S1154 National Colorectal Cancer Screening Programme in the Czech Republic

Abstract

Background: The Czech Republic (10.5 million inhabitants, 3.7 million aged over 50) occupies the top position in world statistics of colorectal cancer (CRC) incidence and mortality. In year 2006 this malignancy was diagnosed in 7 828 people and 4 183 died because of this disease. Although the organized screening programme has currently been running for nearly a decade (introduced on July 1st 2000), the incidence and mortality of colorectal cancer has been stable over recent years. No noticeable shift in rates or proportions of clinical stages has been recorded since the launch of the programme. Objective: Current status of programme implementation, its monitoring and reporting, results from years 2006 2009. Methods: In years 2000 2008, guiac fecal occult blood test (gFOBT) was offered to asymptomatic individuals aged over 50, followed by colonoscopy in case of its positivity. In the beginning of year 2009 the design of the program was changed, introducing primary screening colonoscopy and immunochemical FOBT as another screening modality. To asymptomatic individuals aged 50 54, guiac or immunochemical FOBT is offered, followed by screening colonoscopy, if positive. In age of 55, there is a choice of either FOBT biannually or primary screening colonoscopy in 10 years interval. Results: Since the beginning of online individual data management in year 2006, until September 2009, there were 23 620 screening colonoscopies (FOBT+) and 498 primary screening colonoscopies performed (main findings are described in the table). The proportion of advanced carcinomas was 22% and advanced adenomas 49%. The positivity 3.4% (intervals 2.7 5,0%) of FOBT was achieved. There has been reported 9 cases of perforations (0,37 per 1000 colonoscopies) in diagnostic procedure and 8 cases of perforation and 83 cases (0.33 and 3.44 per 1000 colonoscopies) of major bleeding during endoscopic polypectomy. Conclusion: The Czech Republic established an organized colorectal cancer screening programme, equipped with highly functional information system. In order to achieve higher compliance rate, screening colonoscopy was added to current FOBT screening as an alternative method. Main results from years 2006 2009