Population based Colorectal Cancer Screening; preliminary results from Győr

Background and aim: Colorectal cancer (CRC) mass screening programs have been settled and organized worldwide since a couple of decades. Evidence based data indicate that either faecal occult blood test (FOBT) based CRC screening protocols or screening with primary colonoscopy may decrease the CRC incidence and the mortality as well. In Hungary since June 2013 population based pilot CRC screening activities have been initiated by the National Public Health Service (NPHS) in three voluntary joined counties, including Győr-Moson-Sopron County. The aim of our interim analysis was to evaluate the methodology and preliminary results of the still ongoing screening activity in our region. Methods: According to the screening campaign iFOBT packages were distributed by the local NPHS offices to those 31 general practitioners (GP) who voluntary joined the program. During a 20 months period a total of 4278 iFOBTs were transferred by GP-s to 50 – 70 year old individuals irrespectively co-morbidities. Patients with non-negative iFOBT results were referred to our gastroenterology unit for a start-up consultations. Results: During the 20 months period 265 patients visited our outpatient clinic with positive iFOBT test. The total of 251 colonoscopy was performed with a 84% coecum intubation rate. As many as 104 patients (41%) had significant comorbidity like ischaemic heart disease, hepatic cirrhosis, ongoing anticoagulant or anti-PLT aggregation medication or malignant disease in the patient history. With colonoscopy a total of 578 colorectal polyps and 9 invasive cancers were detected in 194 patients resulting a 77.2% specificity of iFOBT. Adenoma detection rate was 42.6% (107/251) and in 17 patients traditional serrated adenoma (TSA) while in 22 patients high grade dysplasias (HGD) were detected by histology. Among all polyps found 19.3% (122/578) proved to have hyperplastic histology. Out of all adenomas 19.4% (68/349) were located in the right colon and the polyp sizes ranged as 0 – 5 mm:40.6%, 5 – 10 mm:32.5% and > 10 mm: 26.9%. Conclusion: Our interim analysis data show that supposing specially organized human and technical efforts iFOBT based population CRC screening programs might be as effective in Hungary as in the developed health care countries.