Results of the FIT-based National Colorectal Cancer Screening Program in Slovenia

Tepeš, Bojan; Bračko, Matej; Mlakar, Dominika Novak; Stefanović, Milan; Štabuc, Borut; Grazio, Snježana Frković; Zakotnik, Jožica Maučec

doi:10.1097/mcg.0000000000000662

Cited by 23 publications

(19 citation statements)

References 47 publications

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“…In our study, the rate of treatment of patients with CRC by endoscopy was very high (30 %, 785 cases), higher than that reported elsewhere in Europe (23 %) 31 . More than two-thirds of CRCs (70 %) were classified as early-stage disease (N negative), this rate being similar in both types of hospital and similar to that in other screening programmes using FITs.…”

Section: Discussioncontrasting

confidence: 69%

Colorectal cancer screening program using FIT: quality of colonoscopy varies according to hospital type

Portillo¹,

Idígoras²,

Bilbao³

et al. 2018

Endosc Int Open

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Background and study aims To compare the quality of colonoscopy in a population-based coordinated program of colorectal cancer screening according to type of hospital (academic or non-academic). Patients and methods Consecutive patients undergoing colonoscopy after positive FIT (≥ 20 ug Hb/g feces) between January 2009 and September 2016 were prospectively included at five academic and seven non-academic public hospitals. Screening colonoscopy quality indicators considered were adenoma detection rate, cecal intubation rate, complications and bowel preparation quality. Results A total of 48,759 patients underwent colonoscopy, 34,616 (80 %) in academic hospitals and 14,143 in non-academic hospitals. Among these cases, 19,942 (37.1 %) advanced adenomas and 2,607 (5.3 %) colorectal cancers (CRCs) were detected, representing a total of 22,549 (46.2 %) cases of advanced neoplasia. The adenoma detection rate was 64 %, 63.1 % in academic hospitals and 66.4 % in non-academic hospitals ( P < 0.001). Rates of advanced adenoma detection, cecal intubation and adequate colonic preparation were 45.8 %, 96.2 % and 88.3 %, respectively, and in all cases were lower (implying worse quality care) in academic hospitals (45.3 % vs 48.7 %; odds ratio [OR] 0.87, 95 % confidence interval [CI] 0.84 – 0.91; 95.9 % vs 97 %; OR 0.48, 95 % CI 0.38 – 0.69; and 86.4 % vs 93 %; OR 0.48, 95 % CI 0.45 – 0.5; respectively; P < 0.001 in all cases). In 13 patients, all in the academic hospital group, CRC was diagnosed after colonoscopy (0.26 cases × 1000 colonoscopies). Rates of CRC treated by endoscopy were similar in both types of hospital (30 %). The rate of severe complication was 1.2 % (602 patients), with no significant differences by hospital type: bleeding occurred in 1/147 colonoscopies and perforation in 1/329. One patient died within 30 days after screening colonoscopy. Conclusions The quality of colonoscopy was better in non-academic hospitals. The rate of detection of advanced neoplasia was higher in non-academic hospitals and correlated with the rate of post-colonoscopy CRC.

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Section: Discussioncontrasting

confidence: 69%

Colorectal cancer screening program using FIT: quality of colonoscopy varies according to hospital type

Portillo¹,

Idígoras²,

Bilbao³

et al. 2018

Endosc Int Open

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“…The majority of cancers found in this prevalent round of FIT screening were at an early stage ( Table 3). The percentage of pT1 cancers treated by endoscopic resection is similar to that recently reported by a national Slovenian FIT screening study (15). These pT1 cancers were discussed at multidisciplinary team meetings.…”

Section: Discussionsupporting

confidence: 79%

“…The PPV for colorectal cancer detection for those submitting a FIT is broadly similar to another reported FIT programme (15) and not greatly different from the earlier guaiac-based programmes, especially given the differing age cohorts (Table 5; refs. 18,19).…”

Section: Discussionsupporting

confidence: 71%

A National Bowel Cancer Screening Programme using FIT: Achievements and Challenges

O’Donoghue¹,

Sheahan²,

MacMathúna³

et al. 2019

Cancer Prevention Research

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Colorectal cancer accounts for 11% of all cancerrelated deaths in Ireland. With the aim of diagnosing these cancers at an earlier stage, and detecting premalignant lesions, the National Screening Service (NSS) offered a fecal immunochemical test (FIT) to all individuals aged 60 to 69. All individuals in the age range were contacted by post and invited to participate in the programme. Those with a positive FIT result were offered a colonoscopy in an internationally accredited unit. From an eligible population of 488,628, 196,238 individuals participated giving an uptake of 40.2%. Commencing at a FIT threshold of 20 mg Hg/g feces, the positivity rate was 8.6%, which overwhelmed colonoscopy capacity and, thus, the threshold was increased to 45 mg, resulting in an overall 5% positivity rate. A total of 520 individuals had cancer detected (68.3% stage I or II), of which 104 were removed endoscopically (pT1s). Adenomas were present in 54.2% of all colonoscopies, 17.4% deemed high risk. Despite a lower uptake, males were twice as likely to have colorectal cancers as females and had a 59% increased rate of high-risk adenomas diagnosed. Challenges facing the programme include increasing participation, especially among males, and increasing colonoscopy capacity. The ability to alter the sensitivity of FIT to match colonoscopy capacity is a valuable option for such a programme as it ensures that the maximum public health benefit can be achieved within available resources.

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“…A localized clinical stage was found in 70.2% of cases. Cancer was cured in 22.8% of CRC patients with endoscopic resection only[ 111 ].…”

Section: Crc Screening Program Attributesmentioning

confidence: 99%

Colorectal cancer screening: An updated review of the available options

Issa

Noureddine

2017

WJG

451

350

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Colorectal cancer (CRC) is a significant cause of morbidity and mortality worldwide. However, colon cancer incidence and mortality is declining over the past decade owing to adoption of effective screening programs. Nevertheless, in some parts of the world, CRC incidence and mortality remain on the rise, likely due to factors including “westernized” diet, lifestyle, and lack of health-care infrastructure and resources. Participation and adherence to different national screening programs remain obstacles limiting the achievement of screening goals. Different modalities are available ranging from stool based tests to radiology and endoscopy with varying sensitivity and specificity. However, the availability of these tests is limited to areas with high economic resources. Recently, FDA approved a blood-based test (Epi procolon®) for CRC screening. This blood based test may serve to increase the participation and adherence rates. Hence, leading to increase in colon cancer detection and prevention. This article will discuss various CRC screening tests with a particular focus on the data regarding the new approved blood test. Finally, we will propose an algorithm for a simple cost-effective CRC screening program.

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Results of the FIT-based National Colorectal Cancer Screening Program in Slovenia

Abstract: In the NCSP, CRC was found in 6.2% of those participants attending colonoscopy, with 81.3% of carcinomas found in the left colon. A localized clinical stage was found in 70.2% participants. In 22.8% of CRC patients, cancer was cured with endoscopic resection only.

Cited by 23 publications

References 47 publications

Colorectal cancer screening program using FIT: quality of colonoscopy varies according to hospital type

Colorectal cancer screening program using FIT: quality of colonoscopy varies according to hospital type

A National Bowel Cancer Screening Programme using FIT: Achievements and Challenges

Colorectal cancer screening: An updated review of the available options

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