Design of the Polish Colonoscopy Screening Program: a randomized health services study

Area of Science:

• Public Health
• Gastroenterology
• Health Services Research

Background:

• Colonoscopy screening for colorectal cancer lacks randomized controlled trial (RCT) evidence on its benefits.
• Opportunistic screening programs, common in implementation, deviate from European Union guideline recommendations.
• Poland initiated a population-based colonoscopy screening program (PCSP) in 2012.

Purpose of the Study:

• To describe the rationale and design of Poland's first population-based colonoscopy screening program (PCSP).
• To establish a randomized health services (RHS) study framework for evaluating screening effectiveness.
• To compare different screening ages, invitation strategies, and quality interventions within the PCSP.

Main Methods:

• The PCSP builds upon existing opportunistic screening infrastructure, including 92 centers and a quality assurance program.
• A randomized health services (RHS) design is employed, randomly assigning eligible individuals (aged 55-64) to immediate or postponed screening invitations.
• A control group ('never invited') is included for specific birth cohorts to establish a baseline for comparison.

Main Results:

• As of 2015, the PCSP covered 34.2% of the country with 24 developed centers.
• Over 851,535 individuals were enrolled in the program by 2015.
• The RHS design allows for robust evaluation of screening effectiveness and optimization of program parameters.

Conclusions:

• The Polish PCSP serves as a model for implementing population-based colonoscopy screening.
• The integrated experimental (RHS) design ensures rigorous evaluation of screening effectiveness.
• This approach addresses the need for evidence-based population-wide cancer screening programs.