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Abstract

Objective

Participation, an indicator of screening programme acceptance and effectiveness, varies widely in clinical trials and population-based colorectal cancer (CRC) screening programmes. We aimed to assess whether CRC screening participation rates can be compared across organized guaiac fecal occult blood test (G-FOBT)/fecal immunochemical test (FIT)-based programmes, and what factors influence these rates.

Methods

Programme representatives from countries participating in the International Cancer Screening Network were surveyed to describe their G-FOBT/FIT-based CRC screening programmes, how screening participation is defined and measured, and to provide participation data for their most recent completed screening round.

Results

Information was obtained from 15 programmes in 12 countries. Programmes varied in size, reach, maturity, target age groups, exclusions, type of test kit, method of providing test kits and use, and frequency of reminders. Coverage by invitation ranged from 30–100%, coverage by the screening programme from 7–67.7%, overall uptake/participation rate from 7–67.7%, and first invitation participation from 7–64.3%. Participation rates generally increased with age and were higher among women than men and for subsequent compared with first invitation participation.

Conclusion

Comparisons among CRC screening programmes should be made cautiously, given differences in organization, target populations, and interpretation of indicators. More meaningful comparisons are possible if rates are calculated across a uniform age range, by gender, and separately for people invited for the first time vs. previously.

Keywords

Colorectal neoplasm screening population FOBT organized programmes participation uptake

Introduction

Participation is a key indicator of a cancer screening programme’s acceptance and effectiveness. High uptake in the target population is necessary for a screening programme to achieve the mortality reductions demonstrated in clinical trials.^1,2 Clinical trials and population-based programmes of colorectal cancer (CRC) screening have shown that participation varies widely and is relatively low.³ A recent review found that few organized CRC screening programmes and pilot studies met the European recommendation for minimum uptake of 45% and a desirable participation rate of 65–70%.^3,4 This may be partly due to the relatively recent implementation of CRC screening programmes compared with those for breast and cervical cancer.^5,6

Population characteristics and programme design and implementation can affect participation rate.^7–9 Inconsistencies in how CRC screening participation is defined, measured, and reported^4,10 make direct comparison of participation rates challenging. Multiple indicators of screening participation have been developed, including coverage by invitation, coverage by examination, the participation rate, and long-term adherence over two or more screening rounds.^3,11 To investigate how organized CRC screening programmes in different countries define and measure participation in screening, a study was initiated through the International Cancer Screening Network (ICSN), a consortium of countries that have population-based cancer screening programmes and active efforts to evaluate and improve cancer screening (http://appliedresearch.cancer.gov/icsn). Study aims were to assess the extent to which CRC screening participation rates can be compared across programmes, factors that may influence participation rates, and the feasibility of using questionnaires to collect data on CRC screening participation to improve the validity of direct comparisons across programmes and jurisdictions.

Methods

A Screening Participation Rates Work Group, formed following the ICSN-meeting in Denmark in June 2008, designed a two-part study to assess measurement of CRC screening participation rates among ICSN countries with organized CRC screening programmes:

In May 2011, 29 ICSN country representatives were emailed a questionnaire to ascertain whether they had an organized CRC screening programme (defined as targeting a specific population group, having a mechanism for identifying people eligible for screening, and sending letters inviting eligible people in the target population to participate in screening), characteristics of the programme (eg. when launched, targeted age groups, number of rounds completed, test modality used, screening interval), and how screening participation was defined and measured.

