Performance of colorectal cancer screening in the European Union Member States: data from the second European screening report

• Published in: Gut Vol. 68; no. 7; pp. 1232 - 1244
• Main Authors: Senore, Carlo, Basu, Partha, Anttila, Ahti, Ponti, Antonio, Tomatis, Mariano, Vale, Diama Bhadra, Ronco, Gugliemo, Soerjomataram, Isabelle, Primic-Žakelj, Maja, Riggi, Emilia, Dillner, Joakim, Elfström, Miriam Klara, Lönnberg, Stefan, Sankaranarayanan, Rengaswamy, Segnan, Nereo
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.07.2019
• Subjects: Adenoma - diagnosis; Aged; Breast cancer; Cancer screening; Colon; Colonoscopy; Colorectal cancer; Colorectal carcinoma; Colorectal Neoplasms - diagnosis; Cross-Sectional Studies; Early Detection of Cancer - statistics & numerical data; Endoscopy; European Union; Facilities and Services Utilization; Female; Humans; Male; Medical screening; Medicin och hälsovetenskap; Middle Aged; Patient Acceptance of Health Care - statistics & numerical data; Predictive Value of Tests; Quality control; Quality Improvement; Tumors; colorectal adenomas; colorectal cancer screening; colorectal cancer; colonoscopy
• ISSN: 0017-5749; 1468-3288; 1468-3288
• DOI: 10.1136/gutjnl-2018-317293

ObjectiveTo present comparative data about the performance of colorectal cancer (CRC) screening programmes in the European Union Member States (EU MSs).DesignCross-sectional study. We analysed key performance indicators—participation rate, positivity rate (PR), detection rate (DR) and positive predictive value for adenomas and CRC—based on the aggregated quantitative data collected for the second EU screening report. We derived crude and pooled (through a random effects model) estimates to describe and compare trends across different MSs/regions and screening protocols.ResultsParticipation rate was higher in countries adopting faecal immunochemical test (FIT) (range: 22.8%–71.3%) than in those using guaiac faecal occult blood test (gFOBT) (range 4.5%–66.6%), and it showed a positive correlation (ρ=0.842, p<0.001) with participation in breast cancer screening in the same areas. Screening performance showed a large variability. Compliance with referral for colonoscopy (total colonoscopy (TC)) assessment ranged between 64% and 92%; TC completion rate ranged between 92% and 99%. PR and DR of advanced adenomas and CRC were higher in FIT, as compared with gFOBT programmes, and independent of the protocol among men, older subjects and those performing their first screening.ConclusionsThe variability in the results of quality indicators across population-based screening programmes highlights the importance of continuous monitoring, as well as the need to promote quality improvement efforts, as recommended in the EU guidelines. The implementation of monitoring systems, ensuring availability of data for the entire process, together with initiatives aimed to enhance reproducibility of histology and quality of endoscopy, represent a priority in screening programmes management.