Organized Colorectal Cancer Screening Research Articles

Influence of sample return time and ambient temperature on the performance of an immunochemical faecal occult blood test with a new buffer for colorectal cancer screening.

The haemoglobin concentration measured by faecal immunochemical tests (FIT) may be decreased in cases of delayed sample return or high temperature. It is an issue of great importance. The aim of this study was to investigate the effects of sample return time and of season on the performance of an FIT (FOB-Gold) with a new buffer. The study included 20 371 participants involved in the French organized colorectal cancer (CRC) screening programme. The probability of a positive screening test, detection rates and positive predictive values for CRC and advanced adenoma were analysed according to sample return time and season of screening. A sample of positive FIT was stored for 7 days in an incubator at 20°C or 30°C. The positivity rate was 4.1% for a sample return time of up to 3 days, 4.1% for 4-5 days and 4.6% for 6-7 days (P=0.25). In multivariate analysis, there was no association between positivity rates, detection rates and positive predictive values for CRC and advanced adenoma and the sample return time or the season of screening. At a constant temperature of 20°C, there was a decrease in the haemoglobin concentration of 5.1% after 7 days. The decrease reached 20.5% at a temperature of 30°C. It was only 4.5% during the first 4 days of storage in the incubator. With the new buffer, delay in sample return or season did not affect the clinical outcome. When temperatures reach 30°C, the faecal sample must be returned promptly.

Reducing income-related inequities in colorectal cancer screening: lessons learned from a retrospective analysis of organised programme and non-programme screening delivery in Winnipeg, Manitoba

ObjectiveWe examined organised colorectal cancer (CRC) screening programme and non-programme faecal occult blood test (FOBT) use from 2008 to 2012 for individuals living in Winnipeg, Manitoba, by area-level income.SettingWinnipeg, Manitoba,...

Organized colorectal cancer screening in Serbia - the first round within 2013-2014.

The National Organized Colorectal Cancer Screening Program was conducted in the Republic of Serbia during 2013-2014 covering the population of both genders, aged 50 to 74 years, in 28 municipalities out of 180, with the target population of 651,445 people. This organized colorectal cancer screening aims to reduce mortality from colorectal cancer in the target population. The aim of this study was to show the results of organized screening for colorectal cancer during the first biannual round in Serbia. General practitioners from the primary health centers, invited target population by letters and by phone to perform immunochemical fecal occult blood test. Persons with a positive test results were referred to the colonoscopy. The database of health insurance and other citizens of the target population was used for invitation for screening in primary health centers. Descriptive statistical analysis of the results in organized colorectal cancer screening in the first round was performed for the key screening indicators. In the first round, a total of 99,592 persons were invited. The participation rate was 62.5%. Colonoscopy was performed in 1,554 persons. Adenomas were found in 586 persons (0.9% of all the tested), e.g. 37.7 % of all colonoscopied. In 129 persons colorectal cancer was diagnosed (0.2% of all the tested), e.g. 8.3% of all the colonoscopied. In the left half of the colon (rectum, sigmoid and descending colon) there were 70.4% diagnosed polyps and 77.3% carcinomas, while 29.6% of polyps and 22.7% carcinomas were found in the proximal parts of the colon. In the first round of the organized colorectal cancer screening in Serbia the participation rate of the targeted population was high and gave encouraging result. It was expected that in the forthcoming rounds even higher coverage of the target population would be accomplished. A positive predictive value of the completed colonoscopies showed that further work on observing the stages of diagnosed adenomas and carcinomas would reach the goals of the expected improvement in early detection of colorectal cancer in Serbia.

Knowledge and Informed Decision-Making about Population-Based Colorectal Cancer Screening Participation in Groups with Low and Adequate Health Literacy.

