Nation-wide participation in FIT-based colorectal cancer screening in Denmark during the COVID-19 pandemic: An observational study

  1. Tina Bech Olesen  Is a corresponding author
  2. Henry Jensen
  3. Henrik Møller
  4. Jens Winther Jensen
  5. Berit Andersen
  6. Morten Rasmussen
  1. The Danish Clinical Quality Program - National Clinical Registries, Denmark
  2. Randers Regional Hospital, Denmark
  3. Bispebjerg Hospital, Denmark

Abstract

Background: Worldwide, most colorectal cancer screening programmes were paused at the start of the COVID-19 pandemic, whilst the Danish faecal immunochemical test (FIT)-based programme continued without pausing. We examined colorectal cancer screening participation and compliance with subsequent colonoscopy in Denmark throughout the pandemic.

Methods: We used data from the Danish Colorectal Cancer Screening Database among individuals aged 50-74 years old invited to participate in colorectal cancer screening from 2018-2021 combined with population-wide registries. Using a generalised linear model, we estimated prevalence ratios (PR) and 95% confidence intervals (CI) of colorectal cancer screening participation within 90 days since invitation and compliance with colonoscopy within 60 days since a positive FIT test during the pandemic in comparison with the previous years adjusting for age, month and year of invitation.

Results: Altogether, 3,133,947 invitations were sent out to 1,928,725 individuals and there were 94,373 positive FIT tests (in 92,848 individuals) during the study period. Before the pandemic, 60.7% participated in screening within 90 days. A minor reduction in participation was observed at the start of the pandemic (PR=0.95; 95% CI: 0.94-0.96 in pre-lockdown and PR=0.85; 95% CI: 0.85-0.86 in 1st lockdown) corresponding to a participation rate of 54.9% during pre-lockdown and 53.0% during 1st lockdown. This was followed by a 5-10% increased participation in screening corresponding to a participation rate of up to 64.9%. The largest increase in participation was observed among 55-59 year olds and among immigrants. The compliance with colonoscopy within 60 days was 89.9% before the pandemic. A slight reduction was observed during 1st lockdown (PR=0.96; 95% CI: 0.93-0.98), where after it resumed to normal levels.

Conclusions: Participation in the Danish FIT-based colorectal cancer screening programme and subsequent compliance to colonoscopy after a positive FIT result was only slightly affected by the COVID-19 pandemic.

Funding: The study was funded by the Danish Cancer Society Scientific Committee (grant number R321-A17417) and the Danish regions.

Data availability

Data availability statementIn order to comply with the Danish regulations on data privacy, the datasets generated and analysed during this project are not publicly available as the data are stored and maintained electronically at Statistics Denmark, where it only can be accessed by pre-approved researchers using a secure VPN remote access. Furthermore, no data at a personal level nor data not exclusively necessary for publication are allowed to be extracted from the secure data environment at Statistics Denmark. Access to the data can however be granted by the authors of the present study upon a reasonable scientific proposal within the boundaries of the present project and for scientific purposes only.

Article and author information

Author details

  1. Tina Bech Olesen

    The Danish Clinical Quality Program - National Clinical Registries, Aarhus N, Denmark
    For correspondence
    forthemanuscripts@gmail.com
    Competing interests
    The authors declare that no competing interests exist.
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0002-6295-7399
  2. Henry Jensen

    The Danish Clinical Quality Program - National Clinical Registries, Aarhus N, Denmark
    Competing interests
    The authors declare that no competing interests exist.
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0003-4040-7334
  3. Henrik Møller

    The Danish Clinical Quality Program - National Clinical Registries, Aarhus N, Denmark
    Competing interests
    The authors declare that no competing interests exist.
  4. Jens Winther Jensen

    The Danish Clinical Quality Program - National Clinical Registries, Aarhus N, Denmark
    Competing interests
    The authors declare that no competing interests exist.
  5. Berit Andersen

    Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark
    Competing interests
    The authors declare that no competing interests exist.
  6. Morten Rasmussen

    The Colorectal Cancer Screening Programme, Bispebjerg Hospital, Copenhagen, Denmark
    Competing interests
    The authors declare that no competing interests exist.

Funding

The Danish Cancer Society (R321-A17417)

  • Tina Bech Olesen
  • Henrik Møller

The Danish regions

  • Tina Bech Olesen
  • Henry Jensen

The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication.

