The first two years of colorectal cancer screening in Ferrara, Italy

Objective. To illustrate the effort of colorectal cancer (CRC) screening from administration and information to therapy and follow-up, we report on the first screening round in the District of Ferrara, region of Emilia-Romagna, performed between March 2005 and March 2007. Methods. Following invitation to 38.344 persons aged 50-69 years (28.5%), 19.480 (50.8%) accepted the i-FOBT, with 1.149 (6%) resulting positive. One-thousand and one i-FOBT positive (88.2%) accepted examination by either colonoscopy (99.5%) or barium enema (0.5%). Results. In 996 screenees having a colonoscopy, 231 had low-risk adenomas (23.2%) and 239 high-risk adenomas (24%), being treated endoscopically (96%) or surgically (4%). Ninety-one cancers were diagnosed in 9.1% of all colonoscopies (Dukes stadia: A 58.2%; B 19.8%; C 18.7%; D 3.3%). Fourteen cancers (all in polyps) were treated endoscopically, the remaining 77 by surgery. One Dukes B patient and 13/17 Dukes C patients received adjuvant chemotherapy. Three Dukes D patients had chemotherapy only. During the 2-year study period, 87 screenees had a follow-up colonoscopy: no neoplasia was found in 35 patients initially diagnosed with cancer; low risk-adenomas were found in 31/52 patients with initial high-risk adenomas. Conclusions. The first CRC screening round in Ferara was easy to organize, had a high acceptance and discovered 91 cancers (78% of which in stages Dukes A and B, compared to only 40% in sporadic colorectal cancer in the same background population). Chemotherapy was necessary in 17 cases. This report may motivate other health authorities to initiate CRC screening campaigns.