Objective. To analyze and compare decision-relevant knowledge, decisional conflict, and informed decision-making about colorectal cancer (CRC) screening participation between potential screening participants with low and adequate health literacy (HL), defined as the skills to access, understand, and apply information to make informed decisions about health. Methods. Survey including 71 individuals with low HL and 70 with adequate HL, all eligible for the Dutch organized CRC screening program. Knowledge, attitude, intention to participate, and decisional conflict were assessed after reading the standard information materials. HL was assessed using the Short Assessment of Health Literacy in Dutch. Informed decision-making was analyzed by the multidimensional measure of informed choice. Results. 64% of the study population had adequate knowledge of CRC and CRC screening (low HL 43/71 (61%), adequate HL 47/70 (67%), p > 0.05). 57% were informed decision-makers (low HL 34/71 (55%), adequate HL 39/70 (58%), p > 0.05). Intention to participate was 89% (low HL 63/71 (89%), adequate HL 63/70 (90%)). Respondents with low HL experienced significantly more decisional conflict (25.8 versus 16.1; p = 0.00). Conclusion. Informed decision-making about CRC screening participation was suboptimal among both individuals with low HL and individuals with adequate HL. Further research is required to develop and implement effective strategies to convey decision-relevant knowledge about CRC screening to all screening invitees.

Longitudinal Rates of Colon Cancer Screening Use in Winnipeg, Canada: The Experience of a Universal Health-Care System with an Organized Colon Screening Program.

OBJECTIVES:We examined trends in colorectal cancer (CRC) screening (fecal occult blood test (FOBT), colonoscopy, and flexible sigmoidoscopy (FS)) and differences in CRC screening by income in a population with an organized CRC screening program and universal health-care coverage.METHODS:Individuals who had an FOBT, colonoscopy, or FS were identified from the provincial Physician Claims database and the population-based colon cancer screening registry. Trends in age-standardized rates were determined. Logistic regression was performed to explore the association between CRC screening and income quintiles by year.RESULTS:Up-to-date CRC screening (FOBT, colonoscopy, or FS) increased over time for men and women, all age groups, and all income quintiles. Up-to-date CRC screening was very high among 65- to 69- and 70- to 74-year-olds (70% and 73%, respectively). There was a shift toward the use of an FOBT for CRC screening for individuals in the lower income quintiles. The disparity in colonoscopy/FS coverage by income quintile was greater in 2012 than in 1995. Overall, there was no reduction in disparities by income in up-to-date CRC screening nor did the rate of increase in up-to-date CRC screening or FOBT use change after the introduction of the organized provincial CRC screening program.CONCLUSIONS:CRC screening is increasing over time for both men and women and all age groups. However, a disparity in up-to-date CRC screening by income persisted even with an organized CRC screening program in a universal health-care setting.

968 Risk of Colorectal Cancer Among Those Who Are gFOBt Positive but Have Had a Recent Prior Colonoscopy: Experience From an Organized Screening Program

In ColonCancerCheck, Ontario's organized colorectal cancer (CRC) screening program, almost 25% of persons with a positive guaiac fecal occult blood test (gFOBT) fail to have follow-up colonoscopy. Colonoscopy in the 5 years prior to the abnormal gFOBT is associated with failure to have follow-up; the more recent the colonoscopy, the stronger the association with failure to follow-up. It is unclear whether colonoscopy should be repeated in this population. The aim of this study was to evaluate the risk of CRC among 1) those who are gFOBT positive by recency of prior colonoscopy and 2) those undergoing primary screening colonoscopy.

Lack of follow-up colonoscopy after positive FOBT in an organized colorectal cancer screening program is associated with modifiable health care practices

BackgroundColonCancerCheck (CCC), Ontario's organized colorectal cancer (CRC) screening program, uses guaiac fecal occult blood testing (gFOBT). To reduce CRC-related mortality, persons with a positive gFOBT must have colonoscopy. We identified factors associated with failure to have colonoscopy within 6months of a positive gFOBT. MethodsPopulation-based, retrospective cohort analysis of CCC participants with positive gFOBT (April 2008 to December 2009) using health administrative data. Patient, physician and health care utilization factors associated with a lack of follow-up colonoscopy were identified using descriptive and multivariate analyses. ResultsThere were 21,839 participants with a positive gFOBT; 14,091 (64%) had colonoscopy within 6months. The strongest factors associated with failure to follow-up were recent colonoscopy (in 2years prior vs. >10years or never, OR: 4.31, 95% C.I.: 3.82, 4.86), as well as repeat gFOBT (OR: 6.08, 95% C.I.: 5.46, 6.78) and hospital admission (OR: 4.35, 95% C.I.: 3.57, 5.26) in the follow-up period. ConclusionIn the first 18months of the CCC Program, 1/3 of those with a positive gFOBT did not have colonoscopy within 6months. Identification of potentially modifiable factors associated with failure to follow up lay the groundwork for interventions to address this critical quality gap.

