Colonoscopy Needs for Implementation of a Colorectal Cancer Screening Program in Ukraine

Abstract

Background In Ukraine, there is no established colorectal cancer screening program. We aimed to project the number of screening colonoscopies needed for implementation of various CRC screening strategies in Ukraine. Methods We modified a previously developed Markov microsimulation model to reflect the natural history of adenoma and CRC progression among average-risk 50-74-year-olds. We simulated colonoscopies needed for the following screening strategies: no screening, fecal occult blood test yearly, FOBT yearly with flexible sigmoidoscopy every 5 years, FS every 5 years, fecal immunohistochemistry test (FIT) yearly, or colonoscopy every 10 years. Assuming 80% screening adherence, we estimated colonoscopies required at 1 and 5 years depending on the implementation rate. In one-way sensitivity analyses, we varied implementation rate, screening adherence, sensitivity, and specificity. Results Assuming an 80% screening adherence and complete implementation (100%), besides a no screening strategy, the fewest screening colonoscopies are needed with an FOBT program, requiring on average 6,600 and 26,800 colonoscopies per 100,000 persons at 1 and 5 years post-implementation, respectively. The most screening colonoscopies are required with a colonoscopy program, requiring on average 76,600 and 101,000 colonoscopies per 100,000 persons at 1 and 5 years post-implementation, respectively. In sensitivity analyses, the biggest driver of number of colonoscopies needed was screening adherence. Conclusions The number of colonoscopies needed and therefore the potential strain on the healthcare system vary substantially by screening test. These findings can provide valuable information for stakeholders on equipment needs when implementing a national screening program in Ukraine.

Factors Affecting Colorectal Cancer Screening in Primary Care Physician Practices in Ukraine

“…28 Our previous study that estimated the number of screening colonoscopies required for implementing various CRC screening strategies in Ukraine found that the fewest colonoscopies were needed with a FOBT program, while the most were required with a colonoscopy program, highlighting significant variations in resource requirements on the basis of the chosen screening test. 29 In another study in Ukraine, we found inconsistent CRC staging practices and varied adjuvant treatments, likely because of limited resources for providers and the high cost of patient care in the region. 30 In Our study faces several limitations.…”

Armed Conflicts Destroy Civilian Health Systems: Cancer Screening in Ukraine the Newest Casualty of World Conflict

“…The manuscript by Welten et al projects the number of colonoscopies necessary for a national colorectal cancer (CRC) screening program for Ukraine for average risk age 50-74 individuals using an elegant Markov microsimulation model that takes into consideration the adenoma to carcinoma progression [1]. These data would have gone a long way to address cancer care in Ukraine where 2020 cancer statistics found that colorectal cancer was the most common new cancer diagnosed and fourth most common cause of cancer-related death [2].…”

“…These data would have gone a long way to address cancer care in Ukraine where 2020 cancer statistics found that colorectal cancer was the most common new cancer diagnosed and fourth most common cause of cancer-related death [2]. Pre-conflict Ukraine had no formal cancer screening programs, but health care reform was underway as directed by Parliament to strengthen primary care and improve earlier detection of disease [1]. In 2020, the Ukraine Ministry of Health started a national breast screening program with expansion of mammography services with assistance from the World Health Organization (WHO) and France to help address national cancer statistics, showing that 1 in 4 breast cancers were diagnosed in late stage of disease which has significant negative outcome implications for patients [3].…”