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 worldwide
2nd 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
Faecal DNA testing
Non-invasive
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)
Problem
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?
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
Inclusion
Databases
Analysis
Quality
Assessment
• RCTs & Observational studies
• Numbers of males and females invited and
screened
• PubMed
• Embase
• Meta-analysis & subgroup analysis using
Revman
• RCTs – Cochrane risk of bias tool
• Observational studies – Newcastle Ottawa
Scale
The Search
Results
Study
design
Subjects
Uptake
rates
•
•
•
•
6 RCTs,
12 cross-sectional,
1 cohort
15 population based
• 4,789,384 invited
• 1,396,445 screened
• Excluding Park et al (2011):
382, 684 invited - 185,283 screened
• 10.5% (Park et al, 2011) - 90.1% (Fenocchi et al, 2006)
• Less than 40% (7 studies)
• 40-60% (8 studies)
• Over 60% (4 studies)
Study locations
9
3
3
1
3
Results – Uptake
Meta-analysis
0.83 [0.77, 0.90]
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
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 studies
Non population based studies
Studies using advance notification invitations
Studies targeting people over 50 years of age with
no upper age limit
Contact with medical professional
Discussion
• Uptake similar when there is contact with medical
professional
• Uptake similar in studies with no upper age limit
Older males may be more inclined to
participate
Older 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