Mo1955 A Significant Proportion of Patients Still Require Colonoscopy After CT Colonography Within the United Kingdom Bowel Cancer Screening Programme

Background: Several European countries are implementing organized programs for colorectal cancer (CRC) screening, due to their superiority on opportunistic interventions. High-quality studies have already clarified the efficacy of the involved faecal and endoscopic tests. However, their cost-effectiveness within this context are unclear. Methods: A Markov model was constructed comparing the strategies of single sigmoidoscopy (FS) at age 58, fecal immunochemical test (FIT) every 2 years, and a sequential strategy (FS+FIT) in 100,000 subjects, based on the policy and data collected from the organized CRC screening program in the Piedmont region. In FS+FIT strategy subjects non-adherent to FS were re-invited to FIT every 2 years until age 69. Ageand sex-specific CRC incidence and mortality rates were extracted from the Piedmont cancer registry. The expected protective effect of screening on CRC incidence and mortality was derived from the literature. Direct cost analysis was carried out separately for FS and for FIT at first and subsequent rounds. All relevant resources consumed by the program were calculated for each strategy. Incremental cost-effectiveness ratios (ICER) between the different strategies were calculated. Sensitivity and probabilistic analysis were also performed. Results: Direct costs for FS and FIT at 1° and >2° rounds were estimated as ¤160, ¤33 and ¤21, respectively. Assuming the observed participation rates in the Piedmont program (FS: 30%; FIT: 42%), all the simulated strategies appeared to be effective (10-17% of CRC incidence reduction) and cost-effective, compared to the no screening scenario, with an ICER lower than ¤1,000 per life-year saved. However, FS and FS+FIT were the only strategies to be cost-saving or cost-neutral, FS being the least expensive (¤14 saving per person). FS+FIT and FS were the only non-dominated strategies, with FS+FIT being more effective and cost-effective than FS (ICER, ¤945-3,151 per lifeyear saved). At probabilistic analysis, FS+FIT strategy was the most cost-effective strategy in 83% of the scenarios. The residual uncertainty appeared to be mainly related with parameters inherent to efficacy of FIT and adherence, whilst costs did not play any significant role. Conclusions: Organized programs of CRC screening appear to be highly cost-effective, irrespectively of the endoscopic or faecal test selected. However, a sequential approach with sigmoidoscopy and FIT would appear the most cost-effective option. In the case of limited resources, a single sigmoidoscopy would appear the least expensive, but still convenient, approach.

Mo1954 Cost-Effectiveness of Organized Programs for Colorectal Cancer Screening: Sigmoidoscopy and Immunochemical Faecal Occult Blood Test

