Cancer Screening In France Research Articles

Facteurs comportementaux, radiologiques et histopronostiques des cancers du sein de plus de 20 mm détectés dans le programme français de dépistage organisé

Grâce à la collaboration de l’ensemble des médecins coordinateurs chargés du dépistage en France, les auteurs ont étudié des facteurs relatifs à l’histoire personnelle, les caractéristiques des mammographies précédant le diagnostic et des tumeurs de femmes présentant un cancer du sein de plus de 20 mm. Cette étude rétrospective a concerné 7 407 cancers diagnostiqués dans le cadre du dépistage organisé et mesurant plus de 20 mm. Si les critères d’agressivité de la tumeur sont plus marqués ou des facteurs technologiques plus souvent rencontrés, il apparaît que la fidélité au dépistage organisé soit un élément déterminant dans la découverte de ces « grosses tumeurs ». Il est impératif que les citoyens s’emparent de ces programmes de dépistage organisé si l’on espère jouer un rôle décisif dans le pronostic du cancer du sein.

Additional mailing phase for FIT after a medical offer phase: The best way to improve compliance with colorectal cancer screening in France

BackgroundCompliance with colorectal cancer screening is critical to its effectiveness. The organisation of the mass screening programme in France has recently been modified with no evaluation of the consequences. AimsTo evaluate the impact of the way the screening test is delivered on compliance. Patients and methodsDuring the first six months of the screening campaign (Ille-Vilaine, Brittany), general practitioners were asked to propose a faecal immunochemical test (FIT), OC-Sensor, to individuals at average risk for colorectal cancer (n=152,097). A subset of non-participants in the medical phase (n=13,071) was randomly chosen to receive a reminder that included the screening test or a simple postal reminder without the screening test. ResultsCompliance was 31% if the screening test was proposed during a medical consultation. In non-participants during the medical phase, it was 45% in those receiving both a reminder and the screening test and 28% amongst those receiving a simple reminder. An estimated overall participation rate of 54% can be expected if non-participants in the medical phase are sent a reminder together with the screening test. ConclusionIn France, a compliance rate above the minimum uptake rate of 45% recommended by European Union experts can be achieved if the FIT is mailed to non-participants after the medical free-offer phase.

Impact assessment of a pay-for-performance program on breast cancer screening in France using micro data.

A voluntary-based pay-for-performance (P4P) program (the CAPI) aimed at general practitioners (GPs) was implemented in France in 2009. The program targeted prevention practices, including breast cancer screening, by offering a maximal amount of €245 for achieving a target screening rate among eligible women enrolled with the GP. Our objective was to evaluate the impact of the French P4P program (CAPI) on the early detection of breast cancer among women between 50 and 74years old. Based on an administrative database of 50,752 women aged 50-74years followed between 2007 and 2011, we estimated a difference-in-difference model of breast cancer screening uptake as a function of visit to a CAPI signatory referral GP, while controlling for both supply-side and demand-side determinants (e.g., sociodemographics, health and healthcare use). Breast cancer screening rates have not changed significantly since the P4P program implementation. Overall, visiting a CAPI signatory referral GP at least once in the pre-CAPI period increased the probability of undergoing breast cancer screening by 1.38% [95% CI (0.41-2.35%)], but the effect was not significantly different following the implementation of the contract. The French P4P program had a nonsignificant impact on breast cancer screening uptake. This result may reflect the fact that the low-powered incentives implemented in France through the CAPI might not provide sufficient leverage to generate better practices, thus inviting regulators to seek additional tools beyond P4P in the field of prevention and screening.

Genotyping and follow-up of HR-HPV types detected by self-sampling in women from low socioeconomic groups not participating in regular cervical cancer screening in France

