The national FIT-based colorectal cancer screening program in the Netherlands during the COVID-19 pandemic

Abstract

The COVID-19 pandemic has affected many healthcare services worldwide. Like many other nations, the Netherlands experienced large numbers of individuals affected by COVID-19 in 2020, leading to increased demands on hospitals and intensive care units. The Dutch Ministry of Health decided to suspend the Dutch biennial fecal immunochemical test (FIT) based colorectal cancer (CRC) screening program from March 16, 2020. FIT invitations were resumed on June 3. In this study, we describe the short-term effects of this suspension on a myriad of relevant screening outcomes. As a result of the suspension, a quarter of the individuals due for screening between March and November 2020 had not received their invitation for FIT screening by November 30, 2020. Furthermore, 57.8% of those who received a consecutive FIT between the restart and November 30, 2020, received it outside the upper limit of the standard screening interval (26 months). Median time between positive FIT and colonoscopy did not change as a result of the pandemic. Participation rates of FIT screening and follow-up colonoscopy in the months just before and during the suspension were significantly lower than expected, but returned to normal levels after the suspension. Based on the anticipated 2020 cohort size, we estimate that the number of individuals with advanced neoplasia currently detected up until November 2020 was 31.2% lower compared to what would have been expected without a pandemic. Future studies should monitor the impact on long-term screening outcomes as a result of the pandemic.

Self-Reported and Objective Impact of the COVID-19 Pandemic on Planning, Compliance and Timeliness of a Diagnostic Colonoscopy after a Positive FIT Screening Result in the Flemish Colorectal Cancer Screening Program

“…A decrease in DC compliance was also observed in other CRC screening programs [16][17][18]. Corely et al (2017) demonstrated that a DC after 10 months was associated with a higher CRC risk and more advanced-stage CRC compared to a DC at 8-30 days [4].…”

Nimble Approach: fast, adapting, calculating and ethically mindful approach to managing colorectal cancer screening programmes during a pandemic

“…This included a change from non-fixed to fixed appointment time slots 33. The national breast and CRC screening programmes in the Netherlands were suspended on 16 March 2020 and invitations for screening were gradually restarted beginning in May 2020 6 40 42. In Australia, the pandemic has not widely affected kit distribution which is mailed to participants 19.…”

Prioritisation of colonoscopy services in colorectal cancer screening programmes to minimise impact of COVID-19 pandemic on predicted cancer burden: A comparative modelling study

“…Many CRC screening organisations have successfully limited the impact of the pandemic on CRC burden by expeditiously resuming screening services after the disruption. 22 , 23 However, note that the predicted impact still amounts to 339-987 excess CRC-related deaths in each country simulated. As many countries all over the world have faced a disruption to CRC screening programmes 1 , globally a considerable number of potentially excess CRC-related deaths can be expected if countries lack colonoscopy capacity to overcome the screening backlog.…”

“…FIT participation rates and compliance to diagnostic follow-up in the recovery period were set equal to pre-pandemic levels. 22 , 23 We assumed that the order in which individuals were screened during the recovery period was based on the original date of invitation. On average, individuals were delayed for primary screening by 1.5 months ( Figure 1 ).…”