Nation-wide participation in FIT-based colorectal cancer screening in Denmark during the COVID-19 pandemic: An observational study
- The Danish Clinical Quality Program - National Clinical Registries, Denmark
- Randers Regional Hospital, Denmark
- 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
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.
Reviewing Editor
- Eduardo Franco, McGill University, Canada
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.
Version history
- Received: July 12, 2022
- Preprint posted: August 23, 2022 (view preprint)
- Accepted: January 22, 2023
- Accepted Manuscript published: January 25, 2023 (version 1)
- Version of Record published: May 22, 2023 (version 2)
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.
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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
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- Epidemiology and Global Health
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 y old invited to participate in cervical cancer screening from 2015 to 2021 as registered in the Cervical Cancer Screening Database combined with population-wide registries. Using a generalised linear model, we estimated prevalence ratios (PRs) and 95% CIs of cervical cancer screening participation within 90, 180, and 365 d 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 d, 54% participated within 180 d, and 65% participated within 365 d. At the start of the pandemic, participation in cervical cancer screening within 90 d was lower (pre-lockdown PR = 0.58; 95% CI: 0.56–0.59 and first lockdown PR = 0.76; 95% CI: 0.75–0.77) compared with the previous years. A reduction in participation within 180 d was also seen during pre-lockdown (PR = 0.89; 95% CI: 0.88–0.90) and first lockdown (PR = 0.92; 95% CI: 0.91–0.93). Allowing for 365 d 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.
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- Epidemiology and Global Health
- Medicine
- Cancer Biology
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