In part II of the study, a follow-up questionnaire was e-mailed in February 2012 to 19 programme representatives in 12 countries, who had indicated that their country had an organized CRC screening programme using guaiac-based fecal occult blood test (G-FOBT) or fecal immunochemical test (FIT) for primary screening. One programme participating in Part I of the study reported flexible sigmoidoscopy as their primary screening modality, and we excluded this programme from Part II because of difficulties in making comparisons with G-FOBT/FIT-based programmes. The follow-up questionnaire requested data for the programme’s most recent, completed screening round, broken out by age at invitation in five-year groupings (50–54, 55–59, 60–64, 65–69, and 70–74) and by gender. Requested data were: number of people in the target population, number of these eligible for screening, number of eligible people invited to screening, number of eligible people invited for the first time, number of people screened of those invited, number of people screened of those invited for the first time, and the number of people screened of those invited for whom there was a final test result. We also asked about programme organizational and operational features, eg. type of G-FOBT or FIT kit used, number of samples collected and recommended test frequency, whether dietary restrictions are required for test kit completion, how invited people obtain test kits, and criteria for exclusion from screening.

For each programme participating in part II, we calculated three measures of screening participation derived from the European Guidelines for Quality Assurance in Colorectal Cancer Screening:³ i) coverage by invitation (number of people invited to screening divided by number of people eligible for screening in the target population), ii) coverage by the screening programme (number of people screened [of those invited] divided by the number of people eligible for screening in the target population), and iii) uptake or participation overall (number of people screened [of those invited] divided by the number of eligible people invited). We also calculated a fourth measure adapted from the European Network for Indicators in Cancer project:¹² uptake or participation at first invitation (number of people invited for the first time who were screened divided by the number of eligible people who were invited for the first time).

Statistical analysis

Participation rate (in percent) by programme was calculated as the number of participants divided by the number of invited individuals, and stratified by gender and age group. Proportions with 95% confidence intervals were calculated to evaluate whether participation rates differed significantly between genders, and among age groups, and initial versus subsequent invitation round. Because information from Italy summarized 79 regional and local FIT-based programmes, we treated Italy as a single programme.

Results

Characteristics of organized G-FOBT/FIT-based CRC screening programmes

Of 15 programmes in 12 countries, five were national, nine regional, and one (Copenhagen county, Denmark) was a feasibility pilot project (Table 1). Programmes were initiated from 1995 (Israel) to 2011 (Alentejo region, Portugal). Most had completed more than one screening round. Target age ranges were 50–74 (six programmes), 50–69 (five programmes), 60–69 (two programmes), 50–65 (Australia) and 60–74 (England). Seven programmes used G-FOBT, two used high-sensitivity G-FOBT, five used FIT, and one used both G-FOBT and FIT. Programmes used a biennial screening interval, except for Australia, which invited individuals at ages 50, 55, and 65, and Israel, which screened annually. In general, programmes using G-FOBT required three samples, and those using FIT required only one sample, with the exception of Australia (two samples). Eleven of the 15 programmes did not require dietary restrictions for completion of test kits.

Table 1.

Characteristics of Organized G-FOBT/FIT-Based Colorectal Cancer Screening Programmes Participating in the ICSN Survey.

