Bowel Cancer Screening: A Snoozing Problem?

In my previous blog post, I concluded that although a large majority of people take part in bowel cancer screening at least once, few do so consistently. Our latest research findings suggest that procrastination could explain this inconsistent behaviour.

The home-based stool test for bowel cancer screening is offered every two years to all adults living in England aged 60 to 74. Regular participation is important because the current screening test, the guaiac Faecal Occult Blood test, is not very sensitive (Soares-Weiser et al. 2007). Only regular participation has been proven to reduce bowel cancer mortality in randomised controlled trials (Hewitson et al., 2008).

Our latest study showed that returning the screening test kit after 28 days reduces the likelihood of screening participation in a subsequent invitation round. This effect was even observed among people who had taken part twice in a row. This suggests that even those with a proven track record are at risk of dropping out of the screening programme if they have a history of “procrastination”.

If someone has not returned the test kit after 28 days, the screening programme automatically sends them a reminder. Roughly one third of first-time participants are sent a reminder. However, if they fail to undertake timely action again, no further reminders are sent.

Perhaps we could think of screening procrastinators as “snooze button” users. Relying on the alarm clock to remind them repeatedly to get up, snoozers may eventually get caught out and truly oversleep. Unfortunately, we do not know for sure. What our study does not tell us is why people “procrastinate”.

One possibility is that procrastinators find the test particularly onerous. Another – although not necessarily mutually-exclusive – potential explanation is that they are procrastinators in other areas of their lives as well. Further study of the causes that underlie procrastinators to drop out of bowel cancer screening could help inform interventions to increase screening participation.

References

Hewitson P, Glasziou P, Watson E, Towler B, Irwig L (2008) Cochrane systematic review of colorectal cancer screening using the fecal occult blood test (Hemoccult): An update. Am J Gastroenterol 103: 1541-1549, doi: 10.1111/j.1572-0241.2008.01875.x.

Lo, S.H., Halloran, S., Snowball, J., Seaman, H., Wardle, J. & C. von Wagner (2014), Colorectal cancer screening uptake over three biennial invitation rounds in the English Bowel Cancer Screening Programme, Gut, Published Online First: 7th May 2014, doi:10.1136/gutjnl-2013-306144.

Lo, S.H., Halloran, S., Snowball, J., Seaman, H., Wardle, J. & C. von Wagner (2014), Predictors of repeat participation in the NHS Bowel Cancer Screening Programme, British Journal of Cancer, in press.

Soares-Weiser K., Burch J., Duffy S., St John J., Smith S., Westwood M., & J. Kleijnen (2007), Diagnostic Accuracy And Cost-Effectiveness Of Faecal Occult Blood Tests (FOBT) Used In Screening For Colorectal Cancer: a Systematic Review, York, United Kingdom: University of York.