Increasing deaths from colorectal cancer in Poland - insights for optimising colorectal cancer screening in society and space

Introduction and objective. With respect to the increasing numbers of deaths due to colorectal cancer in Poland, the aim of the study was to investigate socio-demographic characteristics which influence colorectal cancer screening acceptance and to assess spatial variation of colorectal cancer mortality. Materials and method. An age-period-cohort model was estimated to assess mortality trends in colorectal cancer in Poland. A geographical analysis was performed by spatial regression. Factors influencing participation in colorectal cancer screening were identified using structural equation modelling. Results. In 2014 in Poland, 6.4 thousand men and 5.0 thousand women died due to colorectal cancer. In total, by 2030 this number is expected to rise to nearly 14.4 thousand. Observed spatial clustering of age-adjusted colorectal cancer mortality is associated with spatial variation in tobacco use, employment in industry, and consumption of red meat. Patient- physician communication, advanced age, and healthy diet are the most important predictors of colorectal cancer screening acceptance. Tobacco and alcohol users are not more likely to participate in colorectal cancer screening, adjusting for other variables. Conclusions. Self-selection of patients who follow healthy diet means that individuals at higher risk of colorectal cancer are less likely to participate in colorectal cancer screening. Therefore, screening should be more targeted. According to the structural equation modelling results, the phenomenon of ‘no-show’ for screening can be mitigated by patient-physician communication. The inhabitants of the Greater Poland region are at the highest risk of dying due to colorectal cancer, which may have public health policy implications.