Background: Several European countries are implementing organized programs for colorectal cancer (CRC) screening, due to their superiority on opportunistic interventions. High-quality studies have already clarified the efficacy of the involved faecal and endoscopic tests. However, their cost-effectiveness within this context are unclear. Methods: A Markov model was constructed comparing the strategies of single sigmoidoscopy (FS) at age 58, fecal immunochemical test (FIT) every 2 years, and a sequential strategy (FS+FIT) in 100,000 subjects, based on the policy and data collected from the organized CRC screening program in the Piedmont region. In FS+FIT strategy subjects non-adherent to FS were re-invited to FIT every 2 years until age 69. Ageand sex-specific CRC incidence and mortality rates were extracted from the Piedmont cancer registry. The expected protective effect of screening on CRC incidence and mortality was derived from the literature. Direct cost analysis was carried out separately for FS and for FIT at first and subsequent rounds. All relevant resources consumed by the program were calculated for each strategy. Incremental cost-effectiveness ratios (ICER) between the different strategies were calculated. Sensitivity and probabilistic analysis were also performed. Results: Direct costs for FS and FIT at 1° and >2° rounds were estimated as ¤160, ¤33 and ¤21, respectively. Assuming the observed participation rates in the Piedmont program (FS: 30%; FIT: 42%), all the simulated strategies appeared to be effective (10-17% of CRC incidence reduction) and cost-effective, compared to the no screening scenario, with an ICER lower than ¤1,000 per life-year saved. However, FS and FS+FIT were the only strategies to be cost-saving or cost-neutral, FS being the least expensive (¤14 saving per person). FS+FIT and FS were the only non-dominated strategies, with FS+FIT being more effective and cost-effective than FS (ICER, ¤945-3,151 per lifeyear saved). At probabilistic analysis, FS+FIT strategy was the most cost-effective strategy in 83% of the scenarios. The residual uncertainty appeared to be mainly related with parameters inherent to efficacy of FIT and adherence, whilst costs did not play any significant role. Conclusions: Organized programs of CRC screening appear to be highly cost-effective, irrespectively of the endoscopic or faecal test selected. However, a sequential approach with sigmoidoscopy and FIT would appear the most cost-effective option. In the case of limited resources, a single sigmoidoscopy would appear the least expensive, but still convenient, approach.

Successes and challenges in population-based cancer screening.

Cancer Care Ontario's (CCO's) organized breast, colorectal and cervical cancer screening programs are in different stages of development and maturity. Headed by clinical and scientific leads, the programs reflect a deep understanding of how to design, evaluate and report on programs based on evidence and best practice. Guided by a CCO-Ministry of Health and Long-Term Care ("the Ministry") joint committee and supported by recent investments in information technology infrastructure, the programs provide high-quality cancer screening to Ontario's eligible population.

Five-year experience of organized colorectal cancer screening in a Swedish population – increased compliance with age, female gender, and subsequent screening round

To evaluate compliance by age, gender, and screening round in the population based Stockholm/Gotland colorectal cancer screening programme. All individuals aged between 60 and 69 living in the counties of Stockholm and Gotland (Sweden) have, since 2008, successively been included in a colorectal cancer screening programme using biennial faecal occult blood tests (Hemoccult®). Personal invitations including test kits have been sent to home addresses, and individuals with a positive test result have been called to a defined clinic for an assessment colonoscopy. Descriptive statistics have been used to evaluate different aspects of compliance. Over the five-year period 2008-2012, more than 200,000 individuals from nine different birth cohorts have been invited, with a compliance rate of approximately 60%, which increased by age, female gender, and subsequent screening round. In total, 4,300 individuals (2.1%) with positive tests were referred to assessment colonoscopy, where 213 colorectal cancers were diagnosed. The compliance with the follow-up colonoscopies varied by year, and ranged from 85.6-92.4%. The strong organization of the programme contributed to a high compliance rate, that increased by screening round. The lower participation rate among men and among individuals at younger ages needs further attention.

Implementing an Organised Colorectal Cancer Screening Programme in Germany: Opportunities and Challenges

