Third Round of Colorectal Cancer Screening in Ferrara (2009-2011): Prevalence of Colorectal Cancer and Advanced Adenoma and Comparison with a 2-year Prescreening Period (2003-2005)

Background and aims: In the Region of Emilia-Romagna (Italy), and particularly in Ferrara, colorectal cancer (CRC) is on the top of the national list of incidence and mortality. In March 2005, a population-based CRC screening campaign was started in Emilia-Romagna. The aim of this study was to report the screening activities of the third round (2009-2011) in Ferrara and to compare the CRC epidemiology over that period with the 2-year prescreening interval (2003-2005). Patients and methods: The screening program was based on a letter of invitation to perform an immunological FOBT (i-FOBT) sent to all the residents of Ferrara aged 50-69 years. If the i-FOBT was positive, the screenee was offered a colonoscopy while following a negative i-FOBT was invited by letter to repeat the test after two years. Adenomas were classified in: 1) low-risk adenomas (diameter <10 mm, villous component <25%, and low-grade dysplasia) and 2) high-risk adenomas (diameter 10 mm, at least 25% of villous component or high-grade dysplasia). If colonoscopy was negative, the screenee was invited to repeat the test after 5 years while if adenomatous polyps were found, endoscopic follow-up was started accordingly. In case of a CRC, necessary surgery was performed within 30 days from histological diagnosis. All patients undergoing an elective colorectal resection for CRC between April 2003 and March 2005 were reviewed and compared with the screnees of the third round (2009-2011) elected for a colorectal resection. The variables considered were: a) demographics (age, gender); b) type of surgical resection, c) pathology data, d) staging of the disease, and postoperative length of hospital stay (LOS). Results: From April 2009 to March 2011, 101,414 people in Ferrara were invited to i-FOBT. Of these, 50.039 (49,3%) adhered to the screening program and executed the test, 49.860 (49,2%) refused the invitation, and 1,515 (1,5%) were discarded for a variety of reasons. Of 50.039 people undergoing i-FOBT, 2.434 (4,9%; 46,0% men, 54,0% women) were i-FOBT positive and 47.571 (95%; 54,6% men, 45,3% women) were FOBT negative. Of 2.434 i-FOBT positive screenees, 274 had low-risk adenomas (11,2%; 64,2% men, 43,8% women), 352 had high-risk adenomas (14,5%; 64,7% men, 35,3% women), 17 had an early colorectal cancer [(pT1) 0.7%; 64,7% men, 35,3% women], and 59 an invasive colorectal cancer (2,4%; 49,2% men, 50,8% women). The comparison between the third round (2009-2011) and the prescreening period was as follows: Variables Prescreening period (2003-2005) N=275 Third screening round (2009-2011) N=46 p Age (years) 70,5 ± 11,9* 65,1 ± 8,6 <0.01 Gender (M : W) 52,7% : 47,3% 47,8% : 52,2% n.s.† Tumor stage - Stage 0 - Stage I - Stage II - Stage III - Stage IV 8,0% 11,3% 42,5% 32,0% 6,2% 26,1% 19,6% 26,1% 26,1% 2,1% <0.01 n.s. 0.05 n.s. n.s. LOS (days) 12 (6-30)‡ 10 (5-37) 0.01 *Mean ± standard deviation; †not significant; ‡Median (range) Conclusions: This study shows that in the third round of the screening program for CRC in Ferrara: 1) the adhesion to i-FOBT remained low (49,3%), and 2) there is a higher rate of early stage CRC as compared to the prescreening period. Thus, adequate campaigns of information for CRC screening are of utmost importance to increase the adhesion rate.