Measures of longitudinal adherence to fecal-based colorectal cancer screening: Literature review and recommended approaches

V. Paul Doria-Rose*, Iris Lansdorp-Vogelaar, Sharon McCarthy, Douglas M. Puricelli-Perin, Vicent Butera, Nereo Segnan, Stephen H. Taplin, Carlo Senore

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

12 Citations (Scopus)


The success of fecal occult blood-based colorectal cancer screening programs is dependent on repeating screening at short intervals (ie, every 1-2 years). We conducted a literature review to assess measures that have been used to assess longitudinal adherence to fecal-based screening. Among 46 citations identified and included in this review, six broad classifications of longitudinal adherence were identified: (a) stratified single-round attendance, (b) all possible adherence permutations, (c) consistent/inconsistent/never attendance, (d) number of times attended, (e) program adherence and (f) proportion of time covered. Advantages and disadvantages of these measures are described, and recommendations on which measures to use based on data availability and scientific question are also given. Stratified single round attendance is particularly useful for describing the yield of screening, while programmatic adherence measures are best suited to evaluating screening efficacy. We recommend that screening programs collect detailed longitudinal, individual-level data, not only for the screening tests themselves but additionally for diagnostic follow-up and surveillance exams, to allow for maximum flexibility in reporting adherence patterns using the measure of choice.

Original languageEnglish
Pages (from-to)316-326
Number of pages11
JournalInternational Journal of Cancer
Issue number2
Publication statusPublished - 3 Apr 2021

Bibliographical note

Funding Information:
The authors wish to thank Ms. Alicia Livinski of the National Institutes of Health (NIH) Library for participating in the development of a search strategy and for conducting the literature searches. They also thank Dr. Veerle Coup? for her helpful comments on an earlier draft of this manuscript. This project has been funded in whole or in part with federal funds from the National Cancer Institute, National Institutes of Health, under Contract No. HHSN261200800001E 75N910D00024, Task Order No. 75N91019F00129. The content of this publication does not necessarily reflect the views or policies of the US Department of Health and Human Services nor does mention of trade names, commercial products or organizations imply endorsement by the US Government.

Funding Information:
National Cancer Institute, Grant/Award Number: Contract No. HHSN261200800001E 75N910D00024, Task Order No. 75N91019F00129; US Department of Health and Human Services; National Institutes of Health Funding information

Publisher Copyright:
© 2021 UICC


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