Organized Colorectal Cancer Screening Research Articles

Implementing organized colorectal cancer screening programs in Europe—protocol for a systematic review of determinants and strategies

BackgroundWith a high mortality of 12.6% of all cancer cases, colorectal cancer (CRC) accounts for substantial burden of disease in Europe. In the past decade, more and more countries have introduced organized colorectal cancer screening programs, making systematic screening available to entire segments of a population, typically based on routine stool tests and/or colonoscopy. While the effectiveness of organized screening in reducing CRC incidence and mortality has been confirmed, studies continuously report persistent program implementation challenges. This systematic review will synthesize the literature on organized CRC screening programs. Its aim is to understand what is currently known about the barriers and facilitators that influence the implementation of these programs and about the implementation strategies used to navigate these determinants.MethodsA systematic review of primary studies of any research design will be conducted. CENTRAL, CINAHL, EMBASE, International Clinical Trials Registry Platform, MEDLINE, PsycINFO, and Scopus will be searched. Websites of (non-)government health care organizations and websites of organizations affiliated with authors of included studies will be screened for unpublished evaluation reports. Existing organized CRC screening programs will be contacted with a request to share program-specific grey literature. Two researchers will independently screen each publication in two rounds for eligibility. Included studies will focus on adult populations involved in the implementation of organized CRC screening programs and contain information about implementation determinants/ strategies. Publications will be assessed for their risk of bias. Data extraction will include study aim, design, location, setting, sample, methods, and measures; program characteristics; implementation stage, framework, determinants, strategies, and outcomes; and service and other outcome information. Findings will be synthesized narratively using the three stages of thematic synthesis.DiscussionWith its sole focus on the implementation of organized CRC screening programs, this review will help to fill a central knowledge gap in the literature on colorectal cancer screening. Its findings can inform the decision-making in policy and practice needed to prioritize resources for establishing new and maintaining existing programs in the future.Systematic review registrationPROSPERO (CRD42022306580).

Implementation of an organized colorectal cancer screening program through quantitative fecal immunochemical test followed by colonoscopy in an urban low-income community: Guidance and strategies

Fecal Immunochemical Test (FIT) followed by a colonoscopy is an efficacious strategy to improve the adenoma detection rate and Colorectal Cancer (CRC). There is no organized national screening program for CRC in Brazil. The aim of this research was to describe the implementation of an organized screening program for CRC through FIT followed by colonoscopy, in an urban low-income community of São Paulo city. The endpoints of the study were: FIT participation rate, FIT positivity rate, colonoscopy compliance rate, Positive Predictive Values (PPV) for adenoma and CRC, and the rate of complications. From May 2016 to October 2019, asymptomatic individuals, 50–75 years old, received a free kit to perform the FIT. Positive FIT (≥ 50 ng/mL) individuals were referred to colonoscopy. 10,057 individuals returned the stool sample for analysis, of which (98.2%) 9,881 were valid. Women represented 64.8% of the participants. 55.3% of individuals did not complete elementary school. Positive FIT was 7.8% (776/9881). The colonoscopy compliance rate was 68.9% (535/776). There were no major colonoscopy complications. Adenoma were detected in 63.2% (332/525) of individuals. Advanced adenomatous lesions were found in 31.4% (165/525). CRC was diagnosed in 5.9% (31/525), characterized as adenocarcinoma: in situ in 3.2% (1/31), intramucosal in 29% (9/31), and invasive in 67.7% (21/31). Endoscopic treatment with curative intent for CRC was performed in 45.2% (14/31) of the cases. Therefore, in an urban low-income community, an organized CRC screening using FIT followed by colonoscopy ensued a high participation rate, and high predictive positive value for both, adenoma and CRC.

