Introduction
Participation in colorectal cancer (CRC) screening programs significantly vary with 36–71% fecal occult blood test (FOBT) uptake rates, and compliance with referral for colonoscopy ranging 64–92% in Europe. The Hungarian population-based colorectal cancer (CRC) screening program (EFOP-1.8.1-VEKOP-15-2016-00001) was launched in 2019 among asymptomatic individuals between the ages of 50 and 70 with average risk of CRC.
Aims & Methods
The aim of this study was to assess the adherence to Hungarian population-based CRC screening program (EFOP-1.8.1-VEKOP-15-2016-00001), and to determine influencing demographic factors. This observational, non-interventional cohort study retrospectively analyzed participation data of the Hungarian population-based CRC screening program between 2019 and 2022, prospectively collected in National Public Health Institute’s registry. Data were analyzed as that of 13/02/2023. Gender and type of residence (municipality, town, city with county rights, and capital) were investigated as demographic parameters potentially influencing adherence rates with logistic regression.
Results
Of 1,819,664 invited individuals, 377,552 returned the screening kit, resulting in 20.8% adherence to FOBT. 36,995 individuals (9.8%) had non-negative results. 20,902 individuals (56.5%) were reported to undergo screening colonoscopy.
Adherence rates to FOBT decreased over the years since the initiation of the screening program: yearly rates for returning screening kits from 2019 to 2022 were 32.1%, 24.8%, 18.8%, and 14.1%, respectively. In contrast, adherence rates to screening colonoscopy showed less variation over the years (58.9%, 52.7%, 52.3%, 55.62% from 2019 to 2022). Average kit returning time over the years was as follows: 99.2±0.2 days, 66.6±0.3 days, 56.0±0.5 days, and 68.0±0.1 days, from 2019 to 2022, respectively. Over the years, colonoscopy was performed following the FOBT results after an average of 85.5±0.9 days, 93.8±1.5 days, 56.6±2.0 days, and 52.8±0.4 days. Female gender was associated with higher adherence to returning screening kits (22.4% vs. 18.8%). Attendance rates at screening colonoscopies were 57.2% for males and 55.5% for females. Screening kits were returned by 19.1% of individuals living in municipalities, 20.5% of those living in towns, 23.5% of those living in cities with county rights and 19.8% of those living in the capital. Attendance rates at colonoscopy according to type of residence were the following: 57.8% for individuals from municipalities, 53.9% for those from towns, 60.3% for those from cities with county rights, and only 50.2% for those from the capital. Adherence rates to FOBT tests were significantly influenced by both gender and type of residence, while attendance rates at screening colonoscopy was only influenced by type of residence.
Conclusion
Adherence rates to Hungarian CRC screening program are somewhat lower than in other European countries. Although adherence rates to FOBT gradually decreased since the initiation of the CRC screening program, adherence rates to screening colonoscopy remained stable. Socio-demographic factors influence screening adherence.