Reasons to Decline Colonoscopy or CT Colonography Screening: A Randomized Controlled Trial

Abstract

Background and aims. In Verona and Turin colorectal cancer screening is performed offering flexible sigmoidoscopy (FS) once in the life in 60 years old (Verona) or 58 years old (Torino) people and immunological faecal occult blood testing (FIT) to people non compliant to sigmoidoscopy. Our aim is to determinate the feasibility and the covering rate of our screening program and the detection rate for adenomas and cancer. Materials and Methods. Subjects are enrolled with a personal invitation letter signed by the GP. Those who report a personal history of colorectal cancer, colorectal polyps or inflammatory bowel disease, colonoscopy within the previous 5 years or a medical condition that would preclude a benefit from screening are excluded from invitation. FS are performed by a gastroenterologist with flexible endoscopes. Bowel preparation is limited to a single enema self-administered at home. Subjects found to have one distal polyp > 5 mm (>= 10 mm in Turin) or at least one adenoma (one advanced adenoma or > 2 adenomas in Turin) at sigmoidoscopy are referred for colonoscopy. People who do not respond to the invitation for FS are invited to FIT (cut off 100 ng/ml). Advanced adenoma (Aad) is defined as an adenoma with high grade dysplasia, or villous component >20%, or size > 9 mm. Results. In the table attached are summarized the results of the two programs. Invitations to FS and to FIT, FS and FIT performed, attendance rate, patients with HR polyps and cancers are reported for males and females. Conclusions. Our experience demonstrates that a screening program with FS offered to people aged 58 to 60 followed by the offer of FIT to non-attenders to FS is feasible. FIT can increase the proportion of people having screening by 25%. The overall coverage is higher in Verona than in Turin, the difference in participation rate being similar for FS and FIT. As in both programmes males show a higher attendance rate to FS, while females show a higher attendance rate to FIT, this strategy allows for achieving a similar coverage in both genders. Furthermore, FIT in people not attending to FS can contribute to detect an additional consistent number of high risk adenomas (0.6%) and cancers (0.1%) in the invited population.