BackgroundHPV vaginal self-sampling can be an alternative for women refusing cytological screening. ObjectivesTo describe HR-HPV types in 35–69 years old women from low socioeconomic groups not attending regular cytological screening in Marseille, France. Study designA cervical screening campaign using HR-HPV self-sampling including 22,702 women aged 35–69 years living in low socioeconomic districts of Marseille was organized. A cytological and/or histological follow-up was undertaken for a subset of women harboring HR-HPV types. Abbott RealTime High Risk HPV test was used for screening, while INNO-LiPA HPV Genotyping Extra assay was used for genotyping. Results4245 self-samplings were performed (participation rate, 18.7%) out of which 609 (14.3%) were HR-HPV+ by the screening test including 114HPV 16 (18.7%), 41HPV 18 (6.7%), 454HR-HPVnon-16/18 (75.4%). A sample of 260 out of the 454HR-HPVnon-16/18 were genotyped by INNO-LiPA which revealed HPV52 (35%), 66 (22.6%), 51 (19.6%), 31 (15.7%), 39 (13%), 56 (10.4%), and 53, 35, 59, 33, 58, 82, 45, 68, 73 (<10% each). At month 12, a 2nd self-collection kit was sent to 274 of 609HR-HPV+ women who did not have a Pap-test previously performed on them. Of these 274 women, 130 provided a sample for HPV testing; one was uninterpretable, 56 were HPV negative, and 73 were HR-HPV+ (10HPV16+, 3HPV18+, 60HR-HPVnon-16/18+). Of the 345 women with cytological and/or histological follow-up 19 (5.5%) had ≥CIN2 lesions, (11 were HPV16+ and 8 were HR-HPVnon-16/18). ConclusionThis study illustrates the potential efficacy of self-sampling as a cancer screening strategy for socioeconomically deprived women who do not participate in regular Pap screening programs.

PCN72 - What is the Most Cost-Effective way to Set-Up Organised Cervical Cancer Screening in France? a Budget Impact Analysis

PCN72 - What is the Most Cost-Effective way to Set-Up Organised Cervical Cancer Screening in France? a Budget Impact Analysis

Cancer screening in France: third edition of the EDIFICE survey.

The EDIFICE programme began in 2005 and set out to provide a clearer insight over time into the participation of the French population in cancer screening. EDIFICE 3 was conducted in 2011 by phone interviews among a representative sample of 1603 individuals aged between 40 and 75 years using the quota method. The analysis focused on the target populations (50-74 years) of the national screening programmes for breast and colorectal cancer. The same populations were also assessed with respect to prostate cancer screening. In 2005, 93% of the sample population had undergone at least one mammogram in their lifetime; this figure reached 94% in 2008 and 95% in 2011. Compliance with recommended intervals improved between 2005 and 2011, and significantly so for women aged 65-74 years. In 2005, 25% of respondents reported having undergone at least one colorectal cancer screening test; this figure reached 38% in 2008 and 59% in 2011. Recommended intervals were respected by 30 and 51% in 2008 and 2011, respectively. In 2005, 2008 and 2011, a total of 36, 49 and 50% of men reported having undergone at least one prostate cancer screening test. This rate decreased significantly in men aged 50-59 years between 2008 and 2011 (44 vs. 37%, P≤0.05). Attendance rates in national screening programmes are high and stable for breast cancer, and although currently improving for colorectal cancer, the European guideline target has not yet been reached. Despite the absence of recommendations for prostate cancer screening, participation remains constant.

Cancer screening in France: Reaching a plateau? New edition of an iterative nationwide survey.

1565 Background: The EDIFICE survey program began in 2005 and set out to ascertain participation rates of the French population in cancer screening and assess changes in these rates over time. Afte...

The effects of obesity and mobility disability in access to breast and cervical cancer screening in france: results from the national health and disability survey.

ObjectivesWe aimed to disentangle the effects of obesity and mobility limitation on cervical and breast cancer screening among community dwelling women.MethodsThe data source was the French national Health and Disability Survey - Household Section, 2008. The Body Mass Index (BMI) was used to categorize obesity status. We constructed a continuous score of mobility limitations to assess the severity of disability (Cronbach's alpha = 0.84). Logistic regressions were performed to examine the association between obesity, mobility limitations and the use of Pap test (n = 8 133) and the use of mammography (n = 7 561). Adjusted odds ratios were calculated (AOR). Interaction terms between obesity and the disability score were included in models testing for effect modifications.ResultsCompared with non-obese women, the odds of having a Pap test in the past 3 years was 24% lower in obese women (AOR = 0.76; 95% CI: 0.65 to 0.89), the odds of having a mammogram in the past 2 years was 23% lower (AOR = 0.77; 95% CI: 0.66 to 0.91). Each time the disability score was 5 points higher, the odds of having a Pap test decreases by 20% (AOR = 0.96; 95% CI: 0.94 to 0.98), the odds of having a mammogram decreases by 25% (AOR = 0.95; 95% CI: 0.94 to 0.97). There was no significant interaction between obesity and disability score.ConclusionObesity and mobility limitation are independently associated with a lower likelihood of cervical and breast cancer screening. Protective outreach and follow-up are necessary to reduce inequalities and thus to reduce health disparities in these vulnerable and high-risk populations of obese women with disabilities.

