RESILIENCE OF A FAECAL IMMUNOCHEMICAL TEST SCREENING PROGRAMME AGAINST SCREENING FATIGUE
Repeated participation is important in faecal immunochemical testing (FIT) screening for colorectal cancer (CRC). However, a large number of screening invitations over time may lead to screening fatigue and consequently, decreased participation rates. We evaluated the impact of screening fatigue on overall screening programme effectiveness.
Using the ASCCA model, we simulated the Dutch CRC screening programme consisting of biennial FIT screening in individuals aged 55-75. We analysed several screening scenarios differing in participation pattern, number of negative screens after which screening fatigue occurs and decrease in participation rate due to screening fatigue. Outcomes were reductions in CRC incidence and mortality compared to no screening.
Assuming 63% participation which was homogenous across the population, i.e. each round each individual was equally likely to attend screening, thirty years of screening reduced CRC incidence and mortality by 39% and 53%, respectively, compared to no screening. When assuming clustered participation, i.e. three subgroups of individuals with a high, intermediate and low participation rate, screening was slightly less effective; reductions were 33% for CRC incidence and 43% for CRC mortality. Screening fatigue considerably reduced screening effectiveness; if individuals would refrain from screening after three negative screens, model-predicted programme effectiveness was reduced by 37% and 46% under homogenous and clustered participation, respectively.
Screening will substantially decrease CRC incidence and mortality. However, screening effectiveness can be seriously compromised if screening fatigue occurs. This warrants careful monitoring of individual screening behaviour and consideration of targeted invitation systems in individuals who have been repeatedly screened.