First results of a pilot population-based faecal occult blood colorectal cancer screening program.

DENIS B, PERRIN P, STRENTZ P, GUTH F, BOYAVAL JM, JUNG SB.
ADECA 68

Communication affichée à la Digestive Disease Week. Chicago 15/05/2005.
Gastroenterology 2005;128:A161.

Introduction        

Despite strong evidence that screening reduces both colorectal cancer (CRC) mortality and incidence, CRC screening remain underutilized.

Aim        

to report the first results of a population-based pilot faecal occult blood (FOBT) CRC screening program.

Methods        

this program took place in the French area of Haut-Rhin (710 000 inhabitants). All 627 general practitioners (GP) were invited to attend paid educational meetings on CRC screening. The screening test used for average risk persons was a biennial non rehydrated FOBT (Hemoccult II) without dietary restriction. Residents aged 50-74 years were invited twice by mail to visit their GP for a CRC screening. The recall letter included a reply coupon which could be used to specify reasons for non participation. FOBT were provided free of charge by the GPs.

Results        

after 14 months, 608 GPs (97%) followed a CRC screening training, 78 % of them attended dedicated meetings. 180 566 persons (98.6%) received the first invitation letter and 80 447 (44%) the recall letter. 13467 (7.4%) persons were excluded for medical reasons (high risk of CRC, concurrent severe disease). 618 (98.6 %) GPs provided tests, 83 % of them being completed. Each GP had a mean number of 84 persons having completed a FOBT (extremes 1 - 385). 50749 persons (27.7%) completed a FOBT. Participation was higher in women (29.4%) than in men (25.9%)(p<0.001) and ranged from 16.5% to 42.3% according to districts. The impact of the first letter lasted a mean of 6 months and led to 69% of the global participation, that of the recall letter lasted 3 months and led to 20% of the overall participation and 53% of all exclusions. FOBT positivity rate was 3.9%. It was higher in men (4.5%) than in women (3.3%)(p<0.001). The positive predictive value calculated on the 925 first colonoscopic procedures was 9.9% for CRC (6.5% in women, 12.9% in men), 20.1% for advanced adenomas (15.2% in women, 24.4% in men) and 12.1% for non advanced adenomas. 25% of CRC were in situ. One perforation was recorded.

Conclusion        

GP's awareness of CRC screening can be increased to a high level. CRC screening rates can be enhanced through a population-based screening program when GPs are motivated and involved. Efforts should be directed at men in the 2nd half of our program, since their participation is lower than women despite a higher CRC risk. Our first results indicate that a participation rate of 60 % should be launched at the end of the program.



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