UEG Week Virtual 2020 Congress Review - 14

UEG Week Congress Review

Scientific Programme Highlights
CRC screening programmes produce
downward trends in incidence and
mortality

Offering FIT alongside colonoscopy
improves participation in CRC
screening

European countries quick to introduce large-scale CRC screening
programmes are now seeing downward trends in CRC incidence
and mortality, suggesting good progress has already been made
in the early detection and prevention of new cases. Researchers
from the German Cancer Research Center used data (CRC cases
diagnosed between 2000 and 2016 or up to the most recent year
with available data) from population-based cancer registries
in 20 European countries to analyse and compare trends in
CRC incidence, mortality, and stage distribution in relation
to screening programmes implemented in those countries.
Data were compared between countries with earlier screening
implementation (e.g. Czech Republic and Germany), those with
later screening implementation (e.g. Netherlands, Slovenia), and
those with no large-scale screening programmes in place (e.g.
Estonia, Norway) during the study period.

A large health services study conducted in Poland has
reported that offering faecal immunochemical testing (FIT)
alongside colonoscopy significantly improves participation
in colonoscopy-based CRC screening programmes. The
study, which was conducted within the framework of the
Polish Colonoscopy Screening Program, randomized 12,485
screening-naïve individuals aged 55-64 years to one of three
screening strategies: current practice (control) involving a
postal invitation for colonoscopy, with a second invitation
posted 6 weeks later in non-responders; a sequential strategy
in which a postal invitation for colonoscopy was followed
6 weeks later in non-responders by a postal invitation to
undergo FIT, or a choice strategy in which a postal invitation
for either FIT or colonoscopy was followed 6 weeks later by
a postal invitation offering the same options. The primary
endpoint of the study was participation in CRC screening
within 18 weeks of enrolment, defined as completion of
colonoscopy or FIT, with subsequent colonoscopy in FITpositive cases.

According to Rafael Cardoso, who presented the team's study
results, in the Czech Republic and Germany, age-standardised CRC
incidence decreased substantially in both men and women after
screening implementation, with an average annual percentage
change (AAPC) of -1.6 (Czech Republic) and -1.8 (Germany) in men
and -1.3% (Czech Republic) and -2.2% (Germany) in women. In the
Netherlands and Slovenia, small increases in CRC incidence were
observed in the 1-2 years after screening was introduced, followed
by notable decreases in AAPC of up to -0.5%. In contrast, in Estonia
and Norway, CRC incidence increased steadily over time (AAPC
in men, +1.1% in Estonia and +0.3 in Norway; in women, +1.0 in
Estonia and +0.6 in Norway).
"As for mortality, although decreases were seen for almost all
countries apart from Estonia, the largest decreases were seen
for countries with earlier screening implementation - the Czech
Republic and Germany - where decreases were two- to three-times
larger than for many other countries," said Rafael Cordoso.
"Our results should encourage countries with screening in place
to maintain and further advance CRC screening efforts," he
noted. "The limited lack of progress that we found for countries
with no screening programmes in place strongly calls for their
implementation."

A significant improvement in participation rates were
observed in both the sequential and choice strategy groups
(25.8% and 26.5%, respectively) compared with the control
group (17.5%; p<0.001 for both comparisons). Multivariable
analysis found that individuals in the sequential strategy
group were 64% more likely to participate in screening
than individuals in the control group (hazard ratio [HR]
1.64; 95% confidence interval [CI] 1.47-1.83); those in the
choice strategy group were 70% more likely to participate in
screening than the control group (HR 1.70; 95% CI 1.53-1.90).
Advanced neoplasia was detected in ~1% of patients in each
screening group.
"Combining FIT and colonoscopy resulted in 60-70% higher
participation rates relative to offering primary colonoscopy
alone," said Nastazja Pilonis from the Maria SklodowskaCurie National Research Institute of Oncology in Warsaw,
Poland, who presented the study findings. "Introducing FIT
resulted in [an] 8-10% increase of participation."

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UEG Week Virtual 2020 Congress Review

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