Country	Region (s)	Name of Screening Programme	Year programme began	Number of screening rounds completed	Age Range covered	Year(s) of data reported	Test Type	Screening interval	Brand name of test kit	Total # of samples	Dietary restrictions required
Australia	National	National Bowel Cancer Screening Program	2006	6	50–65	2011	FIT	>Biennial*	Fujirebio New HemTube (B)	2	No
Belgium	Brussels & Wallonia	Colorectal Cancer Screening Program organized in the French Community of Belgium	2009	1	50–74	2009–2010	G-FOBT	Biennial	Hemoccult	3	No
Canada	Manitoba	ColonCheck	2007	1–2	50–74	2009–2010	HS-FOBT	Biennial	Hemoccult II Sensa	3	Yes
Canada	Saskatchewan	Screening Program for Colorectal Cancer, Saskatchewan Cancer Agency	2009	2	50–74	2010–2011	FIT	Biennial	Somagen OC Auto micro	1	No
Denmark	Copenhagen county	Copenhagen Colon screening feasibility study	2005	1	50–74	2005–2006	G-FOBT	Biennial	Hemoccult II	3	Yes
Finland	National	Organised colorectal cancer screening in Finland	2004	4	60–69	2010	G-FOBT	Biennial	Hemoccult	3	Yes
France	National	National Organized screening Program for colo-rectal cancer in France	2008	2	50–74	2009–2010	G-FOBT	Biennial	Hemoccult II	3	No
Israel	National	CHS National Program for the early detection of Colorectal Cancer	1995	8	50–74	2011	HS-FOBT	Annual	Hemoccult II Sensa	3	No
Italy	79 programs	Italian colorectal screening programs	1982–2010	1–10¹	50–69	2010–2011	FIT	Biennial	OC-Sensor²	1	No
Portugal	Alentejo	Rastreio Do Cancro do Colon e Recto	2011	1	50–70	2011–2012	FIT	Biennial	OC-Sensor	1	No
Spain	Basque	Programa de Cribado de Cancer Colorectal del Pais Vasco	2009	1	50–69	2009–2010	FIT	Biennial	OC-Sensor	1	No
	Catalonia	Colorectal Cancer Screening Program in Hospitalet, Catalonia	2000	4	50–69	2008–2010	G-FOBT & FIT	Biennial	Hema-Screen (FOBT)	3	No
									OC-Sensor (FIT)	1
	Valencia	Colorectal cancer screening program .Comunitat Valenciana. Spain	2005	2	50–69	2008–2010	G-FOBT	Biennial	Cenogenics TRI-SLIDE	3	No
Sweden	Stockholm & Gotland counties	Stockholm Gotland regional colorectal cancer screening program	2008	2	60–69	2010	G-FOBT	Biennial	Hemoccult	3	Yes
England	National	NHS Bowel Cancer Screening Programme	2006	2	60–74	2008 & 2009	G-FOBT	Biennial	Immunostics hema-screen	3	No

The oldest programme began in 1982 and has completed 10 rounds while some programmes had not completed their 1^st round in 2010.

Two other programmes use Sentinel FOB-Gold & Olympus

Participants invited to screening at age 50, 55, and 65

G-FOBT – Guaiac FOBT; HS-FOBT – High Sensitivity FOBT; FIT – Fecal Immunochemical Test

Seven programmes mailed test kits to all invitees; three mailed kits only to those who responded to an invitation letter (Table 2). In three programmes invitees obtained kits from a pharmacy, clinic, or other health care facility. In Israel and two of the Spanish regional programmes (Catalonia and Valencia), individuals invited for the first time were asked to contact the programme to obtain a test kit, but previous participants were mailed kits without having to contact the programme. In Israel, kits could be collected at neighborhood primary care clinics or sent by mail.

Table 2.

Organized G-FOBT/FIT-Based Colorectal Cancer Screening Programmes: Means of Providing Test Kits, Follow-Up, and Exclusions from the Programme.

Country	Region (s)	Method of providing test kit			Follow-Up		Exclusions from Screening
Country	Region (s)	Mail	Request	Pick up required	Number of contacts	Length of wait time	History of CRC	History of bowel disease* or high risk syndrome	Symptoms	Recent Colon- oscopy	Other
Australia	National				1	2 months
Belgium	Brussels & Wallonia			X	0
Canada	Manitoba	X			1	1 month	X	X	X	X
Canada	Saskatchewan	X			2	1 month	X	X	X	X
Denmark	Copenhagen county	X			2	2 months	X	X			X²
Finland	National	X			1	2 months
France	National		X		3	4 months	X	X	X	X
Israel	National	X^a	X^b	X	1	1 month	X	X		X
Italy	79 programmes			X	1	1–4 months¹	X¹	X	X	X	X³
Portugal	Alentejo				1	2 months	X	X	X	X	X⁴
Spain	Basque	X			1		X	X		X	X⁵
	Catalonia	X^a	X^b		1	1 month	X	X	X	X	X⁶
	Valencia	X^a	X^b		1	3 months	X	X	X	X
Sweden	Stockholm & Gotland counties	X			1	2 months
England	National	X			1	1 month				X