A Colorectal Cancer Screening Programs in Middle-Income Countries: A Scoping Review

Background: Colorectal cancer (CRC) is the 3rd most common cancer worldwide, and a major contributor to cancer-related mortality. In contrast to declining CRC incidence and mortality rates across high-income countries, the CRC burden is increasing in low- and middle-income countries. Although CRC screening has been shown to be a cost-effective intervention that decreases CRC incidence and mortality, screening programs remain an unmet need in most low- and middle-income countries. This article reviews evidence on existing CRC screening efforts in middle income countries, where the majority of new CRC cases and deaths are projected to occur over the next decade. Aims: The aim of this study was to identify and describe opportunistic and organized CRC screening programs in middle income countries and to identify barriers and facilitators of such programs. Methods: We identified countries defined as middle income countries by the World Bank and conducted a scoping literature review using PubMed, Google Scholar, and ScienceDirect. For each country, we identified whether CRC screening guidelines or programs exist on the national, regional, or local levels, and summarized data on screening methods and uptake, when this information was available. We also summarized published literature describing barriers and facilitators to CRC screening in middle income countries. Results: Of the 108 countries defined as middle income countries by the World Bank, we identified CRC screening programs in six lower-middle income countries and 23 upper-middle income countries. Most countries have opportunistic CRC screening guidelines/programs. Countries with organized CRC screening programs had higher screening uptake rates, although very few have achieved CRC screening coverage rates of >50% of the eligible population. Most programs were initiated less than 10 years ago, limiting ability to evaluate effect on CRC incidence and mortality. Several barriers to CRC screening were identified, including lack of physician buy in, participant knowledge and resources, and participant fear of screening. Conclusions: While there has been growth of CRC screening programs in the last decade with the initiation of both opportunistic and organized screening programs in middle income countries, there remain significant barriers to the uptake and implementation of such programs.

Проблемы и перспективы скрининга колоректального рака

Colorectal cancer (CRC) is a widespread malignancy that is asymptomatic in the early stages, and late diagnosis is associated with poor outcome. Several levels of CRC risk exist. Thus, 80% of CRCs are sporadic (medium risk), and the rate of their detection increases with age, in particular, after 50 years. 15% of CRCs are caused by familial predisposition or pre-existing colon disease (high risk). 5% of CRCs are associated with genetic diseases (very high risk). Methods for preventing CRC are tailored to these levels of risk. If a patient is classified as having high or very high risk, colonoscopy is the first-line choice depending on the level of risk and age. In very high risk, patients are also referred for genetic counseling. Medium-risk patients are the target group for an organized CRC screening program. Regular screening identifies the disease even at the precancer stage. Noninvasive screening tests for CRC detect blood in the stool. These include stool guaiac test and fecal immunochemical tests. Colonoscopy is the "gold standard" for CRC screening. In addition to colonoscopy, flexible sigmoidoscopy is used for CRC screening. In recent years, molecular genetic tests to identify CRC biomarkers, computed tomography colonography, magnetic resonance colonography, and colon capsule endoscopy have emerged. This paper reviews current issues of CRC screening, i.e., age and gender structure of risk groups, the rate and algorithms used in different countries for CRC early detection, and ways to improve screening efficacy, including artificial intelligence technologies. KEYWORDS: colorectal cancer, age, screening, methods, algorithms, artificial intelligence. FOR CITATION: Radygina L.V., Mochalova L.V. Challenges and prospects of colorectal cancer screening. Russian Medical Inquiry. 2023;7(6):359–365 (in Russ.). DOI: 10.32364/2587-6821-2023-7-6-4.

Artificial intelligence in colorectal cancer screening.

KEY POINTS Colorectal cancer (CRC) is one of the most commonly diagnosed cancers in Canada and leads to death in 10% of cases.[1][1] In Canada, organized CRC screening usually involves a fecal immunochemical test or guaiac fecal occult blood test every 2 years for individuals aged 50–75 years. For

Change in colorectal cancer (CRC) testing rates associated with the introduction of the first organized screening program in canton Uri, Switzerland: Evidence from insurance claims data analyses from 2010 to 2018

