Action (France)