Colorectal and interval cancers of the Colorectal Cancer Screening Program in the Basque Country (Spain)

Abstract

AIMTo assess proportions, related conditions and survival of interval cancer (IC).METHODSThe programme has a linkage with different clinical databases and cancer registers to allow suitable evaluation. This evaluation involves the detection of ICs after a negative faecal inmunochemical test (FIT), interval cancer FIT (IC-FIT) prior to a subsequent invitation, and the detection of ICs after a positive FIT and confirmatory diagnosis without colorectal cancer (CRC) detected and before the following recommended colonoscopy, IC-colonoscopy. We conducted a retrospective observational study analyzing from January 2009 to December 2015 1193602 invited people onto the Programme (participation rate of 68.6%).RESULTSTwo thousand five hundred and eighteen cancers were diagnosed through the programme, 18 cases of IC-colonoscopy were found before the recommended follow-up (43542 colonoscopies performed) and 186 IC-FIT were identified before the following invitation of the 769200 negative FITs. There was no statistically significant relation between the predictor variables of ICs with sex, age and deprivation index, but there was relation between location and stage. Additionally, it was observed that there was less risk when the location was distal rather than proximal (OR = 0.28, 95%CI: 0.20-0.40, P < 0.0001), with no statistical significance when the location was in the rectum as opposed to proximal. When comparing the screen-detected cancers (SCs) with ICs, significant differences in survival were found (P < 0.001); being the 5-years survival for SCs 91.6% and IC-FIT 77.8%.CONCLUSIONThese findings in a Population Based CRC Screening Programme indicate the need of population-based studies that continue analyzing related factors to improve their detection and reducing harm.

Factors influencing participation in colorectal cancer screening programs in Spain

“…As observed in other studies, participation in CRCSP is influenced by age and sex, with participation in Initial screening-first invitation being higher in women (Portillo et al, 2013;Clarke et al, 2015;Molina-Barceló et al, 2014) and in persons aged 60-69 years than in persons aged 50-59 years (Salas et al, 2014). In contrast, adherence to screening among persons with previous participation showed differences by age but not by sex, with lower participation among young men and women, as reported in other studies (Ricardo-Rodrigues et al, 2015;Steele et al, 2010).…”

“…Some studies have shown that participation is higher in women than in men (Klabunde et al, 2015;Portillo et al, 2013;Molina-Barceló et al, 2016, Clarke et al, 2015, especially in those aged 50-59 years (Salas et al, 2014).…”

Incidence of Interval Colorectal Cancer After Negative Results From First-Round Fecal Immunochemical Screening Tests, by Cutoff Value and Participant Sex and Age

“…Our estimated FIT sensitivities are at the higher end of those observed in literature. [11][12][13][14] However, the Kaiser Permanente group also reported a sensitivity of 85% in the first screening round and then showed a decrease in sensitivity of 6%-8% in subsequent screening rounds.…”

Alerts in electronic medical records to promote a colorectal cancer screening programme: a cluster randomised controlled trial in primary care

“…7 The European guidelines for quality assurance in colorectal cancer screening states that the participation rate represents a key quality indicator for ensuring effectiveness and efficiency of populationbased screening programmes. 7 However, results from current programmes in Spain show that participation is not reaching these recommended figures, with uptake rates varying from 17.2% to 42.3%, [10][11][12][13][14] with the exception of the Basque Country (64.3%). 14 The uptake rate in the first round for the Colorectal Cancer Screening Program of Barcelona (CCSPB) was 43.6%.…”

“…7 However, results from current programmes in Spain show that participation is not reaching these recommended figures, with uptake rates varying from 17.2% to 42.3%, [10][11][12][13][14] with the exception of the Basque Country (64.3%). 14 The uptake rate in the first round for the Colorectal Cancer Screening Program of Barcelona (CCSPB) was 43.6%. 15 Differences in programme organisation, sociodemographics, and primary care professional involvement may explain these differences (for example, the involvement of the GP differs depends on certified training, scheduling of colonoscopy, information feedback, or FIT collection in primary care).…”