Colorectal Cancer Screening Pilot Project in Tehran-Iran, a Feasibility Study

Area of Science:

• Oncology
• Public Health
• Gastroenterology

Background:

• Colorectal cancer (CRC) is a significant health concern in Iran, ranking as the third most common cancer.
• Currently, Iran lacks an organized national CRC screening program.
• This study addresses the need for effective CRC screening strategies in the Iranian population.

Purpose of the Study:

• To evaluate the feasibility of implementing a qualitative fecal immunochemical test (FIT) for CRC screening.
• To assess screening outcomes among average-risk adults in Iran.
• To determine the potential for integrating FIT screening into the existing healthcare infrastructure.

Main Methods:

• A feasibility study involving 7039 individuals aged 50-75 years in southern Tehran.
• Community health workers (CHWs) administered qualitative FIT tests with a 50 ng Hb/mL cutoff.
• FIT-positive individuals were referred for colonoscopy to assess detection rates and positive predictive values (PPVs).

Main Results:

• An initial invitation acceptance rate of 71.7% was observed.
• Among 4813 valid FIT samples, 9.8% tested positive.
• Colonoscopy in FIT-positive individuals revealed CRC in 2.0% and adenomas in 27.3%.

Conclusions:

• The study partially supports the feasibility of organized CRC screening using FIT in Iran.
• The existing healthcare system's capacity for colonoscopy services requires careful consideration for scalability.
• Further discussion is needed to ensure adequate colonoscopy resources for a national screening program.