Colonoscopy results of a French regional FOBT-based colorectal cancer screening program with high compliance

Background and study aims: Mass screening for colorectal cancer in France was initiated in pilot regions on the basis of the fecal occult blood test (FOBT) followed by colonoscopy in positive cases. We report the colonoscopy results in one of the first areas to be screened (Ille et Vilaine). Patients and methods: Of the total regional population of 908 449, 187 342 of the 213 635 potential screening candidates who were aged 50 - 74 years were invited for FOBT. Of the 51.3 % compliant individuals, 2.6 % were positive, and of these 90.7 % agreed to undergo colonoscopy (n = 2246). The colonoscopy procedure details, findings, and complications were recorded. Subjects were classified according to the most advanced lesion. Positive predictive values of FOBT were calculated according to sex and age. Results: Colonoscopy was complete in 96.3 % of cases. Only 23 adverse events were encountered (1.02 %). Colorectal cancer was diagnosed in 237 cases (10.6 %, 78.4 % of which were clinical stages I - II). The rates of overall adenomas and advanced adenomas were 33.1 % and 21.6 %, respectively. The risk of cancer and advanced adenoma increased significantly in men and in older people. Conclusion: The results of mass screening with FOBT followed by colonoscopy in this population-based study are very encouraging in terms of compliance, early findings, and complications. Extension of this program to the whole of France is justified.

References

• 1 Remontet L, Esteve J, Bouvier A M. et al . Cancer incidence and mortality in France over the period 1978 - 2000.  Rev Epidemiol Sante Publique. 2003;  51 3-30
• 2 Scholefield J H, Moss S, Sufi F. et al . Effect of faecal occult blood screening on mortality from colorectal cancer: results from a randomised controlled trial.  Gut. 2002;  50 840-844
• 3 Mandel J S, Bond J H, Church T R. et al . Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study.  N Engl J Med. 1993;  328 1365-1371. Erratum in: N Engl J Med 1993; 329 : 672
• 4 Mandel J S, Church T R, Ederer F, Bond J H. Colorectal cancer mortality: effectiveness of biennial screening for fecal occult blood.  J Natl Cancer Inst. 1999;  91 434-437
• 5 Jørgensen O, Kronborg O, Fenger C. A randomised study of screening for colorectal cancer using faecal occult blood testing: results after 13 years and seven biennial screening rounds.  Gut. 2002;  50 29-32
• 6 Faivre J, Dancourt V, Lejeune C. et al . Reduction in colorectal cancer mortality by fecal occult blood screening in a French controlled study.  Gastroenterology. 2004;  126 1674-1680
• 7 Sobin L H, Fleming I D. TNM Prognostic Factors Project. TNM Classification of Malignant Tumors, fifth edition. Union Internationale Contre le Cancer and the American Joint Committee on Cancer 1997: 1803-1804
• 8 Tazi M A. Conférence de consensus. Prévention, dépistage et prise en charge des cancers du côlon.  Gastroenterol Clin Biol. 1998;  22 S218-225
• 9 Towler B, Irwig L, Glasziou P. et al . A systematic review of the effects of screening for colorectal cancer using the faecal occult blood test, Hemoccult.  BMJ. 1998;  317 559-565
• 10 UK Colorectal Cancer Screening Pilot Group . Results of the first round of a demonstration pilot of screening for colorectal cancer in the United Kingdom.  BMJ. 2004;  329 133
• 11 Manfredi S, Clappier P, Mallard G. et al . Study of reasons for non compliance with faecal occult blood testing (FOBT) in the setting of colorectal cancer mass screening.  Endoscopy. 2006;  38 A187
• 12 Keighley M R, O’Morain C, Giacosa A. et al . Public awareness of risk factors and screening for colorectal cancer in Europe.  Eur J Cancer Prev. 2004;  13 257-262
• 13 Steinmetz J, Spyckerelle Y, Gueguen R, Dupre C. Colorectal cancer screening in Health Examination Centers.  Gastroenterol Clin Biol. 2006;  30 832-837
• 14 Kronborg O, Jørgensen O, Fenger C, Rasmussen M. Randomized study of biennial screening with a faecal occult blood test: results after nine screening rounds.  Scand J Gastroenterol. 2004;  39 846-851
• 15 Lieberman D A, Weiss D G, Bond J H. et al . Use of colonoscopy to screen asymptomatic adults for colorectal cancer. Veterans Affairs Cooperative Study Group 380.  N Engl J Med. 2000;  343 162-168
• 16 Schoenfeld P, Cash B, Flood A. et al . Colonoscopic screening of average-risk women for colorectal neoplasia.  N Engl J Med. 2005;  352 2061-2068
• 17 Regula J, Rupinski M, Kraszewska E. et al . Colonoscopy in colorectal-cancer screening for detection of advanced neoplasia.  N Engl J Med. 2006;  355 1863-1872
• 18 Bond J H. The place of fecal occult blood test in colorectal cancer screening in 2006: the US perspective.  Am J Gastroenterol. 2006;  101 219-221
• 19 Imperiale T F, Wagner D R, Lin C Y. et al . Risk of advanced proximal neoplasms in asymptomatic adults according to the distal colorectal findings.  New Engl J Med. 2000;  343 169-174
• 20 Betes M, Munoz-Navas M A, Duque J M. et al . Use of colonoscopy as a primary screening test for colorectal cancer in average risk people.  Am J Gastroenterol. 2003;  98 2648-2654
• 21 Strul H, Kariv R, Leshno M. et al . The prevalence rate and anatomic location of colorectal adenoma and cancer detected by colonoscopy in average-risk individuals aged 40-80 years.  Am J Gastroenterol. 2006;  101 255-262
• 22 Chiu H M, Wang H P, Lee Y C. et al . A prospective study of the frequency and the topographical distribution of colon neoplasia in asymptomatic average-risk Chinese adults as determined by colonoscopic screening.  Gastrointest Endosc. 2005;  61 547-553
• 23 Sant M, Aareleid T, Berrino F. et al . EUROCARE-3: survival of cancer patients diagnosed 1990-94 - results and commentary. EUROCARE Working Group.  Ann Oncol. 2003;  14 V61-V118
• 24 Read T E, Mutch M G, Chang B W. et al . Locoregional recurrence and survival after curative resection of adenocarcinoma of the colon.  J Am Coll Surg. 2002;  195 33-40
• 25 Manfredi S, Bouvier A, Lepage C. et al . Incidence and patterns of recurrence after resection for cure of colonic cancer in a well defined population.  Br J Surg. 2006;  93 1115-1122
• 26 Manfredi S, Benhamiche A M, Meny B. et al . Population-based study of factors influencing occurrence and prognosis of local recurrence after surgery for rectal cancer.  Br J Surg. 2001;  88 1221-1227
• 27 Mandel J S, Church T R, Bond J H. et al . The effect of fecal occult-blood screening on the incidence of colorectal cancer.  N Engl J Med. 2000;  343 1603-1607
• 28 Imperiale T F, Ransohoff D F, Itzkowitz S T. et al . Fecal DNA versus fecal occult blood for colorectal-cancer screening in an average-risk population.  N Engl J Med. 2004;  351 2704-2714
• 29 Imperiale T F, Wagner D R, Lin C Y. et al . Results of screening colonoscopy among persons 40 to 49 years of age.  N Engl J Med. 2002;  346 1781-1785