Reasons for noncompliance with five-yearly screening flexible sigmoidoscopy

OBJECTIVE To determine factors influencing the low return rate observed in a program of flexible sigmoidoscopy for average risk screening for colorectal carcinoma. METHODS Flexible sigmoidoscopy-based screening of average risk 55-64 yr olds has been ongoing since 1995. Greater than 3400 primary and 1000 follow up screening examinations have been performed. Participants with a primary screen in 1997-1999 and eligible for rescreening in 2002-2004 were studied. A questionnaire assessing possible reasons for noncompliance was sent to subjects who did not attend the five year repeat screening. RESULTS 1672 primary screening flexible sigmoidoscopies were performed in 1997-1999 with 1362 being normal or having hyperplastic polyps only. The return rate was 45%: 48% of eligible males and 39% of eligible females had returned (p = 0.001 for difference). 709 questionnaires were mailed with a 50% response rate and 162 requests for repeat flexible sigmoidoscopy were generated. 27% of all respondents had undergone further bowel evaluation since the original normal sigmoidoscopy. Of eligible subjects who refused further screening, 65% did so because of concerns over procedural pain. CONCLUSIONS Reasons for nonattendance relate to uptake of other bowel investigations and pain felt at initial screening. Return rate can be raised with ongoing prompting to attend screening.