The first canton in Switzerland to implement an organized colorectal cancer screening program (OSP) was Uri. Starting in 2013, it offered 50–69-year-olds free testing with colonoscopy every 10 years or fecal occult blood test (FOBT) every 2 years. We tested the association between the OSP and testing rates over time.We analyzed claims data of 50–69-year-olds from Uri and neighboring cantons (NB) provided by a large health insurance and complemented it with data from the OSP. We fitted multivariate adjusted logistic regression models to compare overall testing rates and by method (colonoscopy or FOBT/both) We computed the 2018 rate of the population up-to-date with testing (colonoscopy within 9 years/FOBT within 2 years).Yearly overall testing rates in Uri increased from 8.7% in 2010 to 10.8% in 2018 and from 6.5% to 7.9% in NB. In Uri, the proportion tested with FOBT/both increased from 4.7% to 6.0% but decreased from 2.8% to 1.1% in NB. Testing by FOBT/both increased more between 2015 and 2018 than 2010–2012 in Uri than in NB (OR:2.1[95%CI:1.8–2.4]), it increased less for colonoscopy (OR:0.60[95%CI:0.51–0.70]), with no change in overall CRC testing (OR:0.91[95%CI:0.81–1.02]). In 2018 in Uri, 42.5% were up-to-date with testing (FOBT/both:9.2%, colonoscopy:35.7%); in NBs, 40.7% (FOBT/both:2.7%, colonoscopy:39%).Yearly FOBT rates in Uri were always higher than in NB. Though the OSP in Uri was not associated with a greater increase in overall testing rates, the OSP was associated with increased FOBT.

Declining Colectomy Rates for Nonmalignant Colorectal Polyps in a Large, Ethnically Diverse, Community-Based Population.

INTRODUCTION:Despite studies showing improved safety, efficacy, and cost-effectiveness of endoscopic resection for nonmalignant colorectal polyps, colectomy rates for nonmalignant colorectal polyps have been increasing in the United States and Europe. Given this alarming trend, we aimed to investigate whether colectomy rates for nonmalignant colorectal polyps are increasing or declining in a large, integrated, community-based healthcare system with access to advanced endoscopic resection procedures.METHODS:We identified all individuals aged 50–85 years who underwent a colonoscopy between 2008 and 2018 and were diagnosed with a nonmalignant colorectal polyp(s) at the Kaiser Permanente Northern California integrated healthcare system. Among these individuals, we identified those who underwent a colectomy for nonmalignant colorectal polyps within 12 months after the colonoscopy. We calculated annual colectomy rates for nonmalignant colorectal polyps and stratified rates by age, sex, and race and ethnicity. Changes in rates over time were tested by the Cochran-Armitage test for a linear trend.RESULTS:Among 229,730 patients who were diagnosed with nonmalignant colorectal polyps between 2008 and 2018, 1,611 patients underwent a colectomy. Colectomy rates for nonmalignant colorectal polyps decreased significantly from 125 per 10,000 patients with nonmalignant polyps in 2008 to 12 per 10,000 patients with nonmalignant polyps in 2018 (P < 0.001 for trend). When stratified by age, sex, and race and ethnicity, colectomy rates for nonmalignant colorectal polyps also significantly declined from 2008 to 2018.DISCUSSION:In a large, ethnically diverse, community-based population in the United States, we found that colectomy rates for nonmalignant colorectal polyps declined significantly over the past decade likely because of the establishment of advanced endoscopy centers, improved care coordination, and an organized colorectal cancer screening program.

A Modified Implementation Mapping Methodology for Evaluating and Learning From Existing Implementation.

When empirically supported interventions are implemented in real-world practice settings, the process of how these interventions are implemented is highly relevant for their potential success. Implementation Mapping is a method that provides step-by-step guidance for systematically designing implementation processes that fit the respective intervention and context. It includes needs assessments among relevant stakeholders, the identification of implementation outcomes and determinants, the selection and design of appropriate implementation strategies, the production of implementation protocols and an implementation outcome evaluation. Implementation Mapping is generally conceptualized as a tool to prospectively guide implementation. However, many implementation efforts build on previous or ongoing implementation efforts, i.e., “existing implementation.” Learnings from existing implementation may offer insights critical to the success of further implementation activities. In this article, we present a modified Implementation Mapping methodology to be applied when evaluating existing implementation. We illustrate the methodology using the example of evaluating ongoing organized colorectal cancer screening programs in Switzerland. Through this example, we describe how we identify relevant stakeholders, implementation determinants and outcomes as well as currently employed implementation strategies. Moreover, we describe how we compare the types of strategies that are part of existing implementation efforts with those that implementation science would suggest as being suited to address identified implementation determinants. The results can be used for assessing the current state of implementation outcomes, refining ongoing implementation strategies, and informing future implementation efforts.

