Impact of the Implementation of the Dutch National fit-based CRC Screening Program on Incidence and Characteristics of Screen-Detected CRCS

Aims Since 2014, a population-based colorectal cancer (CRC) screening program was stepwise implemented in the Netherlands, using biennial fecal immunochemical testing (FIT). As of 2019, the program was fully implemented, inviting all individuals aged between 55-75 years. This study assessed the impact of the implementation of a national FIT-based CRC screening program on different outcomes of CRC.

Methods We collected CRC incidence data from the Netherlands Cancer Registry (NCR) from 2010-2019. Patients with CRC diagnosis from 2014-2018 in the NCR were linked with the Dutch nationwide registry of histo- and cytopathology (PALGA) to identify mode of detection (i.e. screen-detected vs. clinically detected). We compared localization, stage distribution, and treatment of screen-detected CRCs to clinically detected CRCs in patients aged 55-75 years from 2014-2018.

Results Prior to introduction of screening, CRC incidence was 215.5 per 100,000 persons in 2013. With the introduction of screening, CRC incidence first increased to 260.2 in 2015, and subsequently decreased to 180.4 per 100,000 persons in 2019. Incidence rate for advanced CRCs (stage III and IV) was 117.7 in 2013 and increased to 123.4 per 100,000 persons in 2015. Hereafter, it decreased to 95.7 per 100,000 persons in 2018. Compared to clinically detected CRCs, screen-detected CRCs were more often located left-sided (44.4 % vs. 32.4 %) and detected in stage I or II (68.0 % vs. 47.1 %, Table 1). Local excision was performed in 17.3 % of screen-detected colon cancers, compared to 5.0 % of clinically detected colon cancers. For rectal cancers, this was 22.7 % vs. 9.5 %.

	Total	Screen-detected CRCs n (%)	Clinically detected CRCs n (%)	p value
Stage I	14,069	6,501 (48.3)	7,568 (23.7)
Stage II	10,135	2,660 (19.7)	7,475 (23.4)
Stage III	13,418	3,587 (26.6)	9,831 (30.7)
Stage IV	7,809	723 (5.4)	7,086 (22.2)	< 0.001

Conclusions After implementation of the Dutch national FIT-based screening program, CRC incidence decreased below the level before implementing the program. Also, incidence rate of advanced-stage CRCs decreased. Together with the observed shift in staging and treatment of screen-detected CRCs, we may carefully conclude that, on the long-term, FIT-screening will lead to a decrease in CRC-related morbidity and mortality.

Citation: Breekveldt ECH, Lansdorp-Vogelaar I, Toes-Zoutendijk E et al. OP35IMPACT OF THE IMPLEMENTATION OF THE DUTCH NATIONAL FIT-BASED CRC SCREENING PROGRAM ON INCIDENCE AND CHARACTERISTICS OF SCREEN-DETECTED CRCS. Endoscopy 2021; 53: S17.

Publication History

Article published online:
19 March 2021