The impact of driving time on participation in colorectal cancer screening with sigmoidoscopy and faecal immunochemical blood test

Mona Berthelsen; Paula Berstad; Kristin R Randel; Geir Hoff; Erik Natvig; Øyvind Holme; Edoardo Botteri

doi:10.1016/j.canep.2022.102244

The impact of driving time on participation in colorectal cancer screening with sigmoidoscopy and faecal immunochemical blood test

Cancer Epidemiol. 2022 Oct:80:102244. doi: 10.1016/j.canep.2022.102244. Epub 2022 Aug 31.

Authors

Mona Berthelsen¹, Paula Berstad², Kristin R Randel³, Geir Hoff⁴, Erik Natvig⁵, Øyvind Holme⁶, Edoardo Botteri⁷

Affiliations

¹ Section for Colorectal Cancer Screening, Cancer Registry of Norway, P.O. Box 5313 Majorstuen, 0304 Oslo, Norway. Electronic address: berthelsen846@gmail.com.
² Section for Colorectal Cancer Screening, Cancer Registry of Norway, P.O. Box 5313 Majorstuen, 0304 Oslo, Norway. Electronic address: pabe@kreftregisteret.no.
³ Section for Colorectal Cancer Screening, Cancer Registry of Norway, P.O. Box 5313 Majorstuen, 0304 Oslo, Norway. Electronic address: kran@kreftregisteret.no.
⁴ Section for Colorectal Cancer Screening, Cancer Registry of Norway, P.O. Box 5313 Majorstuen, 0304 Oslo, Norway; Department of Research and Development, Telemark Hospital Trust, Ulefossvegen 55, 3710 Skien, Norway; Institute of Clinical Medicine, University of Oslo, P.O. Box 1171 Blindern, 0318 Oslo, Norway. Electronic address: hofg@kreftregisteret.no.
⁵ Section for Colorectal Cancer Screening, Cancer Registry of Norway, P.O. Box 5313 Majorstuen, 0304 Oslo, Norway. Electronic address: ekna@kreftregisteret.no.
⁶ Department of Medicine, Sørlandet Hospital, P.O. Box 416 Lundsiden, 4604 Kristiansand, Norway; Institute for Health and Society, University of Oslo, P.O. Box 1130 Blindern, 0318 Oslo, Norway. Electronic address: oyvind.holme@sshf.no.
⁷ Section for Colorectal Cancer Screening, Cancer Registry of Norway, P.O. Box 5313 Majorstuen, 0304 Oslo, Norway; Department of Research, Cancer Registry of Norway, P.O. Box 5313 Majorstuen, 0304 Oslo, Norway. Electronic address: edbo@kreftregisteret.no.

PMID: 36057171
DOI: 10.1016/j.canep.2022.102244

Abstract

Background: High participation rates are important for a colorectal cancer (CRC) screening programme to be effective. Having a long travelling distance to screening centres may impede participation.

Methods: We analysed the association between driving time from home address to screening centre and participation among individuals invited to screening with faecal immunochemical test (FIT) (n = 68,624) or sigmoidoscopy (n = 46,076) in a randomized trial in Norway in 2012-17. Two screening centres were involved. We fitted multiple logistic regression models, adjusted for demographic, socioeconomic and health characteristics, and reported odds ratios (OR) with 95% confidence intervals (CI).

Results: Participation rates were 58.9 % (n = 40,445) for FIT and 51.9 % (n = 23,911) for sigmoidoscopy. In sigmoidoscopy, participation was 56.9 % and 47.9 % in those living < 20 and > 60 min by car from the screening centres, respectively. For each 10 min driving time increase, OR for participating in sigmoidoscopy screening was 0.93 (95 % CI 0.91-0.95). There was a significant difference between the two screening centres (p-value for heterogeneity <0.001). Participation in FIT screening were 61.2 % and 57.1 % in those with < 20 and > 60 min driving time, respectively, and the OR was 0.98 (95 % CI 0.96-0.99) for each 10 min increase (heterogeneity between screening methods, P-value <0.001). Among those with a positive FIT, compliance to colonoscopy was higher in those living < 20 compared to > 60 min from the centres (95.1 % vs. 92.9 %, respectively, OR 0.86; 95 % CI 0.77-0.93 for each 10 min increase).

Conclusions: Driving time to screening centre was a significant predictor of participation, mainly in sigmoidoscopy. There were local differences in the impact of driving time on participation. Driving time also affected compliance to colonoscopy after a positive FIT. When planning a CRC screening programme, one should consider offering people living far from screening sites special assistance to facilitate their participation.

Keywords: Colorectal cancer screening; Driving time; Faecal immunochemical test; Participation; Sigmoidoscopy.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Colonoscopy
Colorectal Neoplasms* / diagnosis
Early Detection of Cancer / methods
Hematologic Tests
Humans
Mass Screening / methods
Occult Blood
Sigmoidoscopy* / methods