Improvement of participation rate in colorectal cancer (CRC) screening by training general practitioners in motivational interviewing (AmDepCCR)

BackgroundColorectal cancer (CRC) is the second leading cause of cancer death in France (17,712 annual deaths). However, this cancer is preventable in the majority of cases by the early detection of adenomas. In France, the organized screening for CRC relies on general practitioners (GPs). The tests delivered by the GPs are carried out in 89% of cases. However, GPs do not systematically offer the test, because of time management and communication.MethodsAmDepCCR is a cluster randomized trial. Patients are prospectively included by their GPs. The study is designed in 2 phases for the GPs: first, GPs who have never participated in motivational interviewing (MI) training will be recruited then randomly split in 2 groups. Secondly, a 6-day motivational interviewing training will be carried out for the intervention group. Then, patients will be included in both groups during a period of 1 year. The primary outcome will be the number of CRC screenings achieved in each group and its difference. The secondary outcome will be the reluctance to screening and the patient’s self-estimated life expectancy at 0, 6, 12, and 24 months using the Health Belief Model (HBM).DiscussionThis study will help to know if GPs motivational interviewing is useful to improve organized CRC screening. In addition, it may help to improve communication between patients and GPs. GPs will be able to improve their practice in other fields of application through motivational interviewing (other screenings, addictions…).Trial registration2019-A01776-51 NCT04492215.

Colonoscopy-Related Adverse Events in Patients With Abnormal Stool-Based Tests: A Systematic Review of Literature and Meta-analysis of Outcomes.

Colorectal cancer (CRC) screening programs based on the fecal immunochemical test (FIT) and guaiac-based fecal occult blood (gFOBT) are associated with a substantial reduction in CRC incidence and mortality. We conducted a systematic review and comprehensive meta-analysis to evaluate colonoscopy-related adverse events in individuals with a positive FIT or gFOBT. A systematic and detailed search was run in January 2021, with the assistance of a medical librarian for studies reporting on colonoscopy-related adverse events as part of organized CRC screening programs. Meta-analysis was performed using the random-effects model, and the results were expressed for pooled proportions along with relevant 95% confidence intervals (CIs). A total of 771,730 colonoscopies were performed in patients undergoing CRC screening using either gFOBT or FIT across 31 studies. The overall pooled incidence of severe adverse events in the entire patient cohort was 0.42% (CI 0.20-0.64); I2 = 38.76%. In patients with abnormal gFOBT, the incidence was 0.2% (CI 0.1-0.3); I2 = 24.6%, and in patients with a positive FIT, it was 0.4% (CI 0.2-0.7); I2 = 48.89%. The overall pooled incidence of perforation, bleeding, and death was 0.13% (CI 0.09-0.21); I2 = 22.84%, 0.3% (CI 0.2-0.4); I2 = 35.58%, and 0.01% (CI 0.00-0.01); I2 = 33.21%, respectively. Our analysis shows that in colonoscopies performed after abnormal stool-based testing, the overall risk of severe adverse events, perforation, bleeding, and death is minimal.

Two randomized controlled trials for colorectal cancer screening invitations developed using a behavioral science approach

The effectiveness of behaviorally informed, targeted invitations to standard invitations and to no invitation (control arm, primary analysis) were compared in the context of an organized colorectal cancer (CRC) screening program. Two multi-arm, pragmatic randomized controlled trials in men (arms: male-specific, unisex, standard invitation, or no invitation) and in women (arms: unisex, standard invitation, or no invitation), were conducted in Ontario, Canada. Eligible persons aged 50–74, due for CRC screening, were randomized. Primary and secondary outcomes were completion of the guaiac fecal occult blood test (gFOBT) and uptake of any colorectal test, respectively, within 5 months of mailing. Impact of invitation type was assessed using logistic regression. Letters were mailed to 75,810 men and women; 38,673 males and 34,453 females were included in the analyses. Men who received the male-specific letter were most likely to screen with gFOBT compared to controls (odds ratio (OR) 7·24, 95% CI: 5·77, 9·09), followed by those receiving the unisex letter (OR 6·75, 95% CI: 5·37, 8·47) and the standard letter (OR 5·99, 95% CI: 4·76, 7·53). Women who received the unisex letter were most likely to be screened with gFOBT compared to controls (OR 7·07, 95% CI: 5·83, 8·59), followed by those receiving the standard letter (OR 6·76, 95% CI: 5·56, 8·21). In both trials, the findings were similar for the secondary outcome. Mailed invitations were effective for both men and women. With greater targeting using the behaviorally informed invitations, the magnitude of benefit relative to no invitation appeared to increase. (ClinicalTrials.gov, NCT02364895).