Women's participation in breast cancer screening in France--an ethical approach.

BackgroundBreast cancer is a major public health challenge. Organized mammography screening (OS) is considered one way to reduce breast cancer mortality. EU recommendations prone mass deployment of OS, and back in 2004, France introduced a national OS programme for women aged 50–74 years. However, in 2012, participation rate was still just 52.7%, well short of the targeted 70% objective. In an effort to re-address the (in) efficiency of the programme, the French National Cancer Institute has drafted an expert-group review of the ethical issues surrounding breast cancer mammography screening.DiscussionPrompted by emerging debate over the efficiency of the screening scheme and its allied public information provision, we keynote the experts’ report based on analysis of epidemiological data and participation rate from the public health authorities. The low coverage of the OS scheme may be partly explained by the fact that a significant number of women undergo mammography outside OS and thus outside OS criteria. These findings call for further thinking on (i) the ethical principles of beneficence and non-malfeasance underpinning this public health initiative, (ii) the reasons behind women’s and professionals’ behavior, and (iii) the need to analyze how information provision to women and the doctor-patient relationship need to evolve in response to scientific controversy over the risks and benefits of conducting mammographic screening.SummaryThis work calls for a reappraisal of the provision of screening programme information. We advocate a move to integrate the points sparking debate over the efficiency of the screening scheme to guarantee full transparency. The perspective is to strengthen the respect for autonomy allowing women to make an informed choice in their decision on whether or not to participate.

The effects of obesity and mobility disability in access to breast and cervical cancer screening in France: results from the National Health and Disability Survey

Objectives We aimed to disentangle the effects of obesity and mobility limitation on cervical and breast cancer screening among community dwelling women. Methods The data source was the French national Health and Disability Survey - Household Section, 2008. The Body Mass Index (BMI) was used to categorize obesity status. We constructed a continuous score of mobility limitations to assess the severity of disability (Cronbach's alpha = 0.84). Logistic regressions were performed to examine the association between obesity, mobility limitations and the use of Pap test (n = 8 133) and the use of mammography (n = 7 561). Adjusted odds ratios were calculated (AOR). Interaction terms between obesity and the disability score were included in models testing for effect modifications. Results Compared with non-obese women, the odds of having a Pap test in the past 3 years was 24% lower in obese women (AOR = 0.76; 95% CI: 0.65 to 0.89), the odds of having a mammogram in the past 2 years was 23% lower (AOR = 0.77; 95% CI: 0.66 to 0.91). Each time the disability score was 5 points higher, the odds of having a Pap test decreases by 20% (AOR = 0.96; 95% CI: 0.94 to 0.98), the odds of having a mammogram decreases by 25% (AOR = 0.95; 95% CI: 0.94 to 0.97). There was no significant interaction between obesity and disability score. Conclusion Obesity and mobility limitation are independently associated with a lower likelihood of cervical and breast cancer screening. Protective outreach and follow-up are necessary to reduce inequalities and thus to reduce health disparities in these vulnerable and high-risk populations of obese women with disabilities.

To what extent is women's economic situation associated with cancer screening uptake when nationwide screening exists? A study of breast and cervical cancer screening in France in 2010.

In France, larger social inequalities are reported for cervical cancer screening, based on individual practice, than for breast cancer screening for which organized screening exists. Our aim was to investigate the association between women's economic situation and breast and cervical cancer screening. We used data from a large French national health survey conducted in 2010. The economic situation was assessed using the number of adverse economic conditions respondents were facing, based on three variables (low income, lacking food, and perceived financial difficulties). Logistic regressions were adjusted for socioeconomic and sociodemographic characteristics, healthcare use and insurance, and health behaviors. Mammography was less frequent among women experiencing two or more adverse economic conditions, whereas Pap smear was less frequent among women experiencing at least one adverse economic condition. For both screenings, higher rates were observed among women who lived in the Paris region. Sociodemographic indicators and health behaviors were associated with Pap smear, whereas healthcare use and insurance characteristics were associated with mammography. The women's economic situation is an important determinant of breast and cervical cancer screening in France in 2010. Alleviating economic barriers to female cancers screening should be a priority in future programs implementation.

