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Colorectal cancer screening in a low-incidence area: general invitation versus family risk targeting: a comparative
Nikola Panic1, Thomas Rösch, Brigita Smolovic
1aDepartment for Digestive Endoscopy, University Clinical Hospital Center 'Dr Dragisa Misovic-Dedinje' bFaculty of Medicine, University of Belgrade cClinic for Gastroenterology dClinic for Digestive Surgery, Clinical Center of Serbia, Belgrade, Serbia eDepartment of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany fDepartment of Gastroenterohepatology, Internal Clinic, Clinical Center of Montenegro gMedical Faculty of Podgorica, University of Podgorica, Podgorica hGeneral Hospital 'Danilo I', Cetinje, Montenegro iDepartment of Gastroenterology, University Clinical Hospital 'Santa Maria della Misericordia', Udine, Italy.
Objectives:
Colorectal cancer (CRC) is one of the most common malignancies worldwide. The aim of this study was to compare the outcomes of two different screening approaches in a small country (Montenegro, 650,000 inhabitants) with a CRC incidence lower than the European average.
Methods:
Two structured invitation programs were compared with respect to compliance and neoplasia yield: (i) program A focused on first-degree relatives of CRC patients diagnosed in two hospitals (n=206), inviting them for colonoscopy; (ii) program B was an invitation program for fecal occult blood testing, followed by colonoscopy if positive, conducted in University Hospital, Podgorica, Montenegro, on 2760 randomly selected average-risk persons, age 50-74 years, living in a single municipality.
Results:
Of 710 first-degree relatives of 206 CRC patients approached, 540 presented for colonoscopy (76.05% uptake). Overall, 31 were diagnosed with a cancer, 58 with advanced adenoma, and 151 with adenoma in general. In the general screening program, of 2760 individuals invited, 920 underwent fecal immunochemical test (33.3% uptake) and colonoscopy was performed in all 95 positive cases (10.3%); six cancers was found in five patients (one patient had two cancers), 19 patients were diagnosed with advanced adenoma, and 26 with any adenomas. The risk-targeted screening program had a significantly higher yield for cancers in both per invited (31/710 vs. 5/2760, P<0.001) and per eligible person analysis (31/540 vs. 5/920, P<0.001).
Conclusion:
In a low-incidence country with limited resources, it may be advisable to start with CRC screening targeted to risk groups.