Colorectal and interval cancers of the Colorectal Cancer Screening Program in the Basque Country (Spain)

Isabel Portillo, Eunate Arana-Arri, Isabel Idigoras, Isabel Bilbao, Lorea Martínez-Indart, Luis Bujanda, Iñaki Gutierrez-Ibarluzea, Isabel Portillo, Eunate Arana-Arri, Isabel Idigoras, Isabel Bilbao, Lorea Martínez-Indart, Luis Bujanda, Iñaki Gutierrez-Ibarluzea

Abstract

Aim: To assess proportions, related conditions and survival of interval cancer (IC).

Methods: The programme has a linkage with different clinical databases and cancer registers to allow suitable evaluation. This evaluation involves the detection of ICs after a negative faecal inmunochemical test (FIT), interval cancer FIT (IC-FIT) prior to a subsequent invitation, and the detection of ICs after a positive FIT and confirmatory diagnosis without colorectal cancer (CRC) detected and before the following recommended colonoscopy, IC-colonoscopy. We conducted a retrospective observational study analyzing from January 2009 to December 2015 1193602 invited people onto the Programme (participation rate of 68.6%).

Results: Two thousand five hundred and eighteen cancers were diagnosed through the programme, 18 cases of IC-colonoscopy were found before the recommended follow-up (43542 colonoscopies performed) and 186 IC-FIT were identified before the following invitation of the 769200 negative FITs. There was no statistically significant relation between the predictor variables of ICs with sex, age and deprivation index, but there was relation between location and stage. Additionally, it was observed that there was less risk when the location was distal rather than proximal (OR = 0.28, 95%CI: 0.20-0.40, P < 0.0001), with no statistical significance when the location was in the rectum as opposed to proximal. When comparing the screen-detected cancers (SCs) with ICs, significant differences in survival were found (P < 0.001); being the 5-years survival for SCs 91.6% and IC-FIT 77.8%.

Conclusion: These findings in a Population Based CRC Screening Programme indicate the need of population-based studies that continue analyzing related factors to improve their detection and reducing harm.

Keywords: Colonoscopy; Colorectal cancer; Diagnosis; Faecal immunochemical test; Interval cancer; Mortality; Population Screening Programme; Survival.

Conflict of interest statement

Conflict-of-interest statement: No conflicts of interest.

Figures

Figure 1
Figure 1
Distribution of colorectal cancer stages by location and type.
Figure 2
Figure 2
Kaplan-Meyer survival curve by different colorectal cancer types.

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