Each year in Germany, about 65,000 people are diagnosed with colorectal cancer (CRC) and more than 25,000 people die of the disease. The majority of these cases could be avoided by a more effective screening programme. Recently, a law came into force that offers a great opportunity in this regard. It calls for introducing an organised CRC screening programme in Germany, which includes an invitation system as well as further measures for quality assurance and programme evaluation. To realise this opportunity, challenges of implementation need to be considered. The aim of this review article is to elaborate the challenges of an organised CRC screening in Germany in order to derive the need for action regarding successful implementation. This review article is based on a selective literature search, including current guidelines and recommendations. In the context of CRC screening, but also by colonoscopies performed for other indications (e.g., due to symptoms), precancerous lesions (adenomas) are detected and removed in a relevant proportion of the target population, which requires a surveillance examination after 3 or 5 years according to current recommendations. Therefore, an efficient invitation system for CRC screening should be designed to allow for a flexible interval depending on previous findings, which differs from mammography screening with its fixed interval. A prerequisite would be the standardised documentation of all colonoscopies irrespective of the indication, given that a substantial proportion of colonoscopies in Germany are performed outside of the screening program. Still, the work load regarding documentation could be less than for mammography screening. Another challenge in terms of organisation results from the parallel offer of 2 different screening tools (colonoscopy and faecal occult blood test). To realise the potential of an organised CRC screening, it seems important to devote sufficient time and resources for developing an efficient and feasible concept, while there might be interim options to avoid further delay regarding the initial invitation of the target population. Given that expertise from, amongst others, gastroenterology, epidemiology, clinical chemistry and health communication is required, an interdisciplinary approach appears essential.

Su1224 Participation in the First Four Rounds of the Colorectal Cancer Screening Program With Guaiac Fecal Occult Blood Test Conducted in the Haut-Rhin (Alsace, France)

Organized screening programs depend on high participation rates to be effective and efficient. Whether uptake rates obtained in randomized controlled trials on colorectal cancer (CRC) screening with guaiac fecal occult blood test (gFOBT) are transposable in the real world is questionable. gFOBT has several drawbacks, one is the requirement for frequent testing, which may limit compliance. Aim: To assess participation in the first 4 rounds of an organized CRC screening program using gFOBT. Methods: Comparison of the determinants of participation in the first 4 rounds (R1 to R4) of the CRC screening programwith Hemoccult II implemented since 2003 in the Haut-Rhin, a French administrative area. We performed a population-based open cohort study of all average risk residents aged 50 74 years. They were invited to participate every other year. A first letter invited them to visit their general practitioner (GP) for CRC screening. Three recall letters were mailed to all those who had not complied, the second with a gFOBT kit. Results: Main results are presented in the table. The decrease in uptake was similar in men and women and was observed in all age groups except the 70 74 year age group. Overall, after 4 rounds, 242,292 persons had been invited and 34545 (14.3%) had completed 4 tests, 26675 (11.0%) 3 tests, 37193 (15.4%) 2 tests and 50070 (20.7%) 1 test. Overall, 148,483 (61.3%) persons had been screened at least once. Of 86,694 people who were eligible in all rounds, 34,545 (39.8%) had completed all the 4 tests, 8679 (10.0%) 3 tests, 8099 (9.3%) 2 tests, 6552 (7.6%) 1 test, and 28,819 (33.2%) 0 test. The uptake following the 2nd, 3rd and 4th invitation in people who never complied before was 17.0%, 8.8% and 5.5%, respectively. 16% of people who had participated in Rn did not participate in Rn+1. The proportion of people screened by GPs increased significantly from 76.9% in the 1st round to 84.0% in the 4th (p<0.01) while that of people screened by direct mailing of the gFOBT kit decreased significantly from 15.6% to 12.1% (p<0.01). The proportion of uptake following the first 2 invitation letters increased from R1 to R4 from 78.4% to 86.9%, while that following the mailing of the gFOBT kit decreased from 15.3% to 7.8%. The uptake decreased between years 2008 2009 and 2011 2012 from 34.3% to 31.7% in France and from 51.3% to 47.1% in our region. The latter uptake was among the highest achieved in France, where it varied from 7.1% to 51.4% depending on regions. Conclusion: The uptake and adherence to repeat testing are modest and deteriorate with time in the French organized population-based gFOBT CRC screening program, so that the reduction in CRC mortality will be significantly lower than in the trials. Effort is needed to enhance uptake and to reduce inequalities in participation related to sex, age, place of residence and deprivation.

Using physician-linked mailed invitations in an organised colorectal cancer screening programme: effectiveness and factors associated with response

ObjectivesA central tenet of organised cancer screening is that all persons in a target population are invited. The aims of this study were to identify participant and physician factors associated...

