Comparison between endoscopic and surgical treatment of screen-detected vs. non-screen-detected colorectal cancers

Abstract

Since 2005, the Italian National Health System (NHS) has implemented a screening program for colorectal cancer for all citizens over 50. Screening tests are free for the target population (so-called Minimal Care Level guaranteed for all Italian citizens). Invitees are asked to take an immunological test for Faecal Occult Blood (FOBT) every two years. Individuals with a positive FOBT test are invited to undergo a total colonoscopy in an SSN-accredited Endoscopy Department. Each Italian Region has a centre for the coordination of the screening programme, which employs a dedicated software that can trace the progress of each citizen within the programme: FOBT invitation (first round) compliance/non-compliance (reminder); FOBT positive cases: total colonoscopy, endoscopic or surgical treatment of screen-detected lesions plus follow-up; FOBT negative cases: FOBT invitation after two years (second round). The ‘Screening Centre’ has a database that can provide a detailed, real-time status of the programme: it is therefore possible to compare the characteristics of screen-detected and non-screen-detected cancers. The target population for the screening programme includes all citizens aged 50–70, except ‘high-risk’ subjects (family history; serious, persistent IBD; previous colorectal surgery; recent non-screen-related FOBT and/or colonoscopy; apparent digestive-tract symptoms (proctorrhagia, abdominal pain, bowel irregularities, etc)).