Dépistage organisé du cancer du sein en France : pour une optimisation de l’information

BackgroundBased on international and national recommendations, organized breast cancer screening in France raises questions of medical ethics built around the key concepts of individual autonomy and public health policy. Because of the evolving knowledge, professionals and institutions involved in the program must review the ethical values associated with this medical practice. MethodsThe ethical aspects of organized breast cancer screening were studied. In response to newly acquired knowledge highlighted by a review of texts governing this practice in France, proposals for changes resulting from reflections of a working group coordinated by the National Cancer Institute are presented. ResultsEthical issues raised by screening must find expression in the general principles of the program's organization: acceptability of screening, efficiency, adverse effects, equity of access, free care…, but also at different stages of the procedure: information delivery, first and second invitations, refusal of further diagnostic investigation… ConclusionA better match between breast cancer screening and recently developed knowledge requires optimal information delivery to women targeted by the program as well as a stronger role for the referring healthcare professional.

Human Papillomavirus Types Distribution in Organised Cervical Cancer Screening in France

BackgroundKnowledge of prevalence rates and distribution of human papillomavirus (HPV) genotypes prior high HPV vaccine coverage is necessary to assess its expected impact on HPV ecology and on cervical lesions and cancers.MethodsResidual specimens of cervical cytology (N = 6,538) were obtained from 16 sites participating in organised cervical cancer screening pilot programs throughout France, anonymised and tested for HPV DNA using the PapilloCheck® genotyping test. Samples were stratified according to age of women and cytological grades.ResultsThe age-standardised prevalence rates of HPV 16 and/or 18 (with or without other high-risk types) was 47.2% (95% Confidence Interval, CI: 42.4–52.1) in high-grade squamous intraepithelial lesions (HSILs), 20.2% in low-grade SIL (95% CI: 16.7–23.7) and 3.9% (95% CI: 2.8–5.1) in normal cytology. Overall HR HPV were detected in 13.7% (95%I CI: 11.7–15.6) of normal cytology. In women below 30 years of age, 64% of HSILs were associated with HPV16 and/or 18. In our study population, HPV16 was the most commonly detected type in all cervical grades with prevalence rates ranking from 3.0% in normal cytology to 50.9% in HSILs. HPV16 was also detected in 54% (27/50) of invasive cervical cancers including 5 adenocarcinomas.ConclusionHPV16 was strongly associated with cervical precancer and cancer. The high prevalence rates of HPV16/18 infection among women below 30 years of age with HSILs suggests that the impact of vaccination would be primarily observed among young women.

Understanding barriers to organized breast cancer screening in France: women's perceptions, attitudes, and knowledge

The participation rate in organized breast cancer screening in France is lower than recommended. Non-participants either use opportunistic screening or do not use either screening modality. To assess any differences in perceptions, attitudes and knowledge related to breast cancer screening between users of opportunistic screening and non-users of any screening mammograms and to identify potential barriers to participation in organized screening. Six focus groups were conducted in May 2010 with 34 French non-participants in organized screening, 15 who used opportunistic screening (OpS group) and 19 who used no screening (NoS group). The guide used for both groups explored perceptions and attitudes related to health, cancer and screening; perceptions of femininity; and knowledge about breast cancer screening. Thematic content analysis was performed. Perceptions, attitudes and knowledge differed between the two groups. Women in the OpS group perceived a high susceptibility to breast cancer, visited their gynaecologist regularly, were unfamiliar with organized screening modalities and had doubts about its quality. NoS women had very high- or low-perceived susceptibility to breast cancer, knew about screening modalities, had doubts about its usefulness and expressed negative opinions of mammograms. Differences in perceptions and attitudes related to breast cancer screening partially explain why some women choose opportunistic screening or no screening. General practitioners and gynaecologists are in a unique position to provide individually tailored preventative messages to improve participation in organized screening.

