The Performance of Colorectal Cancer Screening in Brazil: The First Two Years of the Implementation Program in Barretos Cancer Hospital

Abstract

Colorectal cancer is the second most common cancer in Brazil. Yet, a nationally organized colorectal screening program is not implemented. Barretos Cancer Hospital (BCH) is one of the largest Brazilian institution that cares for underserved patients. BCH developed a fecal immunochemical test (FIT)-based organized colorectal cancer screening program to improve colorectal cancer outcomes. This study aims to present the quality/performance measures of the first 2 years of the FIT-based colorectal cancer screening program and its impact on the colorectal cancer disease stage. Between 2015 and 2017, a total of 6,737 individuals attending the Outpatient Department of Prevention or the Mobile Unit of BCH, which visits 18 cities of Barretos county, ages 50 to 65 years, were personally invited by a health agent/nurse practitioner. Exclusion criteria were personal history of colorectal cancer, adenomatous polyps, inflammatory bowel disease, and colonoscopy, or flexible sigmoidoscopy performed in the past 5 years. European Union (EU) guidelines for colorectal cancer screening programs were evaluated. Overall, 92.8% returned the FIT, with an inadequate examination rate of 1.5%. Among the 6,253 adequately tested, 12.5% had a positive result. The colonoscopy compliance and completion rates were 84.6 and 98.2%, respectively. The PPVs were 60.0%, 16.5%, and 5.6% for adenoma, advanced adenoma, and cancer, respectively. Stage distribution of screen-detected cancers shows earlier stages than clinically diagnosed colorectal cancer cancers reported at BCH and Brazilian cancer registries. Our colorectal cancer screening program achieved desirable quality metrics, aligned with the EU guidelines. The observed shift toward earlier colorectal cancer stages suggests an exciting opportunity to improve colorectal cancer–related cancers in Brazil.

Net survival for colorectal cancer in Cuiabá and Várzea Grande (state of Mato Grosso), Brazil

“…The implementation of population screening was not considered feasible and cost-effective; however, the importance of sending warning signs to the population and health care providers was recognised, as well as providing immediate access to diagnostic means when the disease is suspected [ 32 ]. A recent study showed that population screening based on quantitative faecal immunochemical test may be an opportunity in Brazil for early diagnosis [ 33 ], but a major barrier would still be how to deal with increased demand for definitive diagnosis [ 34 ].…”

Colorectal Cancer Burden and Screening Practices in Brazil: A Qualitative Study on Perceptions from Published Authors

“…Although it is commendable that Brazil has a national screening programme, it is critical to ensure access to facilities across all regions equitably, especially so, since studies predict an increase in the disease burden in the North, Northeast, and Central West regions of Brazil (Souza,2014). The most surprising finding mentioned by a participant was the view of the national CRC screening programme as ineffective, although it was found to have achieved desirable quality metrics, aligned to the European guidelines [4].…”

“…Brazil has also reported on the health care provider knowledge, attitudes and practices on CRC screening. There is evidence that the quality metrics for CRC screening are comparable to other developed countries [4].…”

Somatic targeted mutation profiling of colorectal cancer precursor lesions

“…Results of the first two years (first round) of our colorectal cancer screening program (from Barretos Cancer Hospital program) in Brazil showed a successful implementation with a high test return participation rate, colonoscopy completion, and detection lesion rates. In addition, participant’s blood and FIT (fecal immunochemical test) tests has been stored in the Barretos Cancer Hospital biobank to allow future biomarker studies and consequently improve lesions detection rates [ 24 ].…”