Provincial variation in colorectal cancer screening adherence in Canada; evidence from the Canadian Partnership for Tomorrow's Health

Maryam Darvishian; Amina Moustaqim-Barrette; Philip Awadalla; Parveen Bhatti; Philippe Broet; Kelly McDonald; Rachel A Murphy; Kimberly Skead; Robin Urquhart; Jennifer Vena; Trevor J B Dummer

doi:10.3389/fonc.2023.1113907

Provincial variation in colorectal cancer screening adherence in Canada; evidence from the Canadian Partnership for Tomorrow's Health

Front Oncol. 2023 Jun 16:13:1113907. doi: 10.3389/fonc.2023.1113907. eCollection 2023.

Authors

Maryam Darvishian^{1

2}, Amina Moustaqim-Barrette^{2

3}, Philip Awadalla^{4

5}, Parveen Bhatti^{1

2}, Philippe Broet^{6

7}, Kelly McDonald⁴, Rachel A Murphy^{1

2}, Kimberly Skead⁴, Robin Urquhart⁸, Jennifer Vena⁹, Trevor J B Dummer²

Affiliations

¹ Cancer Control Research, British Columbia (BC) Cancer, Vancouver, BC, Canada.
² School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
³ British Columbia (BC) Centre for Disease Control, Vancouver, BC, Canada.
⁴ Ontario Institute for Cancer Research, Toronto, ON, Canada.
⁵ Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada.
⁶ Department of Preventive and Social Medicine, École de Santé Publique, Université de Montréal, Montreal, QC, Canada.
⁷ Research Centre, CHU Sainte Justine, Montreal, QC, Canada.
⁸ Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada.
⁹ Alberta Health Services, Alberta's Tomorrow Project, Cancer Research & Analytics, Cancer Care Alberta, Edmonton, AB, Canada.

Abstract

Introduction: Although colorectal cancer (CRC) screening program is proven to reduce CRC incidence and mortality, understanding patterns and predictors of suboptimal adherence in screening program requires further investigation in Canada.

Methods: We used self-reported data from five regional cohorts of the Canadian Partnership for Tomorrow's Health (CanPath), namely the BC Generations Project (BCGP), Alberta's Tomorrow Project (ATP), the Ontario Health Study (OHS), Quebec's CARTaGENE, and the Atlantic Partnership for Tomorrow's Health Study (Atlantic PATH). We stratified participants into the following four risk categories: 1) age 50-74 years, 2) family history in a first-degree relative, 3) personal history of chronic inflammatory bowel disease and/or polyps, and 4) co-existence of personal risk and family history. Multivariable logistic regression was used to identify predictors of adherence to the screening guidelines.

Results: Adherence to CRC screening varied considerably between regions, ranging from 16.6% in CARTaGENE to 47.7% in OHS. Compared to the largest cohort OHS, the likelihood of non-adherence to CRC screening was significantly higher in BCGP (OR 1.15, 95% CI 1.11-1.19), the Atlantic PATH (OR 1.90, 95% CI 1.82-1.99) and CARTaGENE (OR 5.10, 95% CI 4.85-5.36). Low physical activity, current smoking, presence of personal risk, family history of CRC significantly reduced the likelihood of adherence to screening recommendations.

Discussion/conclusion: Compared to the national target of ≥ 60% for participation in CRC screening, adherence to regular CRC screening was suboptimal in this cohort of Canadians and varied by region. Further efforts are needed to identify the specific barriers to screening adherence in different provinces and across risk categories.

Keywords: CanPath cohort; Canada; adherence; colorectal cancer; screening.

Grants and funding

CanPath was created with financial support from the Canadian Partnership Against Cancer and by Health Canada. The views expressed herein represent the views of the authors and do not necessarily represent the views of Health Canada. CanPath regional cohorts were also supported by the Ontario Institute for Cancer Research, Alberta Health Services, the Alberta Cancer Prevention Legacy Fund, Alberta Cancer Foundation, Genome Quebec and the BC Cancer Foundation. TD holds the Canadian Cancer Society Chair in Cancer Primary Prevention.