Abstract
Effective quality assurance is essential in any screening programme. This article provides a unique insight into key quality indicators of five rounds of the first population-based colorectal cancer screening programme implemented in Spain (2000–2012), providing the results according to the type of screening (prevalent or first screen and incident or subsequent screen) and test (guaiac or immunochemical). The total crude participation rate increased from 17.2% (11,011) in the first round to 35.9% (22,988) in the last one. Rescreening rate was very high (88.6% in the fifth round). Positivity rate was superior with the faecal immunochemical test (6.2%) than with the guaiac-based test (0.7%) (p < 0.0001) and detection rates were also better with the immunochemical test. The most significant rise in detection rate was observed for high risk adenoma in men (45.5 per 1,000 screened). Most cancers were diagnosed at an early stage (61.4%) and there was a statistically significant difference between those detected in first or subsequent screening (52.6% and 70.0% respectively; p = 0.024). The availability of these results substantially improves data comparisons and the exchange of experience between screening programmes.
Highlights
IntroductionSince screening programmes invite healthy people with no symptoms, it is crucial to achieve an effective quality assurance to guarantee that the benefits of screening (better survival and quality of life) outweigh the harms (false negative result, false positive, complications related to colonoscopy as perforation or lower gastrointestinal bleeding)[7,8]
Since screening programmes invite healthy people with no symptoms, it is crucial to achieve an effective quality assurance to guarantee that the benefits of screening outweigh the harms[7,8]
In order to monitor the programme, we developed a series of key performance indicators (KPIs), including organizational, process, and impact indicators (Table 1)
Summary
Since screening programmes invite healthy people with no symptoms, it is crucial to achieve an effective quality assurance to guarantee that the benefits of screening (better survival and quality of life) outweigh the harms (false negative result, false positive, complications related to colonoscopy as perforation or lower gastrointestinal bleeding)[7,8]. To that effect, screening programmes have the responsibility to ensure that quality is optimized in all ways: high quality, safe procedure and a satisfactory experience. The European Union has proposed Key Performance Indicators for quality assurance and to monitor and compare the results of the screening programmes[9]. In Spain, some regions implement and manage CRC screening programmes[10,11]. In 2000, Catalonia was the first region to launch a population-based CRC screening programme using FOBT in Hospitalet de Llobregat, a city of about 256,000 inhabitants in the metropolitan area of Barcelona[12]. The objective of this study was to evaluate the five rounds (2000–2012) of the CRC screening programme and to identify those quality indicators that require improvement
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