Ontario's ColonCancerCheck: Results from Canada's First Province-Wide Colorectal Cancer Screening Program

ColonCancerCheck (CCC), Canada's first province-wide colorectal cancer screening program, was publicly launched in Ontario in April 2008. The objective of this article is to report on key indicators of CCC Program performance since its inception. The CCC Program recommends biennial guaiac-based fecal occult blood test (gFOBT) for persons 50 to 74 years of age at average risk for colorectal cancer and colonoscopy for those at increased risk (having one or more first-degree relatives with a diagnosis of colorectal cancer). Opportunistic screening with colonoscopy is available in Ontario. Five data sources were used to compute indicators of program performance during 2008 to 2011. The indicators computed were FOBT participation, overdue for screening, FOBT positivity, positive predictive value (PPV) of FOBT for colorectal cancer, diagnostic follow-up, and colorectal cancer detection rate. In 2011, FOBT participation was 29.8% and 46.8% of the target population was overdue for screening. FOBT positivity was higher among men (5.1%) than women (3.5%), and the PPV of FOBT for cancer was 4.3% in 2011. Follow-up colonoscopy within 6 months of a positive FOBT was completed by 74.6% of Program participants in 2011. The cancer detection rates for FOBT and for colonoscopy in those with a family history were 1.3 per 1,000 and 4.0 per 1,000, respectively, in 2011. These results provide an early indication of Program performance and provide findings relevant to other organized colorectal cancer screening programs. The greater cancer detection rate in those at increased risk due to family history who undergo colonoscopy screening suggests that a strategy of risk stratification will enhance the impact of FOBT-based screening programs.

Darmkrebsfrüherkennung

Colorectal cancer (CRC) is the second most common cancer among both men and women in Germany. Owing to its relatively slow growth, perspectives for effective early detection are much better than for other forms of cancer. To summarize the evidence on effectiveness and cost-effectiveness of CRC screening, and to provide an overview on the current state and perspectives for effective CRC screening. Summary and critical review of evidence from randomized trials and observational epidemiological studies. A reduction in CRC mortality by offering annual fecal occult blood tests or once-only flexible sigmoidoscopy has been demonstrated in randomized trials. Novel fecal immunochemical tests for hemoglobin in stool have been shown to be more sensitive than traditional fecal occult blood tests and could substantially improve noninvasive CRC screening. Epidemiological studies suggest that the majority of CRC cases and deaths could be prevented by colonoscopy and removal of colorectal adenomas. However, adherence to screening offered outside organized screening programs is low. The National Cancer Plan recommends an organized CRC screening program in Germany. The law on the early detection of cancer from April 2013 has paved the way for its implementation. The great potential for CRC prevention by early detection has so far only been realized to a very limited extent in Germany. Introduction of an organized screening program and the offer of enhanced noninvasive screening tests could strongly enhance the utilization and effectiveness of CRC screening in Germany. The political frame has been set, and timely quality-assured implementation is required.

Rezultati sprovedenog organizovanog skrininga kolorektalnog karcinoma u Srbiji posle prve godine prvog ciklusa

Rezultati sprovedenog organizovanog skrininga kolorektalnog karcinoma u Srbiji posle prve godine prvog ciklusa

Effectiveness of an organized colorectal cancer screening program on increasing adherence in asymptomatic average-risk Canadians

