Comparison of uptake of colorectal cancer screening based on faecal

immunochemical testing (FIT) in males and females: A systematic review and

meta-analysis

Nicholas Clarke, Aoife Osborne,

Patricia M Kearney, Linda Sharp

Irish Cancer Society Funded PhD Scholar

Overview

• Introduction

• The problem and aims

• Methods and search

• Results

• Discussion

• Implications

Introduction

• Colorectal cancer 3rd most common in women worldwide2nd most common in men worldwide

Age standardised incidence 44% higher in men (20.6 vs. 14.3) worldwide

Age standardised mortality 45% higher in men (10.0 vs. 6.9) worldwide

(GLOBOCAN, 2012)

Colorectal cancer screening

• Reduction in incidence• Reduction in mortality• Economic benefit in life years saved• Improves QOL

Colorectal cancer screening

• Hospital based screening Colonoscopy Flexible sigmoidoscopy Double-contrast barium enema Computed tomographic (CT) colonography

• Home or GP based screening FOBT FIT Non-invasive Faecal DNA testing

Colorectal cancer screening

• FOBT screening uptake higher than more invasive tests (Khalid-de Bakker et al, 2011)

• FIT uptake higher than FOBT (Vart et al, 2012)

• Men more likely to participate in endoscopic based tests (Evans et al 2005, Meissner et al, 2006, Javanprast et al, 2010)

• Men less likely to participate in FOBT based screening (von Wagner et al, 2011, Seef et al, 2004)

Given:

1) males at greater risk of developing and dying from CRC

2) FIT increasingly recommended (Von Karsa et al, 2013, Levin et al, 2008),

is there a differential uptake between males and females in FIT based screening?

Problem

Aims

• To conduct a systematic review of studies containing comparisons of male and female participation rates of FIT based colorectal cancer screening.

• To determine if factors such as age, number of samples, invitation strategy and reminders impact on differences in uptake

Methods

 

The Search

Results

Study locations

3

13

9

3

Results – UptakeMeta-analysis

Figure 2: Forest plot corresponding to the main random effects meta-analysis of 19 risk estimates quantifying the relationship between gender and uptake of FIT based colorectal cancer screening

0.83 [0.77, 0.90]

Results – RCTs Meta analysis

0.83 [0.71, 0.97]

Results – Cross sectional studies meta analysis

0.85 [0.78, 0.94]

Results

• Significantly lower uptake in males• Lower uptake across sub-group analysis• Situations in which there is no difference in

uptake:Low quality studiesNon population based studiesStudies using advance notification invitationsStudies targeting people over 50 years of age with

no upper age limitContact with medical professional

Discussion

• Uptake similar when there is contact with medical professional

• Uptake similar in studies with no upper age limitOlder males may be more inclined to

participateOlder men report less disability (White et al, 2011)

Older men may be more health conscious

Discussion – Males in health care

• Absence of male targeted healthcare programmes (White et al, 2011)

• When males more accepting of screening often see themselves as adhering to physician recommendations (Ritvo et al, 2013)

• Males often procrastinate about screening (Ritvo et al, 2013)

fatalism preventative/protective elements of screening

Summary & Implications

• Significantly lower male uptake of FIT based CRC screening

• Need for targeted gender based strategies to improve uptake in FIT based screening

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Acknowledgement

This research has been funded by an Irish Cancer Society scholarship grant