Characteristics of women using organized or opportunistic breast cancer screening in France. Analysis of the 2006 French Health, Health Care and Insurance Survey

BackgroundThis study aimed at (i) estimating the 2-year self-reported breast cancer screening coverage rate; and (ii) analyzing the relationships between sociodemographic characteristics and healthcare access of women and breast cancer screening (opportunistic or organized) practices. MethodsFrom a 2006 French health survey, 2056 women aged 50 to 74 years were selected and divided into three groups according to their breast cancer screening practices during the previous 2 years: organized screening, opportunistic screening, or no screening. The three groups were compared according to self-reported sociodemographic status, healthcare access, screening behaviors, and perceived health, using polytomic regression. ResultsThe 2-year self-reported coverage rate was 75.8%. It was high among women aged 50 to 69 years and lower among older women. Questions relating to medical access (i.e. having consulted a GP in the last 12 months, having consulted a gynecologist in the last 12 months, and having had a Pap smear in the last 3 years) were the variables most commonly associated with a recent mammogram. Women having a regular follow-up by a gynecologist or having had cervical cancer screening within the last three years used organized breast cancer screening more often and used opportunistic breast cancer screening even more often than other women. ConclusionThe study confirmed the key role of gynecologists and general practitioners in encouraging women to have a mammogram. Awareness among healthcare professionals and women of the benefits of organized breast cancer screening compared to opportunistic screening should be sustained and strengthened.

Cancer screening in France: 3rd edition of the EDIFICE survey.

1568 Background: The EDIFICE survey program started in 2005 and was aimed at providing a better understanding of the participation of the French population in cancer screening programs and assess the evolution over time. The EDIFICE 3 survey was conducted in 2011, following EDIFICE 1 (2005) and EDIFICE 2 (2008), and focused on colorectal, breast and prostate cancer. Methods: This third nationwide observational study, EDIFICE 3, was conducted by phone interviews among a representative sample of 1603 subjects aged between 40 and 75 years, using the quota method. The analysis focused on the target population of the national screening programs for breast and colorectal cancer (50-74 years). The same population was analysed for prostate cancer screening behaviours. Results: For breast cancer, the rate of women attending at least one screening test was 93%/94%/95% in 2005/2008/2011 respectively. A mammography had been performed as recommended within the last two years for 75%/83%/83% among them. We observed an increase in timing compliance between 2005 and 2011, significant for women aged 65-74. For colorectal cancer, the rate of subjects attending at least one screening test was 25%/38%/59%. A fecal test or colonoscopy had been performed according to the recommended timing for NA/30%/51% among them. Colorectal cancer screening has increased significantly in all age groups, especially between 65 and 69 years, and for both genders. For prostate cancer, the rate of men having performed at least one screening test (PSA and/or rectal examination) was 36%/49%/50%.This rate have significantly decreased in men aged 50-59 between 2008 and 2011(44% vs 37%, p&lt;0.05). Conclusions: For National Programs, the attendance rate remains high for breast cancer screening and is improving for colorectal cancer screening. However, the European guideline objective rate of participation for colorectal cancer screening has not yet been reached. Despite the absence of recommendations, prostate cancer screening is frequently carried out and stable overall.

Positivity rates and performances of immunochemical faecal occult blood tests at different cut-off levels within a colorectal cancer screening programme

BackgroundImmunochemical faecal occult blood tests have greater sensitivity for colorectal cancer screening than guaiac-based tests; however the number of positive tests required is still under discussion. MethodsA direct comparison of Hemoccult II with two immunochemical quantitative tests (OC-Sensor and FOB-Gold) using a 2-sample strategy was performed in over 30,000 patients undergoing colorectal cancer screening in France. ResultsPositivity ratio between immunochemical tests and Hemoccult II varied between 2.2 (OC-Sensor) and 2.4 (FOB-Gold) for the lowest cut-off value and 1.5–1.4 for the highest cut-off value. The positive predictive value for colorectal cancer was similar for immunochemical tests and Hemoccult II, and significantly higher for immunochemical tests for advanced adenomas. The detection rate of both colorectal cancer and advanced adenomas was higher with immunochemical tests than with Hemoccult II. With the 2-sample strategy and the lowest cut-off value the detection rate of colorectal cancer almost doubled and for advanced adenomas quadrupled. ConclusionFor colorectal cancer screening with immunochemical faecal occult blood tests, an acceptable strategy would be 2-day sampling with at least one positive test at a cut-off between 150 and 200ng/mL (OC-Sensor) and 176 and 234ng/mL (FOB-Gold). Data on the ease of test interpretation and cost-effectiveness now necessary to make definitive choices.

