Download PDF
CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(06): E770-E776
DOI: 10.1055/a-1386-2095
Original article

Implementation and results of a gastrointestinal cancer screening program in an Amazon rainforest village: A descriptive study

Pedro Averbach
1   Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
,
Angelo Paulo Ferrari
2   Escola Paulista de Medicina da Universidade Federal de São Paulo, Brazil
,
Cristiana M Toscano
3   Departamento de Saúde Coletiva, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Brazil
,
José Luiz Borges
4   Instituto Sírio-Libanês de Ensino e Pesquisa, São Paulo, Brazil
,
Marcelo Averbach
4   Instituto Sírio-Libanês de Ensino e Pesquisa, São Paulo, Brazil
› Author AffiliationsTo make the project feasible, several partnerships were established with both public and private sectors. The municipal health department of Belterra provided the Municipal Hospital facilities and allowed the team of nurses and community health care agents to collaborate on the project. Fujinon Corporation provided endoscopic equipment, such as endoscopes, image processors, and screens, for every expedition. Hospital Sírio-Libanês, through its teaching and research institute, provided the software and expertise for data collection and analysis and performed histopathological tests of the sample specimens. Boston Scientific Corporation was responsible for all costs related to transport and accommodation of the team, and also provided facilities for endoscopic procedures. Moreover, the company also provided a team of two nurses who were sent to Belterra before every expedition in order to set up the working space for the rest of the team. Further, the project was supported by the Hospital Regional do Baixo Amazonas, a local secondary hospital that received patients who needed additional treatment in case of unexpected complications. The sources of funding had no role in the design, conduct, data analysis, and reporting of this study.
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background and study aims Gastrointestinal cancer is an important cause of death worldwide. Remote populations are especially vulnerable to these conditions due to reduced access to screening and adequate treatment. In this context, the Belterra project was designed as a pilot taskforce to deliver gastrointestinal screening to an underserved Amazonian population and to spread knowledge and practice to local health workers. This study aimed to describe the implementation and present the results of the Belterra Project.

Patients and methods The project took place between October 2014 and December 2017 in Belterra, Pará, Brazil. Public-private partnerships were obtained and were essential for funding. The project required complex logistic solutions to provide gastrointestinal screening to every inhabitant between 50 and 70 years of age, including medical equipment and personal transportation to a remote area. Subjects were asked about their medical history, and received a physical examination, endoscopic examinations, and stool tests.

Results Over the course of 19 expeditions, we screened 2,022 inhabitants of Belterra, aged 50 to 70 years. Five colorectal and six gastric adenocarcinomas were diagnosed, as were several lower-stage lesions. Overall, 26 % of the participants undergoing colonoscopy showed some type of colonic lesion.

Conclusions Notwithstanding the geographical, cultural, and financial barriers, this study suggests that the implementation of a gastrointestinal cancer screening program for remote Brazilian populations is feasible, reaching high adherence. Although logistics is very demanding, such campaigns may be a good strategy to provide mass gastrointestinal cancer screening for underserved populations.



Publication History

Received: 05 June 2020

Accepted: 04 January 2021

Article published online:
27 May 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

Comment to this article:

Endoscopy International Open – recently publishedEndoscopy 2021; 53(07): 769-769
DOI: 10.1055/a-1469-4558

 

