4.1 Article

Impact of an organised population screening programme for colorectal cancer: Measurement after first and second rounds

Journal

JOURNAL OF MEDICAL SCREENING
Volume 28, Issue 2, Pages 122-130

Publisher

SAGE PUBLICATIONS LTD
DOI: 10.1177/0969141320921893

Keywords

Colorectal cancer; survival; relative survival; stage; screening; incidence; evaluation

Funding

  1. EITB Telemarathon [BIO15/CA/013/BD]

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The study on the Basque programme for organised colorectal cancer screening showed that screening can decrease incidence, advance diagnosis, reduce mortality, and significantly increase five-year relative survival rate in patients younger than 70 years old.
Objective The first and second rounds of the Basque programme for organised colorectal cancer screening were implemented between 2009 and 2014. Our objective was to measure the changes in incidence, tumour, node, metastasis staging distribution and tumour, node, metastasis-adjusted survival of patients with colorectal cancer from 2003 to 2014. Method Colorectal cancer cases with screening (patients <70 years old) and without screening (patients >= 70 years old) were compared during three four-year periods: 2003-2006, 2007-2010 and 2011-2014 (fully implemented phase). Cox regression, five-year relative survival and cancer probability of death were calculated for each four-year period, age group and tumour, node, metastasis stage. Adjusted incidence rates were analysed by joinpoint regression. Results In an analysis of 23,301 cases of colorectal cancer, the incidence in patients younger than 70 years in 2013 showed a 17% annual decrease. The survival hazard ratios for stages I, II and III for 2003-2006 and 2007-2010 were compared to those for 2011-2014. From the first to the third period, diagnosis in the early stages (I and II) rose from 45.1% to 50.9% in the younger patient group and remained stable in the older group (49.6% and 49.4%). Additionally, the five-year relative survival rate increased significantly from 0.67 to 0.82 in those patients younger than 70 years, whereas in patients 70 years or older the rate did not change significantly (0.61 and 0.65). Conclusion The screening reduced incidence and improved survival by anticipating the diagnosis and by reducing mortality for each tumour, node, metastasis stage in the target population. The effect on survival could also be due to lead-time bias.

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