Measuring public preferences for colorectal cancer screening using new genome-based nanotechnologies.

Fermont, Jilles M. (2011) Measuring public preferences for colorectal cancer screening using new genome-based nanotechnologies.

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Abstract:Objectives. Emerging developments in nanomedicine allow the development of genome-based technologies for unobtrusive and individualised screening for diseases such as colorectal cancer. An example is the nanopill that collects gastrointestinal fluid and screens DNA for tumour markers. The main objectives of this study were to measure patient preferences for a new form of screening and measure expected screening uptake compared to standard colorectal cancer screening. Methods. Data was collected through a discrete choice experiment among individuals aged between 50 and 74 years living in the Netherlands and the United Kingdom. A full-profile fractional factorial design with a balanced overlap was implemented. Fourteen random and two fixed choice-tasks with triplets and dual-none response were used. Through an extensive literature search following attributes were included: preparation, technique, sensitivity, specificity, complication rate and testing frequency. Data were analysed using Hierarchical Bayes analysis and a Multinomial Logit model. Results. Thirteen hundred fifty-six respondents completed the questionnaire, from which 884 (65%) passed the consistency test. Most preferred attributes were: technique (pill), sensitivity (100%), preparation (none), specificity (100%), complications (none) and interval (every 5 years). Nanopill was with an expected screening uptake of 46% the most preferred screening modality, followed by iFOBT (40%), colonoscopy (2%) and sigmoidoscopy (1%). Eleven percent would choose not to be screened. Sensitivity analysis showed that the nanopill should be at least 90% sensitive, 100% specific and have an interval of 5 years to be equally attractive as biennial iFOBT. Conclusions. Colorectal cancer (CRC) screening has been introduced in a number of countries using standard screening techniques. In 2013 a population-based CRC screening program with stool sampling will be implemented in the Netherlands. In the United Kingdom a population-based CRC screening program with iFOBT is already implemented. However, current developments in nanomedicine allow the development of new technologies for individualised screening. Expected benefits of genome-based nanotechnologies are improved screening adherence, earlier diagnosis and more accurate test results. Within the framework of early health technology assessment study results suggest the nanopill to be accepted by the public which does support further development. However, consequences of population-based direct-toconsumer genomic testing are unknown and needs to be studied further. Also hypothetical scenarios to describe the nanopill were used in the study and results do not guarantee public acceptance and screening uptake. Cost-benefit analysis and clinical trials remain mandatory.
Item Type:Essay (Master)
Faculty:BMS: Behavioural, Management and Social Sciences
Subject:85 business administration, organizational science
Programme:Health Sciences MSc (66851)
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