Effectiveness of an organized colorectal cancer screening program on increasing adherence in asymptomatic average-risk Canadians
1 Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Purvis Hall 41, 1020 Pine Ave. West, Montreal, QC H3A 1A2, Canada
2 Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Leacock 418, 855 Sherbrooke St. West, Montreal, QC H3A 2T7, Canada
3 Department of Economics, McGill University, Leacock 418, 855 Sherbrooke St. West, Montreal, QC H3A 2T7, Canada
4 Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, 687 Pine Ave. West V-Building, Montreal, QC H3A 1A1, Canada
5 Department of Medicine, McGill University, 687 Pine Ave. West V-Building, Montreal, QC H3A 1A1, Canada
BMC Health Services Research 2013, 13:449 doi:10.1186/1472-6963-13-449Published: 29 October 2013
Colorectal cancer (CRC) is the third most commonly diagnosed cancer and second highest cause of cancer-related mortality in Canada. Despite the availability of screening services and establishment of guidelines, utilization of colorectal cancer screening in Canada remains low. In 2008, the province of Ontario launched ColonCancerCheck, an organized colorectal cancer screening program aimed at increasing CRC screening adherence. In this study, we adopt a quasi-experimental approach to estimate and describe the impact of ColonCancerCheck on screening behavior in the asymptomatic average risk population.
Annual screening rates from the target population were estimated using five cycles of the Canadian Community Health Survey, a cross-sectional nationally representative survey of health status, healthcare use, and determinants of health in the Canadian population. We used a difference-in-differences design to measure the overall impact of ColonCancerCheck on past-year fecal occult blood testing (FOBT) and endoscopy in Ontario relative to the rest of Canada. Several verification tests validated the suitability of our model specification.
The difference-in-differences analysis shows that ColonCancerCheck increased FOBT screening in the average risk population by 5.2 percentage points (95% CI [3.2, 7.2]), an increase of 33% relative to pre-program screening rates. The program had no observed effect on endoscopy screening and we found no evidence that ColonCancerCheck differentially altered the screening practices of population sub-groups.
Our findings suggest ColonCancerCheck has been successful at increasing use of FOBT in the asymptomatic average risk population.