Efficacy of the population-based pilot colorectal cancer screening, Csongrád county, Hungary, 2015

Background/aim: In Hungary, a nationwide colorectal screening program is about to be introduced in order to improve the high mortality rate of colorectal cancer CRC . The aim was to summarize experiences from and assess short-term efficacy of the populationbased pilot colorectal screening program in 2015 in Csongrád county, Hungary. Materials and methods: Asymptomatic individuals between the ages of 50 and 70 with average risk of colorectal cancer participated in the program that was based on the two-step screening method: immune fecal blood test and colonoscopy. The short-term efficacy was assessed as the change in total CRC incidence and initial tumor stage in the screening year 2015 . Results: 22,130 individuals were invited to participate, and the participation rate was 46.4%. Immune fecal blood test proved to be nonnegative in 1,343 cases 13% , screening colonoscopy was performed in 766 of them 7.5% . Total colonoscopy was performed in 711 individuals. Based on the reports, adenoma was detected in 358 50.3% and malignancy in 42 5.9% individuals. In the background population, the incidence of colon cancer was higher 183 vs. 228; P = 0.026 and was diagnosed at earlier stage P = 0.002 , while lymph node involvement was lower in 2015 48.3% vs. 37.1%; P = 0.049 . Conclusion: The Csongrád county population-based colorectal cancer screening was evidently successful on the short-term considering participation rate, and the changes in CRC incidence and stage, thus its national extension is necessary.

___

  • 1. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. International Journal Cancer 2015;136: E359–E386. doi: 10.1002/ijc.29210
  • 2. Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J, Rosso S, Coebergh JW et al. Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. European Journal of Cancer 2013; 49:1374-1403. doi: 10.1016/j.ejca.2012.12.027
  • 3. Altobelli E, Lattanzi A, Paduano R, Varassi G, Di Orio F et al. Colorectal cancer prevention in Europe: burden of disease and status of screening programs. Preventive Medicine 2014; 62: 132-141. doi: 10.1016/j.ypmed.2014.02.010
  • 4. Fitzmaurice C, Abate D, Abbasi N, Abbastabar H, Abd-Allah F et al. Global Burden of Disease Cancer Collaboration (International Agency for Research on Cancer: World Cancer Report). Geneva, Switzerland: World Health Organization; 2014. doi: 10.1001/jamaoncol.2019.2996
  • 5. Benson VS, Patnick J, Davies AK, Nadel MR, Smith RA et al. International Colorectal Screening Network. Colorectal cancer screening: a comparison of 35 initiatives in 17 countries. International Journal of Cancer 2008; 122:1357-1367. doi: 10.1002/ijc.23273
  • 6. Council of the European Union. Council recommendation of 2 December 2003 on cancer screening (2003/878/EC). Official Journal of European Union 2003; L327: 34-38.
  • 7. Emberi Erőforrások Minisztériuma. Egészséges Nemzetért Népegészségügyi Program 2001–2010. Egészségügyi Közlöny, 2001/16. szám. 2001. augusztus 21 (in Hungarian).
  • 8. Hari DM, Leung AM, Lee JH, Sim MS, Vuong B et al. AJCC Cancer Staging Manual 7th edition criteria for colon cancer: do the complex modifications improve prognostic assessment? Journal of the American College of Surgeons 2013; 217 (2): 181-190. doi: 10.1016/j.jamcollsurg.2013.04.018. Epub 2013 Jun 12.
  • 9. ÁNTSZ Állami Népegészségügyi és Tisztiorvosi Szolgálat honlap: Vastagbélszűrési alprojekt bemutatása, eredményei (in Hungarian).
  • 10. Pignone M, Saha S, Hoerger T, Mandelblatt J. Cost-effectiveness analyses of colorectal cancer screening: a systematic review for the U.S. Preventive Services Task Force. Annals of Internal Medicine 2002; 137: 96-104. doi: 10.7326/0003-4819-137-2- 200207160-00007
  • 11. Központi Statisztikai Hivatal. Surveillance, Epidemiology, and End Results (SEER) Program. 2015.
  • 12. Howlader N, Noone AM, Krapcho M, Miller D, Bishop K et al. SEER Cancer Statistics Review, 1975–2013. National Cancer Institute, Bethesda, MD. November 2015.
  • 13. Siegel RL, Miller KD, Fedewa SA, Ahnen DJ, Meester RGS et al. Colorectal cancer statistics, 2017. CA: Cancer Journal for Clinicians 2017; 67 (3): 177-193. doi: 10.3322/caac.21395
  • 14. Winawer SJ, Zauber AG, Ho MN, O’Brien MJ, Gottlieb LS et al. Prevention of colorectal cancer by colonoscopic polypectomy. The New England Journal of Medicine 1993; 329: 1977-1981. doi: 10.1056/NEJM199312303292701
  • 15. Shroff J, Thosani N, Batra S, Singh H, Guha S. Reduced incidence and mortality from colorectal cancer with flexiblesigmoidoscopy screening: a meta-analysis. World Journal of Gastroenterology 2014; 20: 18466-18476. doi: 10.3748/wjg.v20. i48.18466
  • 16. Brenner H, Stock C, Hoffmeister M. Effect of screening sigmoidoscopy and screening colonoscopy on colorectal cancer incidence and mortality: systematic review and metaanalysis of randomised controlled trials and observational studies. BMJ 2014; 348: g2467. doi: 10.1136/bmj.g2467
  • 17. Robertson DJ, Lee JK, Boland CR, Dominitz JA, Giardiello FM et al. Recommendations on fecal immunochemical testing to screen for colorectal neoplasia: a consensus statement by the US multi-society task force on colorectal cancer. Gastroenterology 2017; 152: 1217-1237.e3. doi: 10.1053/j.gastro.2016.08.053
  • 18. Rembacken B, Hassan C, Riemann JF, Chilton A, Rutter M et al. Quality in screening colonoscopy: position statement of the European Society of Gastrointestinal Endoscopy (ESGE). Endoscopy 2012; 44: 957-968. doi: 10.1055/s-0032-1325686
  • 19. Navarro M, Nicolas A, Ferrandez A, Lanas A. Colorectal cancer population screening programs worldwide in 2016: An update. World Journal of Gastroenterology 2017; 23: 3632-3642. doi: 10.3748/wjg.v23.i20.3632
  • 20. Zauber A G, Winawer S J, O’Brien M J, Lansdorp-Vogelaar I, Ballegooijen M et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. New England Journal of Medicine 2012; 366: 687-696. doi: 10.1056/NEJMoa1100370