Cost effectiveness and projected national impact of colorectal cancer screening in France

Colorectal cancer (CRC) is a major cause of morbidity and mortality in France. Only scanty data on cost-effectiveness of CRC screening in Europe are available, generating uncertainty over its efficiency. Although immunochemical fecal tests (FIT) and guaiac-based fecal occult blood tests (g-FOBT) have been shown to be cost-effective in France, cost-effectiveness of endoscopic screening has not yet been addressed. Cost-effectiveness of screening strategies using colonoscopy, flexible sigmoidoscopy, second-generation colon capsule endoscopy (CCE), FIT and g-FOBT were compared using a Markov model. A 40 % adherence rate was assumed for all strategies. Colonoscopy costs included anesthesiologist assistance. Incremental cost-effectiveness ratios (ICERs) were calculated. Probabilistic and value-of-information analyses were used to estimate the expected benefit of future research. A third-payer perspective was adopted. In the reference case analysis, FIT repeated every year was the most cost-effective strategy, with an ICER of €48165 per life-year gained vs. FIT every 2 years, which was the next most cost-effective strategy. Although CCE every 5 years was as effective as FIT 1-year, it was not a cost-effective alternative. Colonoscopy repeated every 10 years was substantially more costly, and slightly less effective than FIT 1-year. When projecting the model outputs onto the French population, the least (g-FOBT 2-years) and most (FIT 1-year) effective strategies reduced the absolute number of annual CRC deaths from 16037 to 12916 and 11217, respectively, resulting in an annual additional cost of €26 million and €347 million, respectively. Probabilistic sensitivity analysis demonstrated that FIT 1-year was the optimal choice in 20% of the simulated scenarios, whereas sigmoidoscopy 5-years, colonoscopy, and FIT 2-years were the optimal choices in 40%, 26%, and 14%, respectively. A screening program based on FIT 1-year appeared to be the most cost-effective approach for CRC screening in France. However, a substantial uncertainty over this choice is still present.

Uptake of breast cancer screening in women aged over 75years

In France, the age range for organized screening for breast cancer is 50-74 years. From a layperson's perspective, the public health message focusing on a specific target population may be difficult to understand. The aim of this study is to assess how women aged over 75 years deal with this absence of screening recommendations for their age group. The population-based survey, EDIFICE, was carried out by telephone in 2008. Women were interviewed with regard to their behaviour, and in particular relating to breast cancer screening. For 136 breast cancer-free women, aged 75 and above and who had undergone at least one mammography in their lifetime, the test had been done within the last 2 years for only 62 (51%) of them. In a multiregression analysis, only one item (i.e. already having undergone at least five mammographies) was statistically associated with a higher rate of attendance (odds ratio=3.3, 95% confidence interval=1.03-11.1). According to our data, for women aged 75 and above, an estimated 17,000,000 Euros are spent each year on breast cancer screening in France, the net benefit of which is still unknown.

Large population survey

In France, mass screening for breast and colon cancer issupported by the French National Cancer Institute (INCa). In these nationwide screening campaigns, individuals aged between 50 and 74 years receive a personalized letter inviting them for a screening examination every 2 years. Prostate cancer screening is, however, still controversial and has not been included in the INCa recommendations so far. Research organizations are particularly interested in screening and indeed, several studies have been conducted in France and other countries to examine the different aspects of the subject. To provide actual benefits, screening should be undertaken on a regular scheduled basis. Therefore, several studies have assessed the factors influencing the participation rate of women in breast cancer screening in France (). The Institut National de Prévention et d'Education pour la Santé conducted one of these in 2005: the Baromètre Cancer (including 4046 individuals aged 15 years or older, interviewed by telephone) analysed beliefs and perceptions about cancer screening and studied attendance rates for breast, colon and prostate cancer (including scheduled screening). No previous survey has ever been conducted simultaneously among the general population and physicians with regard to individual and scheduled screening for breast cancer and colorectal cancer (CRC) or individual screening for prostate cancer. EDIFICE is thus the first large-scale survey to assess screening practices in France by analysing the targeted population on the one hand and the clinical practice of French general practitioners (GPs) on the other hand, using the 'mirror study' method to compare results. Two national surveys were conducted in 2005 and 2008. In 2005, only 22 geographical regions were included in the screening programme for CRC.