BackgroundColorectal cancer (CRC) is the third most commonly diagnosed cancer and second highest cause of cancer-related mortality in Canada. Despite the availability of screening services and establishment of guidelines, utilization of colorectal cancer screening in Canada remains low. In 2008, the province of Ontario launched ColonCancerCheck, an organized colorectal cancer screening program aimed at increasing CRC screening adherence. In this study, we adopt a quasi-experimental approach to estimate and describe the impact of ColonCancerCheck on screening behavior in the asymptomatic average risk population.MethodsAnnual screening rates from the target population were estimated using five cycles of the Canadian Community Health Survey, a cross-sectional nationally representative survey of health status, healthcare use, and determinants of health in the Canadian population. We used a difference-in-differences design to measure the overall impact of ColonCancerCheck on past-year fecal occult blood testing (FOBT) and endoscopy in Ontario relative to the rest of Canada. Several verification tests validated the suitability of our model specification.ResultsThe difference-in-differences analysis shows that ColonCancerCheck increased FOBT screening in the average risk population by 5.2 percentage points (95% CI [3.2, 7.2]), an increase of 33% relative to pre-program screening rates. The program had no observed effect on endoscopy screening and we found no evidence that ColonCancerCheck differentially altered the screening practices of population sub-groups.ConclusionsOur findings suggest ColonCancerCheck has been successful at increasing use of FOBT in the asymptomatic average risk population.

Incidence trend of malignant polyps through the data of a specialized colorectal cancer registry: clinical features and effect of screening

Objectives. The purposes of the study are to describe the incidence trend of malignant polyp of large bowel over a 25-year period in the District of Modena and to assess the effect of an organized colorectal cancer screening program. Material and methods. Through the data of a specialized colorectal cancer Registry, we evaluate the clinical and pathological features of the polyps. Trend analysis was assessed with the Joinpoint Regression Program. Results. A total of 172 patients with malignant polyps were diagnosed throughout the study (3.5% of 4.835 registered patients); their overall frequency during the registration period increased from zero cases in the initial years (1984–85) to 57 cases in the past 3 years (2006–2008). Crude incidence rate passed from 0.37 in 1986–89 to 10.2 in 2006. Joinpoint trend analysis of crude rates showed a significant increase of incidence during the study period, with percent of annual variation ranging between 38.6% (95% CI 12.5–70.7) and 7.3% (95% CI 2.6–12.1). During the screening period (2005–2008, the past 4 years of registration) there was a significant increase of sessile polyps (p < 0.001), while other clinical and morphological features, including the number of low- and high-risk malignant polyps, remained unchanged. The surgery (after polypectomy) tended to raise both in low- and high-risk subgroups. Conclusion. The incidence of malignant polyps increased significantly from the initial to the most recent periods of colorectal cancer registration. Screening was associated with changes in gross morphology of polyps and with an increased use of the surgery after endoscopic polypectomy.

219 Incidence and Phenotype At Diagnosis of Inflammatory Bowel Disease Across 9 Countries in Asia-Pacific

Whether the results of randomized controlled trials on colorectal cancer (CRC) screening with guaiac fecal occult blood test (gFOBT) are transposable in the real world is questionable. gFOBT has several drawbacks, one is the requirement for frequent testing, which may limit compliance and thereby effectiveness. Aim: To assess the short term outcomes of the four first rounds of a population-based CRC screening program using gFOBT. Methods: Comparison of the outcomes of the four first rounds (R1 to R4) of the organized CRC screening program with Hemoccult II implemented in the Haut-Rhin, a French administrative area, since 2003 (Denis B et al Gut 2007;56:1579-84). All average-risk residents aged 50 74 were invited by mail to participate every other year. Results: Main outcomes are presented in the table. The crude uptake rate decreased from 47.9% to 38.5%. The decrease in adjusted uptake was similar in men and women but was observed in younger age groups (50 64) only and maximal in the 50 54 year age group. 15.8% of people who participated in Rn did not participate in Rn+1. Overall, 56.7% of the target population had completed at least one test and 19.6% four tests. More than 80% of the completed tests were provided by general practitioners. The positive predictive value for advanced neoplasia decreased significantly from 31.4% in R1 to 26.1% in R4 (and detection rate from 9.7‰ to 4.7‰). The rate of stage I colon cancers decreased significantly from 44.9% in R1 to 38.1% in R4. Conclusion: Participation and yield deteriorated with time in our organized population-based gFOBT CRC screening program. This deterioration was not observed in previous randomized controlled trials on gFOBT screening and may question the reproducibility of their effectiveness on the reduction of CRC mortality in the real world. Effort is needed to enhance uptake and to reduce inequalities in participation related to sex, age, place of residence and deprivation.