A National Bowel Cancer Screening Programme using FIT: Achievements and challenges.

A National Bowel Cancer Screening Programme using FIT: Achievements and challenges.

Cancer Prev Res (Phila). 2018 Dec 04;:

Authors: O'Donoghue DP, Sheahan K, MacMathuna P, Stephens RB, Fenlon H, Morrin M, Mooney J, Fahy L, Mooney T, Smith A

Abstract
Colorectal Cancer (CRC) accounts for 11% of all cancer deaths in Ireland. With the aim of diagnosing these cancers at an earlier stage, and detecting pre-malignant lesions, the National Screening Service offered a Faecal Immunochemical Test (FIT) to all individuals aged 60-69. All individuals in the age range were contacted by post and invited to participate in the programme. Those with a positive FIT result were offered a colonoscopy in an internationally accredited unit. From an eligible population of 488,628, 196,238 individuals participated giving an uptake of 40.2%. Commencing at a FIT threshold of 20µg Hg/g faeces, the positivity rate was 8.6% which overwhelmed colonoscopy capacity and thus the threshold was increased to 45µg resulting in an overall 5% positivity rate. 520 individuals had cancer detected, (68.3% stage I or II) of which 104 were removed endoscopically (pT1s). Adenomas were present in 54.2% of all colonoscopies, 17.4% deemed high risk. Despite a lower uptake, males were twice as likely to have CRCs as females and had a 59% increased rate of high risk adenomas diagnosed. Challenges facing the programme include increasing participation, especially amongst males, and increasing colonoscopy capacity. The ability to alter the sensitivity of FIT to match colonoscopy capacity is a valuable option for such a programme as it ensures that the maximum public health benefit can be achieved within available resources.

PMID: 30514807 [PubMed - as supplied by publisher]

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