PDF herunterladen
Endoscopy 2013; 45(01): 27-34
DOI: 10.1055/s-0032-1325800
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Outcomes and cost evaluation of the first two rounds of a colorectal cancer screening program based on immunochemical fecal occult blood test in northern Italy

F. Parente
1   Gastrointestinal Unit, A. Manzoni Hospital, Lecco, Italy
,
C. Boemo
1   Gastrointestinal Unit, A. Manzoni Hospital, Lecco, Italy
,
A. Ardizzoia
2   Oncology Department, A. Manzoni Hospital, Lecco, Italy
,
M. Costa
3   Department of Surgery, A. Manzoni Hospital, Lecco, Italy
,
P. Carzaniga
4   Division of General Surgery, Merate Hospital, Merate, Italy
,
A. Ilardo
5   Community Health Care Centre, Lecco, Italy
,
R. Moretti
5   Community Health Care Centre, Lecco, Italy
,
M. Cremaschini
6   Community Health Care Centre, Bergamo, Italy
,
E. M. Parente
7   Faculty of Economics, Catholic University, Milan, Italy
,
M. E. Pirola
8   Regional Reference Centre for Screening, Milan, Italy
› Institutsangaben
Weitere Informationen

Publikationsverlauf

submitted 02. Mai 2012

accepted after revision 20. August 2012

Publikationsdatum:
19. Dezember 2012 (online)

Auch verfügbar auf
    Lizenzen und Reprints

Background and study aims: Colorectal cancer (CRC) screening aims to reduce mortality by detecting cancers at an early stage and removing adenomatous polyps at an acceptable cost. The aim of the current study were to assess the outcomes and costs of the first two biennial rounds of a population-based CRC screening program using the immunochemical fecal occult blood test (i-FOBT) in a northern Italian province.

Methods: All residents aged 50 – 69 years were invited to take part in a biennial screening program using a 1-day i-FOBT, followed by colonoscopy in positive individuals. The i-FOBT uptake, compliance to colonoscopy, detection rate for cancer or advanced adenomas according to age and sex, and direct cost analysis were carried out separately for the 1st and 2nd rounds of screening.

Results: In 78 083 (1st round) and 81 619 (2nd round) individuals who were invited to screening, the participation rates were 49.7 % and 54.4 % and i-FOBT positivity rates were 6.2 % and 5.8 %, respectively. Detection rates for cancer and advanced adenomas were lower in the 2nd screening compared with the 1st one (1.6‰ vs. 2.5‰ for cancers and 15.8‰ vs. 17.9‰ for advanced adenomas, respectively), whereas positive predictive values for cancer and advanced adenoma were similar in both rounds. In 165 adenocarcinomas detected, 52 % were Dukes’ stage A and 21 % were stage B. All cost indicators were slightly higher in the 1st round of screening compared with the 2nd. The direct cost per cancer or advanced adenoma detection was similar in the two rounds (€ 1252 and € 1260, respectively).

Conclusions: Compliance and diagnostic yield of i-FOBT screening were satisfactory. Most detected cancers were at a very early stage. Program costs were reasonable and did not increase with repeat screening. Screening could contribute to decreasing the cost of CRC care by improving the stage at diagnosis.

 

