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Pilot study on feasibility of interdisciplinary project on adherence to colorectal cancer


Maria Timofeeva (SUND), Kaare Christensen (SUND) and Søren Askegaard (SAMF) 


Project description

Population-based colorectal cancer (CRC) screening programs using faeccal occult blood tests (FOBT) have been shown to reduce CRC-related mortality with various effectiveness (Gini et al., 2020). In 2014 the Danish National CRC Screening Program was implemented free of charge to all residents aged 50-74 years. 

The adherance to the screening programe has been shown to be lower in demographic groups with higher risk of cancer and poor survival (Egeberg et al., 2008, Frederiksen et al., 2009), such as males, individuals having lower income and/or living alone (Njor et al., 2018, Larsen et al., 2017). 

Previous research indicated a strong presence of multiple economic, social and cultural factors influencing adherance to screening (Nielsen et al., 2021, Dressler et al., 2021). Understanding factors behing poor compliance among societal groups with increased risk of cancer development and poor survival prognosis can reduce inequalities in access to healthcare. 

Therefore, this project aims to answer following research question: What are the barriers for and facilitators of adherence to CRC screening programs among societal groups with low social-economic status and educational attainment?


Herewith we propose an interdisciplinary project which combines innovative tools across different disciplines in a comprehensive study of factors behind non-participation. 

First, we will use classical and extended twin designs to identify familiar clustering of (non)adherence among twins and their relatives and to estimate relative contribution of genetic and environmental factors (including co-habitation) on participation in screening. 

Second, we will implement a concept of health capital (Schneider-Kamp, 2020, Schneider-Kamp & Askegaard 2022) to understand how cultural, social and financial resources determine individual’s participation in cancer screening. For the first time, this concept will be applied in the twin settings, where the genetic homogeneity and shared early life exposure among discordant twins will allow us for a more focused and precise analysis. 

Finally, we will combine the obtained knowledge to improve our general understanding of non-participation practices with the goal to increase adherence among relevant societal groups.


The proposed pilot study will serve as a basis for further discussion and a joint research proposal. The main activities are outlined in the budget section. In summary we plan:

  1. to organize a workshop to bring together main stakeholders in the field locally and across Denmark (Objective 1);

  2. to gain access to the registry-based data through application to Statistics Denmark (Objective 2);

  3. to develop a research instrument based on the notion of health capital through focus-group study with patient representatives (Tarmkræftforeningen) and focus groups recruited through local General Practices (Prof Jens Søndergaard) (Objective 3);

  4. to prepare a joint application to the Danish Cancer Society and other relevant funding agencies.


The described pilot project will contribute to the development of interdisciplinarity at DIAS and DIAS visibility, by providing a common ground for communication through a workshop and work with GPs, patient representatives and other stakeholders. 

The proposed methodology is unique and innovative and aims to combine quantitative methods of genetic epidemiology and twin research with qualitative methods of social science and consumer culture theory. 

With the overarching aim to reduce health inequality in access to the Danish healthcare system, our research is very well aligned with the other SDU initiatives such as Human Health and SDU’s work on Sustainable Development Goals (SDGs). More specifically, the proposed project address goal 3 (ensure healthy lives and promote well-being for all at all ages) and goal 10 (reduce inequality) of SDGs. 


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