Online self-test added to CRC screening can increase effectiveness of familial cancer risk assessment without increasing distress.

van Erkelens A1, Sie AS1, Spanier MBW2, van Kouwen M3, Visser A4, Prins JB4, Hoogerbrugge N1.

Author information

Abstract

AIM:

Most persons at increased familial colorectal cancer (FCRC) risk are not identified, despite needing enhanced surveillance colonoscopies for effective CRC prevention. An online self-test may enhance this identification. We assessed whether taking an online self-test for identifying increased FCRC risk increases anxiety, distress, or CRC risk perception in population-based CRC screening.

METHODS:

After the colonoscopy pre-procedure consultation, patients with a positive immunohistochemical occult fecal blood test (iFOBT+) in population-based CRC screening were invited by e-mail to take an online self-test at home which returned family history details. Anxiety (STAI-DY), distress (HADS), and CRC risk perception were assessed immediately before and after taking the online self-test, and two weeks later.

RESULTS:

Of 250 invited participants, 177 (71%) completed the online self-test and psychological questionnaires, 153 (61%) completed questionnaires two weeks later. Median age was 65 years (range 61-75). FCRC risk was increased in 17 (9.6%). Of these, 12 (6.8%) had a highly increased FCRC risk and may benefit from Lynch syndrome germline genetic testing. In 7/17 participants (40%) the self-test obtained novel family history information. Anxiety and distress levels were, and remained, below clinical relevance level. CRC risk perception remained unchanged. Most participants (83%) would recommend the online self-test to others.

CONCLUSION:

Of those with an iFOBT+, 9.6% had a previously unidentified increased FCRC risk and need enhanced surveillance colonoscopies instead of iFOBT. As screening for this risk did not increase anxiety or distress, and was highly acceptable, we recommend adding the online self-test to population-based CRC screening. This article is protected by copyright. All rights reserved.