The contribution of a negative colorectal screening test result to symptom appraisal and help-seeking behaviour among patients subsequently diagnosed with an interval colorectal cancer

Karen N. Barnett, David Weller, Steve Smith, Robert J. C. Steele, Peter Vedsted, Sheina Orbell, Sue M. Moss, Jane W. Melia, Julietta Patnick, Christine Campbell (Lead / Corresponding author)

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Background: Colorectal cancer (CRC) screening programmes using a guaiac faecal occult blood test (gFOBt) reduce CRC mortality. Interval cancers are diagnosed between screening rounds: reassurance from a negative gFOBt has the potential to influence the pathway to diagnosis of an interval colorectal cancer.

Methods: Twenty-six semi-structured face-to-face interviews were carried out in Scotland and England, with individuals diagnosed with an interval colorectal cancer following a negative gFOBt result.

Results: Participants reported they were reassured by a negative gFOBt, interpreting their result as an "all clear". Therefore, most did not suspect cancer as a possible cause of symptoms and many did not recall their screening result during symptom appraisal. Among those who did consider cancer, and did think about their screening test result, reassurance from a negative gFOBt led some to "downplay" the seriousness of their symptoms with some interviewees explicitly stating that their negative test result contributed to a delayed decision to seek help.

Conclusion: Screening participants need to be informed of the limitations of screening and the ongoing risk of developing colorectal cancer even when in receipt of a negative result: the importance of minimizing delay in seeking medical advice for colorectal symptoms should be emphasized.

Original languageEnglish
Pages (from-to)764-773
Number of pages10
JournalHealth Expectations
Issue number4
Early online date19 Feb 2018
Publication statusPublished - 1 Aug 2018



  • colorectal cancer screening
  • help-seeking
  • interval cancer
  • negative screening result
  • symptom appraisal
  • understanding of screening

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