Perceived importance of the benefits and harms of colorectal cancer screening: a best-worst scaling study

Published:January 13, 2023DOI:
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      • Colorectal cancer screening is beneficial on a population level, but the benefits do not always outweigh the potential harms on an individual level. Individual preferences play an important role in weighing the benefits and harms of participating in screening.
      • In this study, we quantified how important screening invitees perceived the harms of colorectal cancer screening as compared to the benefits.
      • The preference values obtained in this study will be used to help screening invitees make an informed decision about participating in screening.



      To elicit the relative importance of the benefits and harms of colorectal cancer (CRC) screening among potential screening participants in the Dutch population.


      In a consensus meeting with 11 experts, risk reduction of CRC and CRC deaths (benefits) and complications from colonoscopy, stress of receiving positive fecal immunological test (FIT) results, as well as false positive and false negative FIT results (harms) were selected as determinant end points to consider during decision making. We conducted an online best-worst scaling survey among adults aged 55 to 75 years from the Nivel Dutch Health Care Consumer Panel to elicit preference values for these outcomes. The preference values were estimated using conditional logit regression.


      Of 265 participants, 234 (89%) had ever participated in CRC screening. Compared to stress of receiving a positive FIT result, the outcome perceived most important was the risk of CRC death (OR 4.5, 95% CI 3.9 to 5.1), followed by risk of CRC (OR 4.1, 95% CI 3.6 to 4.7), a false negative FIT result (OR 3.1, 95% CI 2.7 to 3.5), colonoscopy complications (OR 1.6, 95% CI 1.4 to 1.8), and a false positive FIT result (OR 1.4, 95% CI 1.3 to 1.6). The magnitude of these differences in perceived importance varied according to age, educational level, ethnic background and whether the individual had previously participated in CRC screening.


      Dutch men and women eligible for FIT-based CRC screening perceive the benefits of screening to be more important than the harms.


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