Screening for colorectal neoplasia in the Tel Aviv area: cumulative data 1979-89 and initial conclusions

We present an analysis comprising the initial 10 years experience with a screening program for colorectal neoplasia in the Tel Aviv area that involved 5,625 screenees. It demonstrated that selective screening, based on pre-established epidemiologic criteria and selective screening methodology, resulted in a colorectal neoplasia yield that related directly to the screenee's risk of neoplasia. We have no evidence that the program is life-saving or cost-effective. Medically, however, it yielded early-stage neoplasms that were mainly adenomas, and most cancers were early-stage and noninvasive. Among the screenees 1% had cancer, of which 2/3 were Duke's A or B; 10% had adenomas and 7.3% of these (0.7% of all screenees) had severe dysplasia. Removal of these adenomas has been shown to reduce large bowel cancer incidence. Presently we cannot generally recommend mass screening by the available screening tests, fecal occult blood and endoscopy. However, an outreach case-finding program, based on existing health services, is possible and medically rewarding especially in groups at high risk for neoplasia.