Inflammatory bowel or Crohn’s Disease

If screened in previous round

If 1^st time invited

Different programmes apply different exclusion criteria/intervals for reminders

Known adenomas

Unable to give consent & 2 first degree relatives with CRC

Patients with transient benign pathology and patients with other serious illness or disability that limit participation in screening

Terminal Illness

Terminal illness & severe disabling condition

All programmes except Brussels & Wallonia (Belgium) sent reminders to individuals who had not returned a completed test kit within a specified time period (Table 2). Ten programmes sent one reminder, two sent up to two reminders, and one sent up to three. Reminders were sent between one and four months after the initial invitation (mode two months). None of the programmes used reminder telephone calls.

Eligibility criteria also varied between programmes (Table 2). Four programmes (Australia, Brussels & Wallonia [Belgium], Finland, Stockholm & Gotland [Sweden]) had no exclusions. The other programmes excluded people based on one or more of the following factors: personal history of CRC, adenomas, or inflammatory bowel disease; family history of CRC or high-risk genetic syndrome; recent colonoscopy; and symptoms of CRC or other bowel disease or life-limiting chronic illness.

Participation indicators in organized G-FOBT/FIT-based CRC screening programmes

Programme size varied, with target populations between 35,000 (Saskatchewan, Canada) and 17 million (France), as did invitation coverage, from 30–100% (Table 3). Screening coverage (those actually screened of the whole eligible target population) ranged from 7.0% in Brussels & Wallonia (Belgium) to 67.7% in Finland. Uptake (participation) rate ranged from 7.0% in Brussels & Wallonia (Belgium) to 67.7% in Finland. In the 13 programmes able to distinguish people invited for the first time from those previously invited, first invitation participation varied from 7.0% (Brussels & Wallonia, Belgium) to 64.3% (Basque region, Spain).

Table 3.

Participation Indicators for 15 G-FOBT/FIT-Based Colorectal Cancer Screening Programmes.

Country	Region(s)	Size of target population eligible for screening (A)	Number invited for screening (B)	Number screened (C)	Number Invited first time (D)	Number screened first time (E)	Coverage by Invitation (B/A)	Coverage by the Screening Programme (C/A)	Uptake (Participation) Rate (C/B)	First Invitation Participation Rate (E/D)
Country	Region(s)	Size of target population eligible for screening (A)	Number invited for screening (B)	Number screened (C)	Number Invited first time (D)	Number screened first time (E)	Overall	Overall	Overall	Overall
Australia	National	827,984	827,984	274,199	827,984	274,199	100.0	33.1	33.1	33.1
Belgium	Brussels & Wallonia	1,121,845	1,121,845	78,755	1,121,845	78,755	100.0	7.0	7.0	7.0
Canada	Manitoba	288,748	92,259	21,365	88,684	19,410	32.0	7.4	23.2	21.9
Canada	Saskatchewan	35,308	19,750	6,739	19,748	6,399	55.9	19.1	34.1	32.4
Denmark	Copenhagen county	85,594	85,594	38,886	85,594	38,886	100.0	45.4	45.4	45.4
Finland	National	67,907	67,907	45,937	16,499	10,243	100.0	67.7	67.7	62.1
France	National	17,000,000	17,000,000	5,140,000	–	–	100.0	34.0	34.0	–
Israel	National	709,232	709,232	269,525	–	–	100.0	38.0	38.0	–
Italy	79 programmes	7,162,416	5,700,796	2,811,911	1,953,440	843,839	79.6	39.3	49.3	43.2
Portugal	Alentejo	10,837	10,837	5,318	10,837	5,318	100.0	49.1	49.1	49.1
Spain	Basque	240,913	235,371	151,343	235,371	151,343	97.7	62.8	64.3	64.3
Spain	Catalonia	63,166	62,934	19,761	9,118	1,969	99.6	31.3	31.4	21.6
Spain	Valencia	177,789	158,568	69,541	87,328	37,355	89.2	39.1	43.9	42.8
Sweden	Stockholm & Gotland counties	68,901	68,901	44,760	25,729	13,720	100.0	65.0	65.0	53.3
England	National	14,792,265	4,439,056	2,324,458	4,032,847	2,138,043	30.0	15.7	52.4	53.0

“–” indicates data are not available

Figure 1 shows that participation rates were statistically significantly higher among women than men for all programmes except Brussels & Wallonia (Belgium), where they were equivalent. The gender difference was most evident in Finland, with 75% participation rate among women compared with 60% among men.

