What can We Learn From High-Performing Screening Programs to Increase Bowel Cancer Screening Participation in...

Area of Science:

• Oncology
• Public Health
• Health Services Research

Background:

• Colorectal cancer (CRC) is a leading cause of cancer death in Australia, with high incidence and mortality rates.
• Australia's National Bowel Cancer Screening Program faces low participation, with only 44% of mailed kits returned in 2018-2019.
• Identifying effective strategies to improve CRC screening participation is a public health priority.

Purpose of the Study:

• To identify successful practices and features of international bowel cancer screening programs with higher participation rates.
• To inform potential interventions for optimizing CRC screening participation in Australia.
• To understand factors influencing participant and practitioner engagement in screening programs.

Main Methods:

• Conducted a literature search for national CRC screening programs with over 50% participation using postal iFOBT kits.
• Included programs with free return of home kits.
• Performed interviews with cancer registry staff and academic researchers on screening engagement.

Main Results:

• National programs in the Netherlands, Scotland, Denmark, and Finland reported over 50% screening participation.
• These countries share characteristics such as smaller populations, high literacy, one-sample iFOBT kits, national registration systems, and use of randomized trials in program research.
• No single solution was identified for Australia's low uptake, apart from the potential benefit of a one-sample kit.

Conclusions:

• International comparisons suggest that implementing within-program intervention trials is a promising strategy to increase Australian screening participation.
• Randomized trials within screening programs hold potential for improving CRC screening uptake.
• Optimizing screening participation requires a multifaceted approach, including research and program-level interventions.