Advancing Health Equity for Medicaid Beneficiaries by Adding Colorectal Cancer Screening to the Centers for Medicare and Medicaid Services Adult Core Set

Advancing Health Equity for Medicaid Beneficiaries by Adding Colorectal Cancer Screening to the Centers for Medicare and Medicaid Services Adult Core Set

Colorectal cancer screening participation according to poverty rates in the department of Bouches-du-Rhône (France)

The rate of participation in organized colorectal cancer screening (DOCCR) remains insufficient in France, with strong disparities between departments. The aim of this work was to assess the relationship between the DOCCR response rates for the communes of the Bouches-du-Rhône (BdR) department and the boroughs ofMarseille and their poverty levels. The DOCCR response rate was assessed for the 2017-2018 campaign. The Pearson coefficient wascalculated to assess correlations with the average poverty rate per commune/borough, the density of general practitioners (GPs) and Potential Localized Accessibility (PLA) to GPs. Among the DOCCR guests, 29.7% (±4.7) responded. The rate of respondents differed significantly between the communes/boroughs of the department (P&lt;0.001). The rate of respondents was inversely correlated with the rate of people living below the poverty line, both for the communes/boroughs of the department, with a high correlation (r=-0.795, P&lt;0.001) and for the Marseille boroughs, with an even higher correlation (r=-0.910, P&lt;0.001). It was inversely correlated with the density of GPs (r=-0.430, P&lt;0.001). On the other hand, there was a weak positive correlation with Potential Localized Accessibility to GPs (r= 0.193, P&lt;0.001), as well as with the age of guests (r=0.476, P&lt;0.001). The poverty rate in the BdR, which is higher than the national average, may partly explain the low rate of DOCCR respondents; other factors such as the density of GPs and their accessibility may play a role.

Interim evaluation of the colorectal cancer screening programme in the Netherlands

An increasing number of countries have introduced nationwide colorectal cancer (CRC) screening in the past few years and decades, and most screening programmes involve invitation of the target age group starting from age 50, 55, or 60 years.1,2 In the Netherlands, a stool test-based screening strategy was developed, with extensive research in a pilot phase before the population-based programme was rolled out in 2014. The organised CRC screening programme was stepwise implemented from 2014 to 2019, and comprised of mailing of a faecal immunochemical test (FIT) every 2 years to all people in the age group 55–75 years.

Factors associated with organized and non-organized colorectal cancer screening

Abstract Background Data on non-organized colorectal cancer screening using fecal occult blood tests (FOBTs) is currently lacking. We identified factors associated with organized and non-organized FOBT screening. Methods Data of 308 municipalities in Flanders (6.6 million residents, 57% of Belgium) during 2015-2017 were analyzed. Logistic regression with generalized estimating equations was used to assess associations between municipal characteristics and organized and non-organized screening coverages. Results Median organized screening coverage increased (36.4% to 40.1%) while non-organized screening coverage decreased (4.8% to 3.3%) in 2015-2017. Organized screening coverage was negatively associated with average income (OR = 0.97, 95%CI: 0.96-0.98) and percentage of people with a non-Belgian/Dutch nationality (OR = 0.962, 95%CI: 0.957-0.967). More older people (70-74) in the target screening population were related to lower coverages by both organized (OR = 0.98, 95%CI: 0.97-0.99) and non-organized screening (OR = 0.98, 95%CI: 0.96-0.999). Education level was positively associated with organized screening coverage (OR = 1.010, 95%CI: 1.008-1.011). While GP visit was positively associated with both organized and non-organized screening coverages, average number of patients per GP and having a global medical dossier handled by preferred GP showed more pronounced associations with non-organized screening (OR = 1.021, 95%CI: 1.016-1.026 and OR = 1.025, 95%CI: 1.018-1.031, respectively) compared to organized screening coverage. Conclusions Higher average income, lower average education level, more older people and people with foreign nationality were associated with lower organized screening coverage. GP involvement showed a positive association with non-organized screening. It seems that some GPs and screening-invited individuals are still not fully aware of the benefits of organized screening. Available instruments in screening programs should be optimized to fill this gap in knowledge. Key messages We identified factors associated with both organized and non-organized colorectal cancer screening using fecal occult blood tests (FOBTs). Based on this knowledge, strategies can be developed to promote screening among non-participants and encourage non-organized participants to switch to organized screening.