  • References

  • 1 Australian Institute of Health and Welfare 2016. Australiaʼs health 2016. Australia’s health series no. 15. Cat. no. AUS 199. AIHW. Canberra: 2016
    PubMedGoogle Scholar
  • 2 Condon JR, Barnes T, Armstrong BK. et al. Stage at diagnosis and cancer survival for Indigenous Australians in the Northern Territory. Med J Aust 2005; 182: 277-280
    CrossrefPubMedGoogle Scholar
  • 3 Hill S, Sarfati D, Blakely T. et al. Survival disparities in Indigenous and non-Indigenous New Zealanders with colon cancer: the role of patient comorbidity, treatment and health service factors. J Epidemiol Community Health 2010; 64: 117-123
    CrossrefPubMedGoogle Scholar
  • 4 Ward P, Javanparast S, Wilson C. Equity of colorectal cancer screening: which groups have inequitable participation and what can we do about it?. Aust J Prim Health 2011; 17: 334-346
    CrossrefPubMedGoogle Scholar
  • 5 Honein-Abouhaidar GN, Baxter NN, Moinedden R. et al. Trends and inequities in colorectal cancer screening participation in Ontario, Canada, 2005-2011. Cancer Epidemiol 2013; 37: 946-956
    CrossrefPubMedGoogle Scholar
  • 6 Kalahdooz F, Jang S, Corriveau A. et al. Knowledge, attitudes, and behaviours towards cancer screening in indigenous populations: a systematic review. Lancet Oncol 2014; 15: e504-16
    CrossrefPubMedGoogle Scholar
  • 7 Wardle J, Von Wagner C, Kalj-Hans L. et al. Effects of evidence-based strategies to reduce the socioeconomic gradient of uptake in the English NHS bowel cancer screening program (ASCEND): four cluster randomized controlled trials. Lancet 2016; 387: 751-759
    CrossrefPubMedGoogle Scholar
  • 8 Andrilla CHA, Moore TE, Man WongK. et al. Investigating the Impact of Geographic Location on Colorectal Cancer Stage at Diagnosis: A National Study of the SEER Cancer Registry. J Rural Health 2020; 36: 316-325 DOI: 10.1111/jrh.12392.
    CrossrefPubMedGoogle Scholar
  • 9 Harris PA, Taylor R, Thielke R. et al. Research electronic data capture (REDCap) - a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42: 377-381
    CrossrefPubMedGoogle Scholar
  • 10 Center for Cancer Control and Information Services – NCC. Cancer statistics in Japan ʼ13. Japan: Foundation for Promotion of Cancer Research; 2013 http://www.ncc.go.jp/en/cis/index.html
    PubMedGoogle Scholar
  • 11 Choi KS, Lee HY, Jun JK. et al. Adherence to follow- up after a positive fecal occult blood test in an organized colorectal cancer screening program in Korea, 2004-2008. J Gastroenterol Hepatol 2012; 27: 1070-1077
    CrossrefPubMedGoogle Scholar
  • 12 Australian Government. Screening monograph no 6/2005. The Australian Bowel Cancer Screening Pilot Program and Beyond: final evaluation report; 2005 http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/content/9C0493AFEB3FD33CCA257D720005C9F2/$File/final-eval.pdf
    PubMedGoogle Scholar
  • 13 Rex DK, Schoenfeld PS, Cohen J. et al. Quality indicators for colonoscopy. Gastrointest Endosc 2015; 81: 31-53
    CrossrefPubMedGoogle Scholar
  • 14 Rastogi A, Early DS, Gupta N. et al. Randomized, controlled trial of standard definition white light, high definition white light, and narrow band imaging colonoscopy for the detection of colon polyps and prediction of polyp histology. Gastrointest Endosc 2011; 74: 593-602
    CrossrefPubMedGoogle Scholar
  • 15 Buchner AM, Shahid MW, Heckman MG. et al. High definition colonoscopy detects colorectal polyps at a higher rate than standard white light colonoscopy. Clin Gastroenterol Hepatol 2010; 8: 364-370
    CrossrefPubMedGoogle Scholar
  • 16 Subramanian V, Mannath J, Hawkey CJ. et al. High definition colonoscopy vs. standard video endoscopy for the detection of colonic polyps: A meta analysis. Endoscopy 2011; 43: 499-505
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Moriyama T, Uraoka T, Esaki M. et al. Advanced technology for the improvement of adenoma and polyp detection during colonoscopy. Dig Endosc 2015; 27: 40-44
    CrossrefPubMedGoogle Scholar
  • 18 Tziatzios G, Gkolfakis P, Lazaridis LD. et al. High-definition colonoscopy for improving adenoma detection: a systematic review and meta-analysis of randomized controlled studies. Gastrointest Endosc 2020; 91: 1027-1036.e9 DOI: 10.1016/j.gie.2019.12.052.
    CrossrefPubMedGoogle Scholar
  • 19 Siripongpreeda B, Mahidol C, Dusitanond N. et al. High prevalence of advanced colorectal neoplasia in the Thai population: a prospective screening colonoscopy of 1,404 cases. BMC Gastroenterol 2016; 16: 101
    CrossrefPubMedGoogle Scholar
  • 20 Burón A, Grau J, Andreu M. et al. Colorectal Cancer Early Screening Program of Barcelona, Spain: Indicators of the first round of a program with participation of community pharmacies. Med Clin Barc 2015; 145: 141-146
    CrossrefPubMedGoogle Scholar
  • 21 Aniwan S, Ratanachu EkT, Pongprasobchai S. et al. The optimal cut-off level of the fecal immunochemical test for colorectal cancer screening in a country with limited colonoscopy resources: a multi-center study from Thailand. Asian Pac J Cancer Prev 2017; 18: 405-412
    PubMedGoogle Scholar
  • 22 Navarro M, Nicolas A, Ferrandez A. et al. Colorectal cancer population screening programs worldwide in 2016: An update. World J Gastroenterol 2017; 23: 3632-3642
    CrossrefPubMedGoogle Scholar
  • 23 Liao Y, Li S, Chen C. et al. Screening for colorectal cancer in Tianhe, Guangzhou: results of combining fecal immunochemical tests and risk factors for selecting patients requiring colonoscopy. Gastroenterol Rep (Oxf) 2018; 6: 132-136
    CrossrefPubMedGoogle Scholar
  • 24 Lairson DR, Kim J, Byrd T. et al. Cost-effectiveness of community interventions for colorectal cancer screening: low-income Hispanic population. Health Promot Pract 2018; 19: 863-872
    CrossrefPubMedGoogle Scholar
  • 25 Rim JH, Youk T, Kang JG. et al. Fecal occult blood test results of the national colorectal cancer screening program in South Korea (2006–2013). Sci Rep 2017; 7: 2804
    CrossrefPubMedGoogle Scholar
  • 26 Katii M, Antoljak N, Kujundži M. et al. Results of National Colorectal Cancer Screening Program in Croatia (2007-2011). World J Gastroenterol 2012; 18: 4300-4307
    CrossrefPubMedGoogle Scholar
  • 27 Malila N, Palva T, Malminiemi O. et al. Coverage and performance of colorectal cancer screening with the faecal occult blood test in Finland. J Med Screen 2011; 18: 18-23
    CrossrefPubMedGoogle Scholar
  • 28 Rabeneck L, Tinmouth JM, Paszat LF. et al. Ontario's ColonCancerCheck: results from canadaʼs first province-wide colorectal cancer screening program. Cancer Epidemiol Biomarkers Prev 2014; 23: 508-515
    CrossrefPubMedGoogle Scholar
  • 29 Llorens P. Gastric cancer mass survey in Chile. Semin Surg Oncol 1991; 7: 339-343
    CrossrefPubMedGoogle Scholar
  • 30 Pisani P, Oliver WE, Parkin DM. et al. Case-control study of gastric cancer screening in Venezuela. Br J Cancer 1994; 69: 1102-1105
    CrossrefPubMedGoogle Scholar
  • 31 Mizoue T, Yoshimura T, Tokui N. et al. Prospective study of screening for stomach cancer in Japan. Int J Cancer 2003; 106: 103-107
    CrossrefPubMedGoogle Scholar