Figure 1.

Comparison of participation rates among 15 G-FOBT-based colorectal cancer screening programmes by gender*.

In all ten programmes targeting those aged 50 and older, participation rates were statistically significantly higher for those in their 60s compared with those in their 50s (Table 4). Australia and Israel showed the largest age group differences. In Australia, participation rates were 29.7% and 42.2%, and in Israel 32.2% and 44.1% for the 50–59 and 60–69 age groups, respectively. In four of the five programmes including those aged older than 69, participation rates were statistically significantly higher for the 70+ compared with the 60–69 age groups.

Table 4.

Comparison of Uptake/Participation Rates among 13 G-FOBT/FIT-Based Colorectal Cancer Screening Programmes, by Age Group and Initial versus Subsequent Invitation.

Country	Region	Test	Uptake/participation rate by age group			Uptake/participation rate by initial versus subsequent invitation
Country	Region	Test	50–59, % (95% CI)	60–69, % (95% CI)	≥70, % (95% CI)	First invitation % (95% CI)	Subsequent % (95% CI)
Australia	National	FIT	29.7 (29.5–29.8)	42.2* (42.0–42.4)	NA	NA²	NA²
Belgium	Brussels & Wallonia	G-FOBT	5.8 (5.8–5.9)	7.8 (7.7–7.9)	9.9 (9.8–10.1)	7.0 (6.9–7.1)	NA³
Canada	Manitoba	G-FOBT	19.9 (19.5–20.2)	27.3 (26.8–27.9)	31.4 (30.4–32.4)	21.9 (21.6–22.2)	54.7 (53.1–56.3)
Canada	Saskatchewan	FIT	29.4 (28.5–30.2)	37.8 (36.7–38.9)	44.4 (42.4–46.4)	32.4 (31.7–33.1)	NA³
Finland	National	G-FOBT	NA¹	67.7 (67.3–68.0)	NA¹	62.1 (61.1–62.8)	69.4 (69.0–69.8)
Israel	National	G-FOBT	32.2 (32.0–32.3)	44.1 (43.9–44.3)	43.8 (43.5–44.1)	NA²	NA²
Italy	79 programmes	FIT	47.3 (47.3–47.4)	52.7 (52.5–52.9)	NA	43.2 (43.1–43.3)	52.5 (52.4–52.6)
Portugal	Alentejo	FIT	47.1 (45.9–48.4)	51.9 (50.4–53.4)	NA	49.1 (48.1–50.0)	NA³
Spain	Basque	FIT	62.5 (62.2–62.7)	66.5 (66.2–66.8)	NA	64.3 (64.1–64.5)	NA³
Spain	Catalonia	G-FOBT + FIT	29.3 (28.8–29.8)	33.6 (33.1–34.2)	NA	21.6 (20.7–22.4)	33.1 (32.7–33.5)
Spain	Valencia	G-FOBT	43.4 (43.0–43.7)	44.4 (44.0–44.7)	NA	42.8 (42.5–43.1)	45.2 (44.8–45.5)
Sweden	Stockholm & Gotland	G-FOBT	NA¹	65.0 (64.6–65.3)	NA¹	53.3 (52.7–53.9)	71.9 (71.5–72.3)
England	National	G-FOBT	NA	52.3 (52.2–52.3)	58.0 (57.6–58.3)	53.0 (53.0–53.1)	45.9 (45.7–46.0)

60–65 years age group only NA = not applicable: NA¹ denotes programmes for which age group comparison was not possible because the target population was restricted to 60–69, NA² denotes programmes that were not able to distinguish between first and subsequent invitation participation rates, and NA³ denotes programmes which had performed one screening round only. Denmark and France are excluded from the table because these programmes did not have data that could be analyzed by age group and initial vs. subsequent invitation participation.

