Advanced-stage CRC incidence patterns following the phased implementation of the CRC screening programme in the Netherlands

Breekveldt, Emilie C. H.; Toes‐Zoutendijk, Esther; Spaander, Manon; Schootbrugge-Vandermeer, Hilliene J. van de; Kemenade, Folkert J. van; Ramakers, Christian; Dekker, Evelien; Nagtegaal, Irıs D.; Leerdam, Monique E. van; Lansdorp–Vogelaar, Iris

doi:10.1016/j.ejca.2022.10.016

Cited by 3 publications

(1 citation statement)

References 15 publications

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“…Early-stage CRCs have better survival rates and require less invasive treatment than advanced-stage CRCs. Therefore, a stage shift resulting from the implementation of CRC screening implies the need for less invasive treatment of CRC and a decrease in mortality may be expected 3 4 5 6 .…”

Section: Introductionmentioning

confidence: 99%

Differences in treatment of stage I colorectal cancers: a population-based study of colorectal cancers detected within and outside of a screening program

Toes-Zoutendijk,

Breekveldt,

van der Schee

et al. 2023

Endoscopy

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Background Screen-detected colorectal cancers (CRCs) are often treated less invasively than stage-matched non-screen-detected CRCs, but the reasons for this are not fully understood. This study evaluated the treatment of stage I CRCs detected within and outside of the screening program in the Netherlands. Methods Data from the Netherlands Cancer Registry for all stage I CRCs diagnosed between January 1, 2008 and December 31, 2020 were analyzed, comparing patient, tumor, and treatment characteristics of screen-detected and non-screen-detected stage I CRCs. Multivariable logistic regression was used to assess the association between treatment (local excision only vs. surgical oncologic resection) and patient and tumor characteristics, stratified for T stage and tumor location. Results Screen-detected stage I CRCs were relatively more often T1 than T2 compared with non-screen-detected stage I CRCs (66.9 % vs. 53.3 %; P < 0.001). When only T1 tumors were considered, both screen-detected colon and rectal cancers were more often treated with local excision only than non-screen-detected T1 cancers (odds ratio [OR] 2.19, 95 %CI 1.93–2.49; and OR 1.29, 95 %CI 1.05–1.59, respectively), adjusted for sex, tumor location, lymphovascular invasion (LVI) status, and tumor differentiation. Conclusions Less invasive treatment of screen-detected stage I CRC is partly explained by the higher rate of T1 cancers compared with non-screen-detected stage I CRCs. T1 stage I screen-detected CRCs were also more likely to undergo less invasive treatment than non-screen-detected CRCs, adjusted for risk factors such as LVI and tumor differentiation. Future research should investigate whether the choice of local excision was related to unidentified cancer-related factors or the expertise of the endoscopists.

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Section: Introductionmentioning

confidence: 99%

Differences in treatment of stage I colorectal cancers: a population-based study of colorectal cancers detected within and outside of a screening program

Toes-Zoutendijk,

Breekveldt,

van der Schee

et al. 2023

Endoscopy

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Trends in incidence, treatment, and relative survival of colorectal cancer in the Netherlands between 2000 and 2021

Swartjes,

Sijtsma,

Elferink

et al. 2024

European Journal of Cancer

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The effect on colorectal cancer incidence and stage with population-based FOBT-screening in Sweden

Wilén,

Jonsson,

Blom

2024

Preprint

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Aim To investigate colorectal cancer (CRC) incidence and stage of disease in the population invited vs not invited to the guaiac-based Fecal Occult Blood (gFOBT) and Fecal Immunochemical Test (FIT) colorectal cancer screening program in Stockholm-Gotland, Sweden, 2008–2021 and to estimate the incidence rate by gender and localization in the colorectum. Methods The study cohort consisted of all 60-69-years-old residents of the Stockholm-Gotland region 2008–2012 according to the population register. Screening with biennial gFOBT was introduced in randomized birth cohorts from 2008 and replaced by FIT with cut-off level 40µg/g in women and 80µg/g in men for a positive test in 2015. Record linkage was made to the National Cancer Register and to the Swedish Colorectal Cancer Register (SCRCR). The age-standardized CRC incidence ratio was compared in invited and non-invited during screening and in 70-75-year-olds and assessed overall and by gender, CRC stage and localization. Results In total, 320 989 and 151 533 individuals were invited to a first gFOBT and FIT round, and 5 972 CRCs were diagnosed. During screening, the overall age-adjusted incidence ratio for the gFOBT- and FIT-invited compared to the non-invited was 0.99 (95% CI 0.91–1.07) and 1.03 (95% CI 0.93–1.15) respectively. Post screening, 70–75 years of age, the overall incidence rate was 12% lower among the invited than the non-invited (RR 0.88, 95% CI 0.81–0.97). During FIT screening, the incidence for stage I and proximal CRC was 38 and 23% higher than in the non-invited (RR 1.38, 95% CI 1.09–1.76 and RR 1.23, 95% CI 1.02–1.48 respectively). The incidence post screening was 22% lower regarding stage I CRC, 13% lower in women, and 17% lower for distal CRCs as compared to the non-invited (RR 95% CI 0.78 0.63–0.95, 0.87 0.76-1.00 and 0.83 0.74–0.94 respectively). Conclusion In the Stockholm-Gotland screening program the shift to FIT significantly increased the incidence rate in early staged and proximal CRCs as compared to the uninvited, and the significant decrease in the overall CRC incidence post screening was mainly seen in distal, early staged CRCs in women.

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Advanced-stage CRC incidence patterns following the phased implementation of the CRC screening programme in the Netherlands

Cited by 3 publications

References 15 publications

Differences in treatment of stage I colorectal cancers: a population-based study of colorectal cancers detected within and outside of a screening program

Differences in treatment of stage I colorectal cancers: a population-based study of colorectal cancers detected within and outside of a screening program

Trends in incidence, treatment, and relative survival of colorectal cancer in the Netherlands between 2000 and 2021

The effect on colorectal cancer incidence and stage with population-based FOBT-screening in Sweden

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