  • References

  • 1 Ferlay J, Autier P, Boniol M et al. Estimates of the cancer incidence and mortality in Europe 2006. Ann Oncol 2007; 18: 581-592
    CrossrefPubMedGoogle Scholar
  • 2 Grande E, Inghelmann R, Francisci S et al. Regional estimates of colorectal cancer burden in Italy. Tumori 2007; 93: 352-359
    PubMedGoogle Scholar
  • 3 Kronborg O, Fenger C, Olsen J et al. Randomised study of screening for colorectal cancer with faecal-occult-blood test. Lancet 1996; 348: 1467-1471
    CrossrefPubMedGoogle Scholar
  • 4 Hardcastle JD, Chamberlain JO, Robinson MH et al. Randomised controlled trial of faecal-occult-blood screening for colorectal cancer. Lancet 1996; 348: 1472-1477
    CrossrefPubMedGoogle Scholar
  • 5 Mandel JS, Bond JH, Church TR et al. Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study. N Engl J Med 1993; 328: 1365-1371
    CrossrefPubMedGoogle Scholar
  • 6 Kewenter J, Brevinge H, Engaras B et al. Results of screening, rescreening, and follow-up in a prospective randomized study for detection of colorectal cancer by faecal occult blood testing. Results for 68 308 subjects.. Scand J Gastroenterol 1994; 29: 468-473
    CrossrefPubMedGoogle Scholar
  • 7 Zorzi M, Fedato C, Naldoni C et al. Screening for colorectal cancer in Italy: 2007 survey. Epidemiol Prev 2009; 33: 57-74
    PubMedGoogle Scholar
  • 8 Grazzini G, Castiglione G, Ciabattoni C et al. Colorectal cancer screening programme by faecal occult blood test in Tuscany: first round results. Eur J Cancer Prev 2004; 13: 19-26
    CrossrefPubMedGoogle Scholar
  • 9 Parente F, Marino B, De Vecchi N et al. on behalf of the Lecco Colorectal Cancer Screening Group Faecal occult blood test-based screening programme with high compliance for colonoscopy has a strong clinical impact on colorectal cancer. Br J Surg 2009; 96: 533-540
    CrossrefPubMedGoogle Scholar
  • 10 Parente F, Marino B, Ardizzoia A et al. Impact of a population-based colorectal cancer screening program on local health services demand in Italy: a 7-year survey in a Northern province. Am J Gastroenterol 2011; 106: 1986-1993
    CrossrefPubMedGoogle Scholar
  • 11 Castiglione G, Zappa M, Grazzini G. Screening for colorectal cancer by faecal occult blood test: comparison of immunochemical tests. J Med Screen 2000; 7: 35-37
    CrossrefPubMedGoogle Scholar
  • 12 Denis B, Ruetsch M, Strentz P et al. Short term outcomes of the first round of a pilot colorectal cancer screening programme with guaiac based faecal occult blood test. Gut 2007; 56: 1579-1584
    CrossrefPubMedGoogle Scholar
  • 13 Jørgensen OD, Kronborg O, Fenger C. A randomised study of screening for colorectal cancer using faecal occult blood testing: results after 13 years and seven biennial screening rounds. Gut 2002; 50: 29-32
    CrossrefPubMedGoogle Scholar
  • 14 Schlemper RJ, Kato Y, Stolte M. Diagnostic criteria for gastrointestinal carcinomas in Japan and Western countries: proposal for a new classification system of gastrointestinal epithelial neoplasia. J Gastroenterol Hepatol 2000; 15: G49-G57
    CrossrefPubMedGoogle Scholar
  • 15 Sobin LH, Wittekind C eds. TNM classification of malignant tumours (UICC). 6th. edn. New York: Wiley–Liss; 2002
    Google Scholar
  • 16 Atkin WS, Saunders BP. Surveillance guidelines after removal of colorectal adenomatous polyps. Gut 2002; 51: 6-9
    CrossrefPubMedGoogle Scholar
  • 17 Rostom A, Jolicoeur E. Validation of a new scale for the assessment of bowel preparation quality. Gastrointestinal endoscopy 2004; 59: 482-486 http://www.ncbi.nlm.nih.gov/pubmed/15044882
    CrossrefPubMedGoogle Scholar
  • 18 Drummond MF. Principles of economical appraisal in health care. New York: Oxford Medical; 1980
    Google Scholar
  • 19 Grazzini G, Ciatto S, Cislaghi C et al. Cost evaluation in a colorectal cancer screening programme by faecal occult blood test in the District of Florence. J Med Screen 2008; 15: 175-181
    CrossrefPubMedGoogle Scholar
  • 20 Iacono C, Tozzi V, Zagonel V et al. I PDTA ospedalieri per il carcinoma del colon retto. Milano: Economia Sanitaria Editore; 2009
