Sample preference for colorectal cancer screening tests: Blood or stool?

Joanne M. Osborne, Carlene Wilson, Vivienne Moore, Tess Gregory, Ingrid Flight, Graeme P. Young

CSIRO Preventative Research Flagship, Adelaide, Australia.
Discipline of Public Health, University of Adelaide, Adelaide, Australia.
Flinders Centre for Cancer Prevention and Control, Flinders University of South Australia, Adelaide, Australia.

DOI: 10.4236/ojpm.2012.23047                

Abstract

Objective: Despite the high prevalence of CRC and the proven benefits of faecal sampling tests, participation rates in CRC screening are suboptimal. Literature has identified a number of barriers to participation, including faecal aversion. Emerging test technologies suggest blood-based molecular markers might provide an alternative, more acceptable option, for CRC screening tests. We aim to determine preference for blood compared to faeces as the sample for the screening test. Methods: A survey was mailed to 956 South Australians aged 50 to 74 years. Data were collected on sample preference, demographic variables, and ratings of screening test convenience and comfort. Results: The survey yielded a 43% response rate. The majority of participants preferred to provide a blood sample (78% v 22%, p < 0.001). Women were more likely to prefer blood than men (82% vs 74%, p = 0.05). Sample experience influenced preferences, with a significantly higher preference for faeces among participants with experience in faecal sampling (27% vs 17% with no experience, p < 0.05). Participants who preferred to provide a faecal sample rated it significantly more convenient (p < 0.001), more comfortable (p < 0.001), and more acceptable (p < 0.001) than those who preferred blood sampling. Conclusions: Survey participants overwhelmingly indicate a preference for the idea of a blood sample over a faecal sample for CRC screening. Preference was influenced by gender, experience with sampling method and the individual’s perception of sampling convenience, sampling comfort and sample acceptability. Our results suggest population participation rates are likely to improve with blood-based screening tests.

Keywords

Colon Cancer Screening; Faecal Occult Blood Test; Sample Preference; Stool Sampling; Blood Sampling; Participation

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Australian Institute of Health and Welfare (2008) Australia’s health 2008. AIHW, Canberra.
[2]	Mandel, J.S., Bond, J.H., Church, T.R., et al. (1993) Reducing mortality from colorectal cancer by screening for fecal occult blood. New England Journal of Medicine, 328, 1365-1371. doi:10.1056/NEJM199305133281901
[3]	Hardcastle, J.D., Chamberlain, J.O., Robinson, M.H., et al. (1996) Randomised controlled trial of faecal-occult-blood screening for colorectal cancer. Lancet, 348, 1472- 1477. doi:10.1016/S0140-6736(96)03386-7
[4]	Kronborg, O., Fenger, C., Olsen, J., et al. (1996) Randomised study of screening for colorectal cancer with faecal-occult-blood test. Lancet, 348, 1467-1471. doi:10.1016/S0140-6736(96)03430-7
[5]	Lindholm, E., Brevinge, H. and Haglind, E. (2008) Survival benefit in a randomized clinical trial of faecal occult blood screening for colorectal cancer. British Journal of Surgery, 95, 1029-1036. doi:10.1002/bjs.6136
[6]	Australian Institute of Health and Welfare (2010) National bowel cancer screening program: Annual monitoring report 2009 data supplement 2010. Cancer series no 57 cat no CAN53. AIHW, Canberra.
[7]	Australian Cancer Network Cancer Guidelines Revision Committee (2005) Guidelines for the prevention, early detection and management of colo-rectal cancer. The Cancer Council Australia and Australian Cancer Network, Sydney.
[8]	Weitzman, E.R., Zapka, J., Estabrook, B. and Goins, K.V. (2001) Risk and reluctance: Understanding impediments to colorectal cancer screening. Preventive Medicine, 32, 502-513. doi:10.1006/pmed.2001.0838
[9]	Koka, S., Beebe, T.J., Merry, S.P., et al. (2008) The preferences of adult out-patients in medical or dental care settings for giving saliva, urine or blood for clinical testing. Journal of the American Dental Association, 139, 735- 740.
[10]	Nayaradou, M., Berchi, C., Dejardin, O. and Launoy, G. (2010) Eliciting population preferences for mass colorectal cancer screening organization. Medical Decision Making, 30, 224-233. doi:10.1177/0272989X09342747
[11]	Pfeffer, N. and Laws, S. (2006) “It’s only a blood test”: What people know and think about venepuncture and blood. Social Science & Medicine, 62, 3011-3023. doi:10.1016/j.socscimed.2005.11.050
[12]	Kose, S. and Mandiracioglu, A. (2007) Fear of blood/injection in healthy and unhealthy adults admitted to a teaching hospital. International Journal of Clinical Practice, 61, 453- 457. doi:10.1111/j.1742-1241.2006.01150.x
[13]	Chinese University of Hong Kong, Dept OBG (2010). http://department.obg.cuhk.edu.hk/researchsupport/RxC_contingency_table.ASP,2010
[14]	Javanparast, S., Ward, P. and Cole, S. (2010) A cross-sectional analysis of participation in National Bowel Cancer Screening program in Adelaide by age, gender and geographical location of residence. Australasian Medical Journal, 1, 141-146. doi:10.4066/AMJ.2010.198
[15]	Phillips, K., Johnson, F. and Maddala, T. (2002) Measuring what people value: A comparison of “attitude” and “preference” surveys. Health Services Research, 37, 1659-1679. doi:10.1111/1475-6773.01116