In seven programmes able to evaluate differences in uptake between first and subsequent invitation (Table 4), subsequent invitation participation rates were statistically significantly higher than first invitation rates in Manitoba (Canada), Finland, Italy, Catalonia (Spain), Valencia (Spain), and Sweden. In England, subsequent invitation participation was lower than first invitation participation by about seven percentage points. Manitoba (Canada) showed the largest difference between first and subsequent invitation participation (21.9% v 54.7%). Averaged across the seven programmes, subsequent invitation participation rates were approximately nine percentage points higher than first invitation participation rates.

Discussion

Comparisons of CRC screening participation rates are hampered by diverse methods of defining, measuring, and reporting participation.^4,10 Even though we used a standardized set of definitions to compare four participation indicators (coverage by invitation, coverage by the screening programme, overall uptake or participation, and first invitation participation) among 15 G-FOBT/FIT-based CRC screening programmes, and attempted to collect data in a uniform way, there was considerable variability in the indicators across programmes. Coverage by invitation ranged from 30–100%, coverage by the screening programme and overall uptake or participation both ranged from 7–68%, and first invitation participation from 7–64%. Only six programmes met the European Guidelines’ minimum participation target of 45%.³ We also showed the influence of three factors on participation rates: gender (participation was higher among women than men), age (higher participation among those aged 60–69 and 70+ than younger age groups), and subsequent v first invitation participation (those invited in a previous screening round had higher participation than initial invitees).

Our study demonstrates that it is possible to collect and report participation data in a more standardized way to facilitate comparisons, but also illustrates the considerable diversity in screening programme policies, organization, and implementation that complicate the evaluation and comparison of participation indicators.

Screening participation tends to increase as organized programmes mature and make adjustments to better meet the needs of their populations.^13–15 Some programmes in our study (Israel, Italy, and Catalonia [Spain]) had been in place for more than a decade, but others, established more recently (eg. Australia, England, and regional programmes in Canada and Spain) were still in the roll out phase. As our study encompassed programmes with only one completed screening round (as well as those with multiple rounds), participation in subsequent invitations could not be assessed in all programmes. In our study, the participation rate was increased and the variability across countries and regions was reduced, when comparing initial and subsequent screening in all programmes, apart from England (Table 4). The paradoxical decrease in participation in the subsequent invitation round in the expanding English programme could be related to a large proportion of invitations addressing individuals at an initial phase despite being invitations in the subsequent programme round. We believe that our finding of an increased participation in the subsequent round compared with the first invitation, also documented in other reports from ongoing national and regional programmes, represents an established and generalizable result.

Programmes also differed in size, from a few thousand to several million, and in the age groups targeted. Our study confirmed that younger age groups are less likely to participate in CRC screening,^15–20 and so the ability to examine participation rates by discrete age groups is important, but two of the programmes in our study could not provide data by narrower age groups to permit comparisons with other programmes. Reporting programme data for five year (ie. 50–54, 50–59) or ten year (ie. 50–59) age groupings, instead of the entire age range of the target population (ie. 50–74), and calculating age-specific participation rates would make cross-programme comparisons more meaningful.

Exclusion criteria present another cross-programme comparison challenge. Programmes with exclusion criteria produce a reduced denominator, and generate a seemingly higher compliance rate than programmes that invite the entire targeted age group.⁴ Four programmes in our study had no exclusion criteria; others excluded people based on one or more aspects of their colorectal cancer risk or health status.

