Repeated screening for colorectal cancer with fecal occult blood test in Catalonia, Spain Montse Garcia a,b , Josep Maria Borra `s a,c,e , Gemma Binefa a,b , Nu ´ ria Mila ` a,b , Josep Alfons Espina `s a,c,e and Vı ´ctor Moreno b,c,d The objective of this study was to explore the variables associated with repeated screening for colorectal cancer (CRC) among individuals aged 50–69 years in Catalonia, Spain. We selected for the study all individuals (n = 11 969) screened by a population-based CRC screening program in 2004 and who were eligible for rescreening in two years. A multilevel logistic regression model was derived. The contextual variables were the percentage of people with less than primary studies and the percentage of CRC screening participation. The individual variables used were: sex, age, CRC screening (prior to 2004), guaiac fecal occult blood test result, ease of recruitment, and number of tests used. The rescreening rate was 87%. No differences according to sex and age were found. The strongest barrier for CRC rescreening was an inconclusive fecal occult blood test result at baseline screening [odds ratio (OR): 0.24; 95% confidence intervals (CI): 0.20–0.29]. Individuals who agreed to participate just after receiving the screening invitation were more likely to accept a second screen compared with those who received a reminder letter six weeks later (OR: 1.53; 95% CI: 1.36–1.73). Those individuals who lived in a neighborhood with a higher educational level were more willing to rescreen (OR: 1.22; 95% CI: 1.03–1.45) than those who lived in more deprived areas. Rescreening was highly adequate in our program, reflecting satisfaction with the service received at screening. Strategies to enhance initial screening participation for CRC and to improve quality throughout the screening process should be prioritized. European Journal of Cancer Prevention 21:42– 45  c 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. European Journal of Cancer Prevention 2012, 21:42–45 Keywords: colorectal cancer, mass screening, participation, rescreening a Cancer Prevention and Control Group, IDIBELL, b Catalan Institute of Oncology- ICO, L’Hospitalet de Llobregat, c Department of Clinical Sciences, University of Barcelona, d Colorectal Cancer Group, IDIBELL, L’Hospitalet de Llobregat and e Catalan Cancer Plan, Catalan Health Government, Barcelona, Spain Correspondence to Montse Garcia, PhD, Cancer Prevention and Control Unit, Catalan Institute of Oncology, Av. Gran Via 199-203, L’Hospitalet de Llobregat. Barcelona 08908, Spain Tel: +34 93 260 71 86; fax: +34 93 260 79 56; e-mail: mgarcia@iconcologia.net Received 13 April 2011 Accepted 12 June 2011 Introduction Early detection can play an important role in reducing colorectal cancer (CRC) mortality (Gouveia et al., 2008). High level of ongoing and timely participation in screen- ing is necessary to determine its effectiveness in reducing mortality from CRC (Calazel-Benque et al., 2011). However, most studies have focused on one-time screen- ing rather than repeat adherence. Thus, little is known about the determinants of adherence to repeat fecal testing in population-based CRC screening programs. The objective of this study was to explore the variables associated with rescreening for CRC among men and women aged 50–69 years in Catalonia, Spain. Methods Study population The study population (n = 11 969) included men and women aged 50–69 years who had been screened by the Catalan CRC screening pilot program in 2004 and who remained eligible to repeat screening two years later (Fig. 1). A person was considered screened (participant) when a completed fecal occult blood test (FOBT) kit was returned, irrespective of the results. Screening procedure A detailed description of the screening procedure is provided elsewhere (Peris et al., 2007). In brief, a biennial screening program for CRC using FOBT was implemen- ted in the Hospitalet de Llobregat, an industrial city of 239 000 inhabitants in 2000. Participants collected two stool samples from each of three consecutive bowel movements. The possible results of the FOBT were: (a) weakly positive: one to four positive samples. Those participants with a weakly positive result were asked to perform a second FOBT and if, any sample was positive, were offered colonoscopy without further testing. In contrast, if all six samples were negative, a third FOBT was requested; (b) spoilt kit/ technical failure: laboratory was unable to analyze the kit. The most common reason for a rejected kit was that the information provided with the kit was not complete. Those participants who refused to repeat the test after a weak positive or a spoilt kit/ technical failure were coded as an inconclusive FOBT result; (c) negative: zero out of six positive samples; (d) strongly positive: five or six positive samples. Those participants with positive results were referred for a colonoscopy. If no lesions were found in the colonoscopy 42 Short paper 0959-8278  c 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins DOI: 10.1097/CEJ.0b013e32834a7e9b Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.