Colorectal cancer screening participation in childhood cancer survivors: a report from the French Childhood Cancer Survivors Study (FCCSS).

BACKGROUND

Colorectal cancer (CRC) risk is increased in childhood cancer survivors (CCS). In France, fecal immunochemical testing (FIT) is recommended every 2 years for those aged 50-74 years, although no specific CRC-screening programs are dedicated to CCS.

METHODS

We investigated the participation rate in CRC screening by using the national health data system to identify FIT in the French Childhood Cancer Survivor Study cohort, across three two-year periods-2016-17, 2018-19, and 2020-21-to compare it to the general population via indirect standardization and used multivariable logistic regression to investigate factors influencing CCS participation.

RESULTS

In 2016-17, 2018-19, and 2020-21, respectively, 20.0%, 21.8%, and 23.2% participated in screening, which is lower than the rate for the general population [standardized incidence ratios (95% CI) = 0.62 (0.49-0.78), 0.72 (0.59-0.87), and 0.70 (0.59-0.83), respectively]. Demographic, clinical, therapeutic, and socio-economic determinants were not associated with CRC-screening participation. Although these patterns were not consistently observed across all subgroups, survivors with severe long-term complications tended to have higher participation [odds ratio (95% CI) = 1.64 (1.07-2.53)], whereas higher medical expenses were associated with lower participation (P < .01).

CONCLUSION

Despite an increased risk of CRC after childhood cancer, participation in CRC-screening programs remains low in CCS. Survivors and their physicians require educational initiatives to promote CRC screening and provide risk-adapted surveillance guidelines.