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



DENIS B
, PERRIN P, EBELIN J, WEBER P, KALTENBACH E, SAFRA P, MARIOTTE M, VOGEL J. ADECA 68

Communication affichée à la United European Gastroenterology Week. Copenhagen 19/10/2005. Gut 2005;

Introduction        

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

Aims & methods        

To report the first results of a population-based pilot faecal occult blood (FOBT) CRC screening program. 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 first provided by the GPs and then mailed to persons who didn?t complete the test a year after the 1st invitation.

Results        

After 19 months, 608 GPs (97%) followed a CRC screening training. 185,863 persons (99.2%) received the first invitation, 103,660 (55.3%) the recall letter and 37,571 (20.1%) the test. 15,642 (8.3%) persons were excluded for medical reasons (recent CRC screening, high risk of CRC, severe disease). 618 (98.6 %) GPs provided tests, 84.3 % of them being completed. Each GP had a mean number of 100 persons having completed a FOBT (range 1 - 589). 68,777 persons (36.7%) completed a FOBT. Participation was higher in women (38.3%) than in men (35%)(p<0.001) and ranged from 26.3% to 51.8% according to districts. The impact of the 1st letter lasted a mean of 6 months and led to 59% of the overall participation, that of the recall letter lasted 6 months and led to 30% of the participation and 55% of all exclusions. FOBT positivity rate was 3.6%, higher in men (4.3%) than in women (3.1%)(p<0.001). The positive predictive value calculated on the 1,705 first colonoscopies was 9.8% for CRC (7.2% in women, 12% in men) and 19.9% for advanced adenomas (13.7% in women, 25.1% in men). 26.3% of CRC were in situ. One perforation was recorded.

Conclusion        

GP's awareness of CRC screening can be increased to a high level. When GPs are motivated and involved, CRC screening rates can be enhanced a lot through a population-based screening program. An adjusted participation rate of 60 % should be launched at the end of our program. Efforts should be directed at men since their participation is lower than women despite a higher CRC risk.



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