Determinants in Colorectal Cancer Screening Attendance

Maija Jäntti

Research output: Book/ReportDoctoral thesisCollection of Articles


As the second most common cancer in Finland in both sexes, there is a need for colorectal cancer (CRC) mortality reduction. Screening programmes are primarily aiming to reach the at the time disease-free or at least symptomless people. Therefore, evaluating the effectiveness of the programmes is particularly important. CRC screening is effective in reducing CRC mortality.

The foundation for a successful screening programme is high enough attendance. In previous studies, several demographic factors such as gender, marital status or education have been shown to be associated with screening attendance. Initial attendance has been predictive of future attendance in regional studies. CRC mortality is increased in men compared to women. CRC prevalence is higher in screening non-attendants than in controls.

In addition to sociodemographic determinants, also psychosocial aspects and societal constructs can affect health-related behaviour. Fear of the disease or the treatment for the disease, inability to understand the concept of screening or fatalism can prevent one from attending. On the other hand, social participation can be beneficial for one’s health-related behaviour.

The base population for this research were the 466,253 individuals randomised for CRC screening between 2004 and 2014, and 233,211 of them were invited to CRC screening between 2004 and 2016. To investigate the association between screening and self-rated health (SRH), a survey study on the psychosocial determinants of health was linked to the screening data. The questionnaire was sent to 10,271 individuals a year before and a year after their first ever screening invitation in 2011, in 2010 and in 2012. In addition, the National Survey Study of the Adult Finnish Population (ATH) study at the Finnish Institute for Health and Welfare was linked with the screening data. The survey consisted of questions of various aspects of life, such as well-being, health, lifestyle, services and trust in society. Altogether 5,207 individuals were invited to CRC screening and had answered the ATH-survey at the subsequent year following the first ever CRC invitation or later.

A generalised estimating equation was used to analyse the association between demographic determinants and attendance in the population of 233,211 individuals invited to the screening. There were differences between sexes. We found that men, unmarried, less educated or of immigrant background had lower attendance than women, married, those with tertiary education or a native background.

Men not attending the initial CRC screening had more often poor quality of life later compared to male attenders. The same was not seen in women. CRC screening non-attenders later reported to be more often culturally inactive than screening attenders in both men and women.

When assessing the association between screening invitation or attendance and health, we did not find a difference in invitees compared to controls. However, female attenders reported worse and male attenders a better estimation of self-rated (SRH) compared to same sex controls. Survey respondents were self-selected similarly on both survey rounds.

Clear recommendations in plain language should be provided in addition to information about the benefits and harms of attending screening to better serve the public. Public health care reaches some, but not all. A more innovative approach is needed to get the message across.

We aimed to investigate the determinants associated with attendance at an organised CRC screening programme. The objective was to form a broader view of the non-attendants covering areas previously less investigated. In addition, we examined the association between CRC screening and perceived health.
Original languageEnglish
Place of PublicationTampere
ISBN (Electronic)978-952-03-3033-0
Publication statusPublished - 2023
Publication typeG5 Doctoral dissertation (articles)

Publication series

NameTampere University Dissertations - Tampereen yliopiston väitöskirjat
ISSN (Print)2489-9860
ISSN (Electronic)2490-0028


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