Gender differences in acceptance for colorectal cancer screening: pain as the explanation

Abstract

Background: Participants’ experience with a screening test can influence adherence, and therefore the efficacy of a screening programme. We compared the satisfaction with decision and willingness to repeat colorectal cancer screening with flexible sigmoidoscopy(FS) and faecal immunochemical test(FIT). Methods: In a prospective, randomised trial 3257 individuals (50–74 years) were invited to either FS or FIT(1:1) of whom 1650 (52.6%) attended. In total, 1497 screening participants completed at least one questionnaire measuring willingness to repeat screening, recommend screening and satisfaction with decision to attend, either before screening, and/or three times in the following year. There were 769 and 728 responders in the FS and FIT group respectively. Additionally, 611 (70%) FS participants completed a pain-questionnaire. Results: One year after screening, 10% of the FS participants were not willing to repeat screening, compared to 5% of FIT participants. In the FS group, there was a higher percentage of women who would not repeat screening, compared to men, adjusted OR 2.52(95%CI: 1.48-4.28). Notably, 22% of women reported pain during the FS, compared to 5% of the men. When we added pain to the model, pain was significantly associated with the unwillingness to repeat FS OR 3.15 (95%CI: 1.68-5.87), while gender was no longer OR 1.53 (95%CI: 0.82-2.88). Conclusion: Acceptance for FS and FIT were high among Norwegian screening participants, though FIT participants were more willing to repeat screening. Women were less willing to repeat screening with FS compared to men. This gender difference seemed partly due to pain, and therefore preventable.