Design of implementation measures are extremely important to increase the participation rates and success of a population-based screening program

Eunate Arana-Arria, Begoña Zuberoa, Isabel Portillob,

Isabel Idigorasb, José Ignacio Pijoana

aClinical Epidemiology Unit, Cruces University Hospital, Basque Health ServicebCenter Program Coordinator Colorectal Cancer Screening, Basque Health Service

CLORECTAL CANCER (CCR)

• Worldwide:– Third most common cancer

– Fourth most common cause of cancer deaths

– 1.2 million estimated cases and 609,000 estimated deaths in 2008

• European Union (EU)– Second most common newly-diagnosed cancer

– Second most common cause of cancer death

• Basque Country– First cause of mortality

– Second cancer after: Breast Lung

• Mortality rates for the Basque Country (2006)– 32.2/100,000 in men and 13.1/100,000 in women

(Rates adjusted to European Standard Population)

225/06/2012

COLORECTAL CANCER SCREENING• European Code Against Cancer

“men and women aged 50 years or over

should participate in colorectal cancer screening”

325/06/2012

PREVENTION / SCREENING

The aim of colorectal cancer screening is toimprove prognosis by the detection of cancer

at its early stages

• PREVENTION:– no smoking

– avoiding obesity

– doing regular physical exercise

– increasing the daily intake of fruits and vegetables

– limiting the consumption of foods containing animal fats

425/06/2012

CRC SCREENING PROGRAMOF THE BASQUE COUNTRY

• Target population:50-69 years (EU 2003 50 to 74)

• Fecal Occult Blood Test (FOBT):– Every two years

– Cut-off 100 ng/ml

– Home delivery test

– Pick up at the health center

– Reference laboratory analysis

• FOBT POSITIVE: Complete colonoscopy with deep sedation/anesthesia

• Coordinated Program • Engaging Primary Care and Specialty Care • Information System

525/06/2012

CCR SCREENING PROGRAM: 2009-2010

625/06/2012

PARTICIPATION RATES / POSITIVES

725/06/2012

N= 28,300N= 28,300 N= 11,266N= 11,266 N= 116,980N= 116,980

825/06/2012

Population-based43%

925/06/2012

PARTICIPATION AND POSITIVE RATESBy age group: males

PARTICIPATION AND POSITIVE RATESBy age group: females

1025/06/2012

Diagnostic confirmation: 4,492 colonoscopies

1125/06/2012

INDICATORS Results

Complete Colonoscopy Rate 90.8% (95% CI 90.0-91.6)

Low Grade Adenoma Detection Rate 9.9 x 1,000 (95% CI 9.2-10.6)

High Grade Adenoma Detection Rate

26.6 x 1,000 (95% CI 25.4-27.8)

Invasive Cancer Detection Rate 3.9 x 1,000 (95% CI 3.5-4.4)

Diagnostic confirmation: result of colonoscopies

1225/06/2012

%

48%

Complications of colonoscopies

1325/06/2012

INDICATORS Results

Complications rate 1.09% (95% IC 0.8-1.4)

Complications rate in the first colonoscopy

1.02% (95% IC 0.7-1.4)

COSTS

1425/06/2012

• Cancer detected:

7,324.38• Premalignant and/or malignant lesion:

941.75• Screened person:

28.71

CONCLUSIONS

• REASONS FOR HIGH PARTICIPATION RATES:

– Involvement of primary care physicians and nurses

– Submission of the kits to patients homes

– Delivery of the kits at the primary care settings with open schedule

– Analysis of the sample in the reference hospital without any frills or papers

– Results to primary care physicians and patients homes

– Public and universal health care system

1525/06/2012

1625/06/2012

Eskerrik Asko

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