An adapted program of colorectal cancer screening--7 years experience and cost-benefit analysis

The Czech program of colorectal cancer screening differs from most foreign programs in a number of points. The age interval of screened population was limited to 45 to 60 years. Screening was multicentric, with one reference center. More than 95% of the subjects screened were asymptomatic employees of various factories, boards and institutions. Total colonoscopy was the primary procedure in all Haemoccult-positive subjects. Some 109,213 subjects received 3 Haemoccult slides. Compliance was 83.1%, and Haemoccult was positive in 2.92% of the subjects. The diagnostic program revealed 347 (13.1%) cancers, 763 adenomas in 592 (22.2%) subjects, and other bleeding conditions in 1043 (39.2%) persons. Dukes A or B colorectal cancer was found in two-thirds of the screened subjects and in only one-third of non-screened symptomatic patients. Average diagnostic and therapeutic costs were almost the same in both groups. Gross national product savings realized by one asymptomatic subject were 315,540 Czechoslovak Crowns (approximately 18,560 US-dollars at the 1989 exchange rates). The adapted program was found to be effective, and its use in a population with a high incidence of colorectal neoplasia deserves consideration.