Abstract
BackgroundColorectal cancer (CRC) is the most common cancer in Europe with a mortality rate of almost 50%. The prognosis of patients is largely determined by the clinical and pathological stage at the time of diagnosis. Population screening has been shown to reduce CRC-related mortality rate. Most screening programs worldwide rely on fecal immunochemical testing (FIT). The effectiveness of a FIT screening program is not only influenced by initial participation rate, but also by program adherence during consecutive screening rounds. We aim to evaluate the participation rate in and yield of a third CRC screening round using FIT.Methods and designFour years after the first screening round and two years after the second round, a total number of approximately 11,000 average risk individuals (50 to 75 years of age) will be invited to participate in a third round of FIT-based CRC screening. We will select individuals in the same target area as in the previous screening rounds, using the electronic database of the regional municipal administration registrations. We will invite all FIT-negatives and all non-participants in previous screening rounds, as well as eligible first time invitees who have moved into the area or have become 50 years of age.FITs will be analyzed in the special technique laboratory of the Academic Medical Center of the University of Amsterdam. All FIT-positives will be invited for a consultation at the outpatient clinic. In the absence of contra-indications, a colonoscopy will follow at the Academic Medical Center or at the Flevohospital. The primary outcome measures are the participation rate, defined as the proportion of invitees that return a FIT in this third round of FIT-screening, and the diagnostic yield of the program.ImplicationsThis study will provide precise data on the participation in later FIT screening rounds. This enables to estimate the effectiveness of CRC screening programs that rely on repeated FIT- screening, such as the one that will be implemented in the Netherlands in 2013.
Highlights
Colorectal cancer (CRC) is the most common cancer in Europe with a mortality rate of almost 50%
Implications: This study will provide precise data on the participation in later fecal immunochemical testing (FIT) screening rounds. This enables to estimate the effectiveness of CRC screening programs that rely on repeated FIT- screening, such as the one that will be implemented in the Netherlands in 2013
Several methods are available for population screening for CRC, which can be broadly itemized into stool tests and structural exams [7]
Summary
Objectives Primary objective To evaluate the participation rate in and yield of a third round of FIT-based colorectal cancer screening in the Netherlands, two years after the second round and four years after the first round. In case of a positive test result, the participant will be invited for a consultation at the screening center at the Academic Medical Center in Amsterdam or the Flevo Hospital in Almere. In case of polyps or cancer, Cancer registry All invitees are linked to The Netherlands Cancer Registry, which collects data of new cancer patients, such as tumor type, incidence date and stage [19] Using this registry, we can identify interval carcinomas in the three consecutive screening rounds. Chi-square test statistic will be used to analyze the distribution of cancer stage and location between screen detected cancers of the first, second and third round and interval cancers. Implications This study will provide information on participation and yield in the third round of a FIT- based CRC screening program.
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