Abstract
Simple SummaryThe first Lithuanian analysis of colorectal cancer screening program is presented in our manuscript. We found that program is run with minimal expenses and still surpasses minimal requirements proposed by the European Union. Still the coverage is lower being 49.6% and must be improved.We aimed to report the results of the implementation of the National Colorectal Cancer (CRC) Screening Program covering all the country. The National Health Insurance Fund (NHIF) reimburses the institutions for performing each service; each procedure within the program has its own administrative code. Information about services provided within the program was retrieved from the database of NHIF starting from the 1 January 2014 to the 31 December 2018. Exact date and type of all provided services, test results, date and results of biopsy and histopathological examination were extracted together with the vital status at the end of follow-up, date of death and date of emigration when applicable for all men and women born between 1935 and 1968. Results were compared with the guidelines of the European Union for quality assurance in CRC screening and diagnosis. The screening uptake was 49.5% (754,061 patients) during study period. Participation rate varied from 16% to 18.1% per year and was higher among women than among men. Proportion of test-positive and test-negative results was similar during all the study period—8.7% and 91.3% annually. Between 9.2% and 13.5% of test-positive patients received a biopsy of which 52.3–61.8% were positive for colorectal adenoma and 4.6–7.3% for colorectal carcinoma. CRC detection rate among test-positive individuals varied between 0.93% and 1.28%. The colorectal cancer screening program in Lithuania coverage must be improved. A screening database is needed to systematically evaluate the impact and performance of the national CRC screening program and quality assurance within the program.
Highlights
According to the most recent GLOBOCAN data (2018) [1], colorectal cancer (CRC)is the fourth most common cancer worldwide, with an annual incidence of more than1,800,000 cases and the third highest mortality rate [1]
We currently aim to review 5-year results of the implementation of Colorectal Cancer (CRC) screening program covering all the country with the purpose to inform quality improvement of the CRC screening program
The program is divided into four services: (1) Information about the program (fecal immunochemical test (FIT) included), (2) Referral for colonoscopy, (3) Colonoscopy with or without biopsy, (4) Pathological examination and diagnosis
Summary
1,800,000 cases and the third highest mortality rate [1] It is the second most common cancer in Lithuania—1892 men and women are estimated to be diagnosed with colorectal cancer (11.4% of all cancer diagnoses) [2]. It is possible to screen for CRC due to a few factors: high incidence, long development course, and effective endoscopic treatment options in premalignant stage [5]. This is the reason why the European Union recommends the screening using fecal occult blood test (FOBT) or fecal immunochemical test (FIT) [6,7]. The quality of CRC screening program has been developed previously by an expert group [8,9]
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