Provinciale responsverschillen in het Vlaamse Bevolkingsonderzoek Dikkedarmkanker: inzichten uit gemeentelijke socio-demografische en gezondheidsgerelateerde kenmerken

Municipal characteristics associated with response rate to organised colorectal cancer screening in Flanders Introduction In Flanders (Belgium), the response rate to organised colorectal cancer (CRC) screening is still suboptimal (~ 50%). We studied the characteristics of municipalities in the Flemish provinces with the highest and lowest response rates to explore factors that might be associated with the response rate to organised CRC screening. Methods The response rates of municipalities in 5 Flemish provinces and the characteristics of municipalities in the provinces with the highest and lowest response rates were compared to the average measures of Flanders (data 2017) using an unpaired two-sample Wilcoxon test. Results The municipal response rates in Limburg and Antwerp were significantly higher, and those in West Flanders and Flemish Brabant significantly lower compared to Flanders. Further analyses of Limburg (highest response rate) and Flemish Brabant (lowest response rate) suggested that municipalities with higher response rates had more men and people aged 60-64 in the target population, more jobseekers and more people who contacted GPs/specialists frequently, but fewer people aged 70-74 in the target population and with a lower average income compared to Flanders. In contrast, municipalities with lower response rates had fewer men in the target population, fewer people having a partner, fewer jobseekers and fewer people having a global medical file, but more people with a non-Dutch or non-Belgian nationality and a higher average income (p-values &lt; 0.01). Conclusion This exploratory study identifies certain demographic, socioeconomic and health‑related municipal characteristics that may be related to the response rate to CRC screening in Flanders. These findings can guide future research and investigations with the aim to improve the response rate to CRC screening.

Impact of COVID-19 Related Disruptions to Colorectal Cancer Screening Programs in Three Countries: A Comparative Modelling Study

Background: Colorectal cancer (CRC) screening programs worldwide have been disrupted during the COVID-19 pandemic. This study aimed to estimate the impact of hypothetical disruptions to organized CRC screening programs on short- and long-term CRC incidence and mortality in three countries using microsimulation modelling.Methods: Using CRC microsimulation models for Australia (Policy1-Bowel), Canada (OncoSim) and the Netherlands (ASCCA and MISCAN-Colon) participating in the COVID-19 and Cancer Global Modelling Consortium (CCGMC), we simulated a range of scenarios to assess the potential impact of disruptions to screening on CRC incidence and mortality. Modelled scenarios varied by disruption duration (3-, 6- and 12-months), post-disruption participation decreases, and catch-up screening strategy.Findings: Without catch-up screening, CRC deaths could increase by 0·2-0·5%, 0·4-1·0%, and 0·8-2·0% over 2020-2050 among individuals aged 50 years and older in the three modelled countries after 3-, 6-, and 12- month disruptions, respectively, compared to undisrupted screening. A 6-month disruption would result in an estimated 1,964, 1,319, and 676-856 additional CRC deaths in Australia, Canada and the Netherlands, respectively, compared to undisrupted screening. Providing catch-up screening could minimize the impact of the disruption, while a post-disruption decrease in participation could increase CRC deaths by 1·8-3·7% compared to undisrupted screening.Interpretation: Although the relative impact of the modelled CRC screening disruptions due to the COVID-19 pandemic is modest, there is a clear impact on absolute CRC deaths over the period 2020-2050. It is crucial that, if disrupted, screening programs ensure participation rates return to previously observed rates and provide catch-up screening wherever possible, as the impact of any disruption could be considerably larger otherwise.Funding Statement: The secretariat for the COVID-19 and Cancer Global Modelling Consortium (CCGMC) working group 2 is funded through Cancer Council New South Wales.Declaration of Interests: KC: Dr. Canfell reports and is co-principal investigator of an unrelated investigator-initiated trial of cervical screening in Australia (Compass; ACTRN12613001207707 and NCT02328872), which is conducted and funded by the VCS Foundation (VCS), a government-funded health promotion charity. The VCS Foundation received equipment and a funding contribution from Roche Molecular Systems USA. However, neither KC nor her institution on her behalf (Cancer Council NSW) receives direct funding from industry for this trial or any other project. All other authors declare no conflict of interest.

