The early detection of colorectal cancer and its prevention.

Three cross-sectional surveys of acceptance of faecal occult blood testing for colorectal cancer screening, one survey of non-acceptors and one randomised controlled trial of an information leaflet were conducted. These were workplace based schemes in the private and public sectors and opportunistic screening using blood donors as a model. Simple educational leaflets explaining the high frequency of colorectal cancer and screening which addressed reasons for non-compliance were investigated. Subjects completed faecal occult blood tests at home and those with positive results underwent colonoscopy. Completion of tests in general practice in those aged 51 to 70 years was 33% (665/2029) in men and 42% (900/2147) in women. In private industry in subjects aged 41 to 65 years, compliance in men was 25% (425/1703) and in women 32% (40/125). In public industry in subjects aged 41 to 65 years compliance was 32% (53/165) in men and 46% (376/820) in women. With opportunistic screening at the blood donor centre compliance in those offered screening aged 51 to 65 years was 66% (75/114) in men and in women 59% (41/70). The health educational leaflets increased awareness of cancer and screening and raised intention to participate in a 100 subjects accompanying patients to hospital clinics. Reasons for non-compliance addressed in the leaflet, were identified from an interview survey of 81 non-compliers in Market Harborough. Common reasons were the unpleasantness of stool collection, lack of appreciation that healthy subjects should participate, fear of further tests and surgery and intercurrent illness. After piloting the leaflet it was tested in a randomised community controlled trial in general practice in subjects aged 61 to 70 years. The leaflet increased compliance in men from 25% (91/360) to 38% (143/381) (X2=12.9, p 0.001), but was ineffective in women (33%, 134/405, vs 34%, 145/425, X2=0.1,ns). Organisers of screening should consider opportunistic approaches and health education leaflets to increase participation. As compliance in this study was lower than in some other programmes, more work is needed to identify other reasons for non-compliance.