1143: Advanced-Stage CRC Incidence Patterns Related to the Phased Implementation of the CRC Screening Program in the Netherlands

Breekveldt, Emilie C.; Toes‐Zoutendijk, Esther; Spaander, Manon C.W.; Jonge, Lucie de; Schootbrugge-Vandermeer, Hilliene J. van de; Vuuren, Anneke van; Kemenade, Folkert J. van; Ramakers, Christian; Dekker, Evelien; Nagtegaal, Irıs D.; Leerdam, Monique van; Lansdorp–Vogelaar, Iris

doi:10.1016/s0016-5085(22)60637-1

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“…Early-stage CRCs have better survival rates and require less invasive treatment than advanced-stage CRCs. Therefore, a stage shift resulting from the implementation of CRC screening implies the need for less invasive treatment of CRC and a decrease in mortality may be expected 3 4 5 6 .…”

Section: Introductionmentioning

confidence: 99%

Differences in treatment of stage I colorectal cancers: a population-based study of colorectal cancers detected within and outside of a screening program

Toes-Zoutendijk,

Breekveldt,

van der Schee

et al. 2023

Endoscopy

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Background Screen-detected colorectal cancers (CRCs) are often treated less invasively than stage-matched non-screen-detected CRCs, but the reasons for this are not fully understood. This study evaluated the treatment of stage I CRCs detected within and outside of the screening program in the Netherlands. Methods Data from the Netherlands Cancer Registry for all stage I CRCs diagnosed between January 1, 2008 and December 31, 2020 were analyzed, comparing patient, tumor, and treatment characteristics of screen-detected and non-screen-detected stage I CRCs. Multivariable logistic regression was used to assess the association between treatment (local excision only vs. surgical oncologic resection) and patient and tumor characteristics, stratified for T stage and tumor location. Results Screen-detected stage I CRCs were relatively more often T1 than T2 compared with non-screen-detected stage I CRCs (66.9 % vs. 53.3 %; P < 0.001). When only T1 tumors were considered, both screen-detected colon and rectal cancers were more often treated with local excision only than non-screen-detected T1 cancers (odds ratio [OR] 2.19, 95 %CI 1.93–2.49; and OR 1.29, 95 %CI 1.05–1.59, respectively), adjusted for sex, tumor location, lymphovascular invasion (LVI) status, and tumor differentiation. Conclusions Less invasive treatment of screen-detected stage I CRC is partly explained by the higher rate of T1 cancers compared with non-screen-detected stage I CRCs. T1 stage I screen-detected CRCs were also more likely to undergo less invasive treatment than non-screen-detected CRCs, adjusted for risk factors such as LVI and tumor differentiation. Future research should investigate whether the choice of local excision was related to unidentified cancer-related factors or the expertise of the endoscopists.

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Section: Introductionmentioning

confidence: 99%