A63 REFINING THE CANADIAN ASSOCIATION OF GASTROENTEROLOGY GUIDELINE ON SCREENING IN PERSONS WITH A FAMILY HISTORY OF NONHEREDITARY COLORECTAL CANCER OR ADENOMA: A MODIFIED DELPHI PROCESS

Abstract Background In 2018, the Canadian Association of Gastroenterology (CAG) published an extensive systematic review and guideline on screening in persons with a family history (FHx) of nonhereditary colorectal cancer (CRC) and adenoma. While CAG’s recommendations were evidence-based, some recommendations lacked precision (e.g. ranges for some start ages &amp; intervals) and screening cessation age was not addressed, leading to implementation challenges for practitioners and CRC screening programs. Aims To review and update the evidence since the 2018 guideline and to formulate implementable recommendations in the Ontario context that are aligned with the CAG guideline. Methods ColonCancerCheck (Ontario’s organized CRC screening program) conducted a modified version of the literature search used by CAG (Jan 2017 - Sept 2019). A 19-member expert panel with Canadian and international representatives from endoscopy, primary care, epidemiology, organized CRC screening programs, Ontario’s cancer system and the general public refined the recommendations of the CAG guideline for the purposes of implementation in an organized CRC screening program using a modified Delphi process. This iterative process involved a series of webinars and anonymous survey rounds where the panel reviewed evidence materials and provided online feedback to develop, refine &amp; achieve consensus on screening recommendations in persons with a FHx of CRC/adenoma. Consensus was achieved if ≥75% of members agreed or strongly agreed with the statement. Results Six new systematic reviews and 2 new guidelines were identified. New evidence included data on the absolute risk (10 year &amp; lifetime risk) of CRC by type of FHx, as well as the performance of fecal immunochemical testing (FIT) and barriers to CRC screening in persons with a FHx of CRC. The expert panel participated in 3 webinars and 4 online surveys to arrive at consensus. Panel recommendations and level of consensus will be reported for the 6 statements (Table). Conclusions Building from the CAG guideline, we derived evidence-based and implementable recommendations for screening persons with a FHx of CRC or adenoma. Funding Agencies Ontario Health (Cancer Care Ontario)

ACG Clinical Guidelines: Colorectal Cancer Screening 2021.

Colorectal cancer (CRC) is the third most common cancer in men and women in the United States. CRC screening efforts are directed toward removal of adenomas and sessile serrated lesions and detection of early-stage CRC. The purpose of this article is to update the 2009 American College of Gastroenterology CRC screening guidelines. The guideline is framed around several key questions. We conducted a comprehensive literature search to include studies through October 2020. The inclusion criteria were studies of any design with men and women age 40 years and older. Detailed recommendations for CRC screening in average-risk individuals and those with a family history of CRC are discussed. We also provide recommendations on the role of aspirin for chemoprevention, quality indicators for colonoscopy, approaches to organized CRC screening and improving adherence to CRC screening. CRC screening must be optimized to allow effective and sustained reduction of CRC incidence and mortality. This can be accomplished by achieving high rates of adherence, quality monitoring and improvement, following evidence-based guidelines, and removing barriers through the spectrum of care from noninvasive screening tests to screening and diagnostic colonoscopy. The development of cost-effective, highly accurate, noninvasive modalities associated with improved overall adherence to the screening process is also a desirable goal.

Piloting gender-oriented colorectal cancer screening with a faecal immunochemical test: population-based registry study from Finland

ObjectiveTo assess the feasibility and evaluate the performance of a relaunched colorectal cancer (CRC) screening programme with different cut-offs for men and women.DesignPopulation-based registry study.SettingNine municipalities in Finland which started...