Pandemic‐resilient target setting in colorectal cancer screening for vulnerable older population

Abstract

Background Colorectal cancer screening (CRCS) needs to be pandemic‐resilient to avoid long‐lasting shutdowns; however, realistic participation target remains unelucidated. This study aimed to identify the lowest acceptable participation rate in CRCS during a pandemic, focusing on vulnerable older populations who require urgent intervention. Methods This nationwide cross‐sectional study included 80,946 inpatients aged 70–85 years who were first diagnosed with colorectal cancer (CRC) after 70 years of age, between April 1, 2014 and March 31, 2019, in Japan. To evaluate the association between area‐level CRCS participation rate and individual early CRC detection, a multilevel logistic regression model was constructed. The mandatorily implemented screening rates were converted to the total screening rate equivalents (TSREs), which reflect the remaining contributions of voluntarily provided screenings. Results Early detections during stages 0–I were significantly observed when primary screening rate was ≥38% (TSRE) and combined follow‐up rate was ≥85%. For early detection during Tis–T1, primary screening rate ≥ 38% (TSRE) and combined follow‐up rate ≥ 90% were necessary. For follow‐up rates ≥70% or ≥75%, there were cases where missed detection of Tis–T1 were observed. Conclusion The results indicate that, even during pandemic, CRCS should achieve a primary screening rate of 38% and follow‐up rate of 85% for vulnerable older populations. These values, lower than the current desirable rates, suggest the maximum possible compromise in balancing the resources between cancer screening and pandemic measures. Moreover, they also indicate the minimum target for shifting to fecal immunochemical test‐focused program. Further explorations with varied CRCS settings are necessary for verification.

The impact of deprivation on colorectal cancer‐stage distribution in a setting with high hospital bed density: A Japanese multilevel study

“…Second, some CRC risk factors were not included in the model. Data regarding diet, alcohol consumption, genetic polymorphisms, family history, history of medical tests, and cancer screenings 49 were not available in the DPC/PDPS database. Third, our analyses using the DPC/PDPS database may have overestimated the impact of advanced stages.…”

Challenges and prospects of colorectal cancer screening

“…Эти значения ниже текущих рекомендованных показателей, но они соответствуют максимально возможному компромиссу в балансе ресурсов между скринингом КРР и мерами по борьбе с пандемией COVID-19. Более того, они также указывают минимальную цель для перехода на программу, ориентированную на FIT [24].…”