Colorectal cancer screening in a low-incidence area: general invitation versus family risk targeting. Issue 10 (October 2015)

• Record Type: Journal Article
• Authors: Panic, Nikola; Rösch, Thomas; Smolovic, Brigita; Radunovic, Miodrag; Bulajic, Mirko; Pavlovic-Markovic, Aleksandra; Krivokapic, Zoran; Djuranovic, Srdjan; Ille, Tatjana; Bulajic, Milutin
• Is Part Of: European journal of gastroenterology & hepatology. Volume 27:Issue 10(2015:Oct.)
• Publication Date: 2015-10
• Subjects: adenomas -- colonoscopy -- colorectal cancer -- fecal occult blood testing -- screening; Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; Digestive organs -- Diseases; Liver -- Diseases; Periodicals; 616.33
• DOI: 10.1097/MEG.0000000000000415
• Languages: English
• ISSNs: 0954-691X

Abstract

Abstract : Objectives: Colorectal cancer (CRC) is one of the most common malignancies worldwide. The aim of this study was to compare the outcomes of two different screening approaches in a small country (Montenegro, 650 000 inhabitants) with a CRC incidence lower than the European average. Methods: Two structured invitation programs were compared with respect to compliance and neoplasia yield: (i) program A focused on first-degree relatives of CRC patients diagnosed in two hospitals ( n =206), inviting them for colonoscopy; (ii) program B was an invitation program for fecal occult blood testing, followed by colonoscopy if positive, conducted in University Hospital, Podgorica, Montenegro, on 2760 randomly selected average-risk persons, age 50–74 years, living in a single municipality. Results: Of 710 first-degree relatives of 206 CRC patients approached, 540 presented for colonoscopy (76.05% uptake). Overall, 31 were diagnosed with a cancer, 58 with advanced adenoma, and 151 with adenoma in general. In the general screening program, of 2760 individuals invited, 920 underwent fecal immunochemical test (33.3% uptake) and colonoscopy was performed in all 95 positive cases (10.3%); six cancers was found in five patients (one patient had two cancers), 19 patients were diagnosed with advanced adenoma, and 26 with any adenomas. The risk-targeted screening program had a significantly higher yield for cancers in both per invited (31/710 vs. 5/2760, P <0.001) and per eligible person analysis (31/540 vs. 5/920, P <0.001). Conclusion: In a low-incidence country with limited resources, it may be advisable to start with CRC screening targeted to risk groups. Abstract : Supplemental Digital Content is available in the text.