Screening vs. non-screening detected colorectal cancer: Differences in pre-therapeutic work up and treatment

Abstract

Objectives To compare preoperative staging, multidisciplinary team-assessment, and treatment in patients with screening detected and non-screening detected colorectal cancer. Methods Data on patient and tumour characteristics, staging, multidisciplinary team-assessment and treatment in patients with screening and non-screening detected colorectal cancer from 2008 to 2012 were collected from the Stockholm-Gotland screening register and the Swedish Colorectal Cancer Registry. Results The screening group had a higher proportion of stage I disease (41 vs. 15%; p < 0.001), a more complete staging of primary tumour and metastases and were more frequently multidisciplinary team-assessed than the non-screening group ( p < 0.001). In both groups, patients with endoscopically resected cancers were less completely staged and multidisciplinary team-assessed than patients with surgically resected cancers ( p < 0.001). No statistically significant differences were observed between the screening and non-screening groups in the use of neoadjuvant treatment in rectal cancer (68 vs.76%), surgical treatment with local excision techniques in stage I rectal cancer (6 vs. 9%) or adjuvant chemotherapy in stages II and III disease (46 vs. 52%). Emergency interventions for colorectal cancer occurred in 4% of screening participants vs. 11% of non-compliers. Conclusions Screening detected cancer patients were staged and multidisciplinary team assessed more extensively than patients with non-screening detected cancers. Staging and multidisciplinary team assessment prior to endoscopic resection was less complete compared with surgical resection. Extensive surgical and (neo)adjuvant treatment was given in stage I disease. Participation in screening reduced the risk of emergency surgery for colorectal cancer.

Introduction of a colorectal cancer screening programme: results from a single‐centre study

“…These different proportions compared to the nonscreen‐detected group (28.5% and 41.4% respectively) are in line with previous literature. A higher proportion of tumours found by screening are located in the colon , especially in the left side of the bowel . Blood released from tumours in the right side of the colon has to travel along a greater length of the bowel than that from tumours in the left side of the colon.…”

Postoperative Outcomes of Screen-Detected vs Non–Screen-Detected Colorectal Cancer in the Netherlands

“…Similar mortality rates were found for stage I to III, with a significantly higher mortality rate after resection of screendetected compared with non-screen-detected stage IV rectal cancer. 2625 (17) 2678 (17) .96…”

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A 10-Year Evaluation of Short-Term Outcomes After Synchronous Colorectal Cancer Surgery: a Dutch Population-Based Study

“…Extended resections was more often longer than 14 days. In contrast to the rectal cancer study population, patients with synchronous colon cancer were more frequently readmitted within 30 days after primary surgery than patients with solitary tumors (10.0% vs. 15.2% (rectum-rectum); p=0.012) (Fig. 4).…”

“…2,5,7,10 In 2014, the national bowel cancer screening was introduced in the Netherlands, which has resulted in a shift towards more early-stage CRC diagnosis. 12 Studies have indicated that this has led to a more extensive preoperative workup, [13][14][15] a different surgical approach, 16,17 and lower postoperative morbidity and mortality rate. 12 These studies often excluded synchronous CRC, while especially those patients might benefit from detection at an early stage, thereby potentially limiting the need for more extensive surgery.…”