    Google Scholar
  • 21 Clerc L, Jooste V, Lejeune C et al. Cost of care of colorectal cancers according to health care patterns and stage at diagnosis in France. Eur J Health Econ 2008; 9: 361-367
    CrossrefPubMedGoogle Scholar
  • 22 Pignone M, Saha S, Hoerger T et al. Cost-effectiveness analyses of colorectal cancer screening: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med 2002; 137: 96-104
    CrossrefPubMedGoogle Scholar
  • 23 Frazier AL, Colditz GA, Fuchs CS et al. Cost-effectiveness of screening for colorectal cancer in the general population. JAMA 2000; 284: 1954-1961
    CrossrefPubMedGoogle Scholar
  • 24 Inadomi JM. Update on the cost-effectiveness of screening for colorectal neoplasia. Curr Opin Gastroenterol 2003; 19: 44-50
    CrossrefPubMedGoogle Scholar
  • 25 Ramsey SD, Mandelson MT, Berry K et al. Cancer-attributable costs of diagnosis and care for persons with screen-detected versus symptom-detected colorectal cancer. Gastroenterology 2003; 125: 1645-1650
    CrossrefPubMedGoogle Scholar
  • 26 Whynes DK. Cost-effectiveness of screening for colorectal cancer: evidence from the Nottingham faecal occult blood trial. J Med Screen 2004; 11: 11-15
    CrossrefPubMedGoogle Scholar
  • 27 Quintero E, Castells A, Bujanda L et al. Colonoscopy versus fecal immunochemical testing in colorectal-cancer screening. N Engl J Med 2012; 366: 697-706
    CrossrefPubMedGoogle Scholar
  • 28 van Rossum LG, van Rijn AF, Laheij RJ et al. Random comparison of guaiac and immunochemical fecal occult blood tests for colorectal cancer in a screening population. Gastroenterology 2008; 135: 82-90
    CrossrefPubMedGoogle Scholar
  • 29 Zorzi M, Fedato C, Grazzini G et al. High sensitivity of five colorectal screening programmes with faecal immunochemical test in the Veneto Region, Italy. Gut 2011; 60: 944-949
    CrossrefPubMedGoogle Scholar
  • 30 Hewitson P, Glasziou P, Watson E et al. Cochrane systematic review of colorectal cancer screening using the fecal occult blood test (hemoccult): an update. Am J Gastroenterol 2008; 103: 1541-1549
    CrossrefPubMedGoogle Scholar
  • 31 Faivre J, Dancourt V, Lejeune C et al. Reduction in colorectal cancer mortality by fecal occult blood screening in a French controlled study. Gastroenterology 2004; 126: 1674-1680
    CrossrefPubMedGoogle Scholar
  • 32 UK Colorectal Cancer Screening Pilot Group. Results of the first round of a demonstration pilot of screening for colorectal cancer in the United Kingdom. BMJ 2004; 329: 133
    CrossrefPubMedGoogle Scholar
  • 33 Kronborg O, Jorgensen OD, Fenger C et al. Randomized study of biennial screening with faecal occult blood test: results after nine screening rounds. Scand J Gastroenterol 2004; 39: 846-851
    CrossrefPubMedGoogle Scholar
  • 34 Steele RJ, McClements PL, Libby G et al. Results from the first three rounds of the Scottish demonstration pilot of FOBT screening for colorectal cancer. Gut 2009; 58: 530-535
    CrossrefPubMedGoogle Scholar
  • 35 Manfredi S, Piette C, Durand G et al. Colonoscopy results of a French regional FOBT-based colorectal cancer screening program with high compliance. Endoscopy 2008; 40: 422-427
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 36 Lieberman D. Race, gender, and colorectal cancer screening. Am J Gastroenterol 2005; 100: 2756-2758
    CrossrefPubMedGoogle Scholar
  • 37 Crotta S, Segnan N, Paganin S et al. High rate of advanced adenoma detection in 4 rounds of colorectal cancer screening with the fecal immunochemical test. Clin Gastroenterol Hepatol 2012; 10: 633-638
    CrossrefPubMedGoogle Scholar
  • 38 Regula J, Rupinski M, Kraszewska E et al. Colonoscopy in colorectal-cancer screening for detection of advanced neoplasia. N Engl J Med 2006; 355: 1863-1872
    CrossrefPubMedGoogle Scholar
  • 39 Paimela H, Malila N, Palva T et al. Early detection of colorectal cancer with faecal occult blood test screening. Br J Surg 2010; 97: 1567-1571
    CrossrefPubMedGoogle Scholar