Ethics

Human subjects: Ethical considerationsThe study is registered at the Central Denmark Region's register of research projects (journal number 1-16-02-381-20). Patient consent is not required by Danish law for register-based studies.

Reviewing Editor

  1. Eduardo Franco, McGill University, Canada

Publication history

  1. Received: July 12, 2022
  2. Accepted: January 22, 2023
  3. Accepted Manuscript published: January 25, 2023 (version 1)

Copyright

© 2023, Olesen et al.

This article is distributed under the terms of the Creative Commons Attribution License permitting unrestricted use and redistribution provided that the original author and source are credited.

Metrics

  • 29
    Page views
  • 9
    Downloads
  • 0
    Citations

Article citation count generated by polling the highest count across the following sources: Crossref, PubMed Central, Scopus.

Download links

A two-part list of links to download the article, or parts of the article, in various formats.

Downloads (link to download the article as PDF)

Open citations (links to open the citations from this article in various online reference manager services)

Cite this article (links to download the citations from this article in formats compatible with various reference manager tools)

  1. Tina Bech Olesen
  2. Henry Jensen
  3. Henrik Møller
  4. Jens Winther Jensen
  5. Berit Andersen
  6. Morten Rasmussen
(2023)
Nation-wide participation in FIT-based colorectal cancer screening in Denmark during the COVID-19 pandemic: An observational study
eLife 12:e81808.
https://doi.org/10.7554/eLife.81808

Further reading

    1. Epidemiology and Global Health
    Tina Bech Olesen, Henry Jensen ... Berit Andersen
    Research Article

    Background: In contrast to most of the world, the cervical cancer screening programme continued in Denmark throughout the COVID-19 pandemic. We examined the cervical cancer screening participation during the pandemic in Denmark.

    Methods: We included all women aged 23-64 years old invited to participate in cervical cancer screening from 2015-2021 as registered in the Cervical Cancer Screening Database combined with population-wide registries. Using a generalised linear model, we estimated prevalence ratios (PR) and 95% confidence intervals (CI) of cervical cancer screening participation within 90, 180 and 365 days since invitation during the pandemic in comparison with the previous years adjusting for age, year and month of invitation.

    Results: Altogether, 2,220,000 invited women (in 1,466,353 individuals) were included in the study. Before the pandemic, 36% of invited women participated in screening within 90 days, 54% participated within 180 days and 65% participated within 365 days. At the start of the pandemic, participation in cervical cancer screening within 90 days was lower (pre-lockdown PR=0.58; 95% CI: 0.56-0.59 and 1st lockdown PR=0.76; 95% CI: 0.75-0.77) compared with the previous years. A reduction in participation within 180 days was also seen during pre-lockdown (PR=0.89; 95% CI: 0.88-0.90) and 1st lockdown (PR=0.92; 95% CI: 0.91-0.93). Allowing for 365 days to participation, only a slight reduction (3%) in participation was seen with slightly lower participation in some groups (immigrants, low education and low income).

    Conclusions: The overall participation in cervical cancer screening was reduced during the early phase of the pandemic. However, the decline almost diminished with longer follow-up time.

    Funding: The study was funded by the Danish Cancer Society Scientific Committee (grant number R321-A17417) and the Danish regions.

    1. Epidemiology and Global Health
    Nick Golding, David J Price ... Freya M Shearer
    Research Article

    Against a backdrop ofwidespread global transmission, a number of countries have successfully brought large outbreaks of COVID-19 under control and maintained near-elimination status. A key element of epidemic response is the tracking of disease transmissibility in near real-time. During major out-breaks, the effective reproduction number can be estimated froma time-series of case, hospitalisation or death counts. In low or zero incidence settings, knowing the potential for the virus to spread is a response priority. Absence of case data means that this potential cannot be estimated directly. We present a semi-mechanisticmodelling framework that draws on time-series of both behavioural data and case data (when disease activity is present) to estimate the transmissibility of SARS-CoV-2 fromperiods of high to low- or zero- case incidence, with a coherent transition in interpretation across the changing epidemiological situations. Of note, during periods of epidemic activity, our analysis recovers the effective reproduction number, while during periods of low- or zero- case incidence, it provides an estimate of transmission risk. This enables tracking and planning of progress towards the control of large outbreaks, maintenance of virus suppression, and monitoring the risk posed by re-introduction of the virus. We demonstrate the value of our methods by reporting on their use throughout 2020 in Australia, where they have become a central component of the national COVID-19 response.