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Garcia M.,Cancer Prevention and Control Group | Garcia M.,Catalan Institute of Oncology ICO | Mila N.,Cancer Prevention and Control Group | Mila N.,Catalan Institute of Oncology ICO | And 9 more authors.
Journal of Medical Screening | Year: 2012

Objective: To identify factors associated with a false-positive result in a population-based colorectal cancer (CRC) screening programme with the faecal occult blood test (FOBT) in Catalonia between 2000 and 2010. Methods: The study population consisted of participants of the Catalan CRC screening programme with a positive FOBT who underwent a colonoscopy for diagnostic confirmation from 2000 to 2010. A false-positive result was defined as having a positive test but detecting no high-risk adenoma or cancer in the follow-up colonoscopy. Multivariate logistic regression models were performed to identify sociodemographic and screening variables related to false-positive results. Adjusted odds ratios (OR) and their 95% confidence intervals (CI) were estimated. Results: Over the screening period, 1074 (1.7%) of the 63,332 screening tests had a positive result in the Catalan CRC screening programme. The false-positive proportion was 55.2% (n = 546). Women were more likely to have a positive FOBT in the absence of CRC neoplasia than men (adjusted OR = 2.91; 95% CI: 2.22-3.28). During the first prevalence round, the proportion of false-positive results was higher than in subsequent rounds (69.5% vs. 48.9%; P < 0.05). Re-screening and having a bleeding pathology such as haemorrhoids or anal fissures were also associated with a false-positive result. Conclusion: The proportion of false-positive results and the associated risks should be estimated to provide an eligible population with more reliable information on the adverse effects of screening.


Garcia M.,Cancer Prevention and Control Group | Garcia M.,Catalan Institute of Oncology ICO | Maria Borras J.,Cancer Prevention and Control Group | Maria Borras J.,University of Barcelona | And 9 more authors.
European Journal of Cancer Prevention | Year: 2012

The objective of this study was to explore the variables associated with repeated screening for colorectal cancer (CRC) among individuals aged 50-69 years in Catalonia, Spain. We selected for the study all individuals (n=11 969) screened by a population-based CRC screening program in 2004 and who were eligible for rescreening in two years. A multilevel logistic regression model was derived. The contextual variables were the percentage of people with less than primary studies and the percentage of CRC screening participation. The individual variables used were: sex, age, CRC screening (prior to 2004), guaiac fecal occult blood test result, ease of recruitment, and number of tests used. The rescreening rate was 87%. No differences according to sex and age were found. The strongest barrier for CRC rescreening was an inconclusive fecal occult blood test result at baseline screening [odds ratio (OR): 0.24; 95% confidence intervals (CI): 0.20-0.29]. Individuals who agreed to participate just after receiving the screening invitation were more likely to accept a second screen compared with those who received a reminder letter six weeks later (OR: 1.53; 95% CI: 1.36-1.73). Those individuals who lived in a neighborhood with a higher educational level were more willing to rescreen (OR: 1.22; 95% CI: 1.03-1.45) than those who lived in more deprived areas. Rescreening was highly adequate in our program, reflecting satisfaction with the service received at screening. Strategies to enhance initial screening participation for CRC and to improve quality throughout the screening process should be prioritized. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Garcia M.,Cancer Prevention and Control Group | Garcia M.,Catalan Institute of Oncology ICO | Borras J.M.,Cancer Prevention and Control Group | Borras J.M.,University of Barcelona | And 14 more authors.
Preventive Medicine | Year: 2011

Objective: To identify barriers and facilitators associated with participation in the first round of a population-based program for colorectal cancer (CRC) in Catalonia, Spain and to identify strategies for motivating and supporting behavioral change. Material and methods: A two-part, mixed-methods design was used. In first place, a prospective study of individuals aged 50-69. years (n = 1961) was conducted in 2006-2007. Secondly, focus groups were undertaken with participants and non-participants of the CRC screening, in 2008. Results: Intention to participate was an important determinant of participation (82.9% vs 65.9%, OR = 2.56, 95%CI:1.95-3.36) in addition to knowledge about CRC and its early detection. Respondents who reported that CRC may be asymptomatic in early stages enrolled in the screening program more frequently than those who thought CRC is always symptomatic (49.4% vs 44.8%, OR:1.82; 95%CI:1.3-2.6). Barriers for participation mentioned in focus groups were competing perceived for other health problems and other demands as well as misunderstanding about personal relevance of the screening. Conclusion: Individuals' perceptions of CRC are amenable to change through education-based interventions. Increasing public knowledge related to the burden of CRC and its preventive potential may be an effective way for improving participation in a population-based screening program. © 2011 Elsevier Inc.

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