Organised colorectal cancer screening in Lampang Province, Thailand: preliminary results from a pilot implementation programme

Abstract

ObjectiveColorectal cancer (CRC) is the third-most and fifth-most common cancer in men and women, in Thailand. The increasing CRC incidence and mortality can be reduced by screening and treating adenomas and early cancers. A pilot CRC screening programme using immunochemical faecal occult blood testing (iFOBT) and colonoscopy for test-positives were implemented through the routine Government Health Services in Lampang Province, to inform the acceptability, feasibility and scaling-up of screening in Thailand. This report describes the implementation, coverage and performance indicators of this project.DesignA target population aged 50–65 years was informed about and invited face to face to undergo CRC screening by community health workers (HWs). The HWs provided faecal sample collection kits and participants brought their samples to one of the primary health units or community hospitals where nurses performed iFOBT. iFOBT-positive persons were referred for colonoscopy at the Lampang cancer hospital, and endoscopic polypectomy/biopsies were performed according to the colonoscopic findings. Those with confirmed CRC received appropriate treatment.ResultsOf the 127 301 target population, 62.9% were screened using iFOBT between April 2011 and November 2012. Participation was higher among women (67.8%) than men (57.8%) and lower in 50–54 year-old persons than in 60–65-year-olds. Of those screened, 873 (1.1%) were found positive; positivity was higher in men (1.2%) than in women (1.0%). To date 627 (72.0%) iFOBT-positive persons have had colonoscopy in which 3.7% had CRC and 30.6% had adenomas.ConclusionsThe successful implementation of the pilot CRC screening with satisfactory process measures indicate the feasibility of scaling-up organised CRC screening through existing health services in Thailand.

Providers' knowledge, attitudes, and practices related to colorectal cancer control in Brazil

“…FOBT and other similarly less invasive tests could play a fundamental role in reaching more people because of better acceptability (Benson et al, 2008; Hardcastle et al, 1996; Multicentre Australian Colorectal-neoplasia Screening Group, 2006; Segnan et al, 2005). In Thailand, where 62% of primary care physicians routinely recommend CRC screening to asymptomatic average-risk patients (Thanapirom et al, 2012), results of a pilot implementation program using fecal immunochemical tests (FIT) demonstrated the possibility of screening a large number of people without straining the health system, and considerably reducing the need for more complex exams, such as sigmoidoscopy and colonoscopy (Khuhaprema et al, 2014). This may be particularly beneficial to Brazil, where health units might adequately offer a secondary prevention service of lower complexity, increasing the breadth of their services and expanding their capacity for cancer control.…”

Screening for Cancer in Low- and Middle-Income Countries

“…The feasibility of introducing and scaling-up CRC screening using iFOBT was successfully demonstrated in Thailand recently as a prelude to national scale-up. 4 Oral cancer has a long preclinical detection phase consisting of potentially malignant disorders such as leukoplakia, submucous fibrosis, erythroplakia, and early preclinical invasive cancers presenting as painless, small ulcers or growths that can be clinically detected through careful visual inspection and palpation of the oral mucosa. Oral visual screening was followed by a 34% reduction in oral cancer mortality among users of tobacco or alcohol or both and a much higher reduction in those complying with all rounds of screening in a randomized trial in India.…”

“…1 Introducing pilot programs covering a region of a country before national scale-up is a prudent way of introducing screening programs. [2][3][4] In this review, I will specifically discuss screening for suitable cancers.…”

Colorectal cancer screening: a global overview of existing programmes

“…In Thailand, an organised pilot programme based on FIT screening has been implemented in April 2011. It focuses on persons aged 50–65 years in the Lampang Province 65. Preliminary results from the pilot show participation rates of 62.9% among the 127 301 persons in the target population 65…”