This document discusses the colorectal cancer screening program in the Basque Country. It achieved a high participation rate of 43% through measures like home delivery of screening kits, collection at health centers, and results communication to physicians and homes. The screening found premalignant and malignant lesions in 9.4% of participants. Colonoscopies on positive screens detected cancer in 3.9 per 1,000 and had a low complication rate of 1.09%. The screening program was found to be cost-effective.

1. Design of implementation measures are extremely
important to increase the participation rates and success of
a population-based screening program
Eunate Arana-Arria, Begoña Zuberoa, Isabel Portillob,
Isabel Idigorasb, José Ignacio Pijoana
Clinical Epidemiology Unit, Cruces University Hospital, Basque Health Service
a
Center Program Coordinator Colorectal Cancer Screening, Basque Health Service
b

2. CLORECTAL CANCER (CCR)
• Worldwide:
– Third most common cancer
– Fourth most common cause of cancer deaths
– 1.2 million estimated cases and 609,000 estimated deaths in 2008
• European Union (EU)
– Second most common newly-diagnosed cancer
– Second most common cause of cancer death
• Basque Country
– First cause of mortality
– Second cancer after:
 Breast
 Lung
• Mortality rates for the Basque Country (2006)
– 32.2/100,000 in men and 13.1/100,000 in women
(Rates adjusted to European Standard Population)
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3. COLORECTAL CANCER SCREENING
• European Code Against Cancer
“men and women aged 50 years or over
should participate in colorectal cancer screening”
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4. PREVENTION / SCREENING
The aim of colorectal cancer screening is to
improve prognosis by the detection of cancer
at its early stages
• PREVENTION:
– no smoking
– avoiding obesity
– doing regular physical exercise
– increasing the daily intake of fruits and vegetables
– limiting the consumption of foods containing animal fats
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5. CRC SCREENING PROGRAM
OF THE BASQUE COUNTRY
• Target population:
50-69 years (EU 2003 50 to 74)
• Fecal Occult Blood Test (FOBT):
– Every two years
– Cut-off 100 ng/ml
– Home delivery test
– Pick up at the health center
– Reference laboratory analysis
• FOBT POSITIVE:
Complete colonoscopy with deep sedation/anesthesia
• Coordinated Program
• Engaging Primary Care and Specialty Care
• Information System
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6. CCR SCREENING PROGRAM: 2009-2010
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7. PARTICIPATION RATES / POSITIVES
N= 28,300
N= 28,300 N= 11,266
N= 11,266 N= 116,980
N= 116,980
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8. Population-based
43%
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9. PARTICIPATION AND POSITIVE RATES
By age group: males
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10. PARTICIPATION AND POSITIVE RATES
By age group: females
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11. Diagnostic confirmation: 4,492 colonoscopies
INDICATORS Results
Complete Colonoscopy Rate 90.8% (95% CI 90.0-91.6)
Low Grade Adenoma Detection Rate 9.9 x 1,000 (95% CI 9.2-10.6)
High Grade Adenoma Detection Rate 26.6 x 1,000 (95% CI 25.4-27.8)
Invasive Cancer Detection Rate 3.9 x 1,000 (95% CI 3.5-4.4)
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12. Diagnostic confirmation: result of colonoscopies
48%
%
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13. Complications of colonoscopies
INDICATORS Results
Complications rate 1.09% (95% IC 0.8-1.4)
Complications rate in the first
1.02% (95% IC 0.7-1.4)
colonoscopy
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14. COSTS
• Cancer detected:
7,324.38
• Premalignant and/or malignant lesion:
941.75
• Screened person:
28.71
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15. CONCLUSIONS
• REASONS FOR HIGH PARTICIPATION
RATES:
– Involvement of primary care physicians and nurses
– Submission of the kits to patients homes
– Delivery of the kits at the primary care settings with
open schedule
– Analysis of the sample in the reference hospital without
any frills or papers
– Results to primary care physicians and patients homes
– Public and universal health care system
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16. ‫תודה‬
धनयवाद
спасибо Eskerrik
Asko
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