Most programmes in our study used G-FOBT test kits requiring three stool samples, as opposed to one for the FIT-based programmes. Four of the G-FOBT-based programmes also imposed dietary restrictions for successful test completion. Due to lack of randomization of the test used, we did not assess whether participation rates varied by test type, number of stool samples required, or use of dietary restrictions. Even if the same test (G-FOBT) and dietary restrictions were used, programmes could differ in ways of providing the test. In 10 programmes in our study, the test kit was mailed together with the invitation, but in other programmes participants had to ask for the kit, or collect it at a clinic/pharmacy, which might lower participation^21,22 and make cross-programme comparisons difficult. Programmes also differed in their use of reminders to individuals who failed to return a completed test kit. Although all but one programme reported mailing reminders, the number of reminders varied from one to three, and the timing of the reminders ranged from one to four months following the initial invitation to screening.

Our study has limitations. Only countries that participate in the ICSN could be included, somewhat hampering the generalizability of the results, although several ICSN countries (the Netherlands, Luxembourg, New Zealand) have recently launched organized CRC screening programmes, and a larger, more comprehensive study of participation indicators may be feasible in the future. In addition, the observational study design limited our ability to evaluate the influence of various programme features on participation indicators. Although the gender and screening history trends seem common across countries, the baseline differences could be due to cultural, health-systems’ characteristics, and organizational differences rather than the actual screening strategy.

Conclusion

Establishing common measures is an important initial step in the ability to compare participation across screening programmes. Our results show that more meaningful comparisons of CRC screening participation indicators across programmes are possible if participation indicators are calculated using uniform definitions, and differences in programme organization and population characteristics are taken into account. The majority of organized screening programmes underperform in uptake, with a general trend toward lower uptake among men and younger age groups, and the reasons for such trends need to be addressed in future studies. Comparability of measures of cumulative participation is of particular importance, given ongoing efforts to implement and evaluate CRC screening programmes.

Footnotes

Acknowledgements

We thank Kathy Sedgwick of NOVA Research Company for data collection assistance.

ICSN Screening Participation Rates Work Group members: Johannes Blom (Sweden), Jean-Luc Bulliard (Switzerland), Gregory Doyle (Canada), Montse Garcia (Spain), Lea Hagoel (Israel), Iben Holten (Denmark), Carrie Klabunde (United States; co-chair), Verna Mai (Canada; co-chair), Julietta Patnick (England), Carlo Senore (Italy), and Sven Törnberg (Sweden).

Study participants: Questionnaires for the study were completed by: Scott Antle (Newfoundland and Labrador, Canada), Natalie Biswanger (Manitoba, Canada), Ron Bridges (Alberta, Canada), Hsiu-His Chen (Taiwan), Michel Candeur (Belgium), Dan Coulombe (New Brunswick, Canada), Jose Alfons Espinas (Catalonia, Spain), Montse Garcia (Catalonia, Spain), Andre-Robert Grivegnee (Belgium), Lea Hagoel (Israel), Frank van Hees (Netherlands), Iben Holten (Denmark), Kate Jorgenson (Australia), Theodore Levin (USA), Melissa Leypoldt (USA), Tereza Lopes (Portugal), Nea Malila (Finland), Lorraine Marrett (Ontario, Canada), Sandra Meeres (Saskatchewan, Canada), Erika Nicholson (Nova Scotia, Canada), Julietta Patnick (England), Jaroslaw Regula (Poland), Helene Sancho-Garnier (France), Hiroshi Saito (Japan), Astrid Scharpantgen (Luxembourg), Carlo Senore (Italy), Alan Smith (Ireland), Stepan Suchanek (Czech Republic), Sven Törnberg (Sweden), Delores Salas (Valencia, Spain), Isabel Portillo (Basque, Spain), Manuel Zorzi (Italy).

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Participation rates for organized colorectal cancer screening programmes: an international comparison

Abstract

Objective

Methods

Results

Conclusion

Keywords

Introduction

Methods

Statistical analysis

Results

Characteristics of organized G-FOBT/FIT-based CRC screening programmes

Participation indicators in organized G-FOBT/FIT-based CRC screening programmes

Discussion

Conclusion

Footnotes

Acknowledgements

References