Assessing the Feasibility of Community-Based Colorectal Cancer Screening in Pune, India

The colorectal cancer rates in India are lower than in other Southeast Asian countries, but there is an increasing trend in incidence as well as mortality. We are reporting the results of a large community-based colorectal cancer screening project implemented through a house-to-house survey. Consenting men and women of ages 50 to 75 years were informed about the purpose of the study and the benefits of colorectal cancer screening. They were educated on how to collect stool sample for occult blood test in a sample collection tube. Health visitors collected the stool sample from the study participants on the next day. Samples were tested with CANCHECK-FOBT, which is Conformite Europeenne-approved and is a rapid, qualitative, two-site sandwich immunoassay for the detection of immunochemical fecal occult blood (iFOB) concentration in human feces. Participants with a positive iFOB test (iFOBT) result underwent colonoscopy as an outpatient procedure at the gastroenterologist's clinic. A total of 5,003 participants provided consent, and 4,352 (86.98%) provided the stool sample. iFOBT was positive among 70/4,352 (1.61%) participants, of whom 31 (44.92%) completed the colonoscopy procedure. Five participants were diagnosed with adenomatous polyps, and one participant had colorectal cancer. The detection rate of histologically confirmed colorectal cancer was 0.23 and that of adenomatous polyp was 1.15 per 1,000 screened persons. Although the screen positivity and adenomatous polyps and colorectal cancer detection rates in our study are much lower than the in neighboring Southeast Asian countries, these findings highlight the importance of investing in preventive healthcare in India.

This is the first community-based colorectal cancer screening study from India that suggests the feasibility of colorectal cancer screening. There is an urgent need for investment in prevention of common cancers in the Indian population.