Introduction

Colorectal cancer (CRC) is one of the most commonly diagnosed types of cancer worldwide, ranking as the third most common neoplasia and the second leading cause of cancer-related deaths according to Global Cancer Statistics 2020 [1]. In Romania, CRC has the highest incidence rate, as reported by the Globocan platform in 2020, although the mortality rate follows global trends. The growing incidence of colorectal cancer poses a significant challenge to the global healthcare system [2].

Aims & Methods

Our aims are to assess and demonstrate the importance and value of a CRC screening program in early diagnosis among individuals aged 50 to 75 years in the southwestern of Oltenia, Romania. We prospectively enrolled apparently healthy individuals between 50 and 75 years old in a CRC prevention program at the University of Medicine and Pharmacy of Craiova, in the southwestern Oltenia region. The ongoing program started in November 2020. Exclusion criteria included individuals already enrolled in a screening program for CRC, with a personal history of colonic polyps, colorectal cancer, or inflammatory bowel diseases and individuals with a family history of inherited syndromes linked with CRC. Patients were identified based on the lists provided by participating general practitioners. All provided informed consent and completed a questionnaire regarding symptoms and family history of CRC. Based on their responses, patients were either offered a fecal immunochemical test (FIT) followed by colonoscopy in case of a positive result or were directly referred for colonoscopy. Those with negative results were instructed to repeat the test in two years.

Results

Until 24 April 2023 we enrolled 44,714 individuals (18,415 male, 41.18%). Of these, 38,610 (86.34%) received FITs, of whom 2,426 (6.28%) had a positive finding and 49 were directly referred for colonoscopy based on their questionnaire answers. We performed 1,262 colonoscopies, also having 1,004 refusals (41.38% of positive FITs) and 209 (8.61%) in waiting. Percentage of positive FIT tests correlated with older age (p<0.05). The chance of a positive colonoscopy finding correlated with the FIT value (p<0.05) and older age (p<0.05), while not being linked to either gender or provenance. We did not find lesions in 400 subjects (31.7% negative colonoscopies). In total, we found 2,092 significant lesions in 862 patients: 100 tumors and 1,992 polyps.

Conclusion

We provided here the first results of a large-scale CRC screening program in the Southwestern region of Romania, proving the importance of a coherent early detection strategy in the successful management of digestive malignancies. The high rate of colonoscopy refusals shows the need for an awareness campaign involving all medical and allied health personnel.

References

1.Sung, Hyuna et al. “Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries.” CA: a cancer journal for clinicians vol. 71,3 (2021): 209-249. doi:10.3322/caac.21660 .
2. Jiang, Yufei et al. “Global pattern and trends of colorectal cancer survival: a systematic review of population-based registration data.” Cancer biology & medicine, vol. 19,2 175–186. 6 Sep. 2021, doi:10.20892/j.issn.2095-3941.2020.0634.

Introduction

The incidence of early-stage colorectal cancer (CRC) rises with the introduction of colorectal screening programs; there is a shift towards less invasive treatment in screen-detected compared to non-screen-detected CRCs.

Aims & Methods

This retrospective, single-center cohort study aimed to assess the impact of colorectal screening on the incidence of submucosal invasive (pT1) CRC and compare treatment characteristics of screen-detected and non-screen-detected lesions between 2010 and 2023.
Screen-detected pT1 CRC (involving lesions detected with the pilot CRC screening in Csongrád-Csanád county in 2015, and those with the Hungarian population-based screening program [EFOP-1.8.1-VEKOP-15-2016-00001] initiated in 2019) lesion, patient and treatment characteristics were compared to pT1 lesions detected outside the screening program in average-risk patients aged 50-70 years during the screening period (2015-2016 and 2019-2023). The impact of screening on pT1 CRC incidence was assessed with investigating new pT1 CRC cases throughout the screening period (2015-2016 and 2019-2023) compared to non-screening periods (2010-2014 and 2017-2018).

Results

During the 14-year study period, a total of 182 pT1 CRCs were detected in average-risk patients aged 50-70 years. 81 of these lesions (44.5%) were detected during non-screening periods. During the screening period, 44 lesions were screen-detected (24.2%, 16 of these detected during the pilot screening) and 57 lesions were non-screen-detected (31.3%). Mean pT1 incidence was higher in the screening than in the non-screening periods (14.7 vs. 11.6 lesions/year, p<0.01); with the highest incidence during the pilot screening (2015-2016; 20 lesions/year), and the lowest during the pandemic (2020-2021, 9 lesions/year).
Patient and lesion characteristics were similar in screen-detected and non-screen-detected lesions (mean age: 63.1 vs 63.5 years, male ratio: 62.8% vs 64.3%, follow-up period: 3.85 vs 3.70 years; location: 31.8% vs 33.3% rectal, morphology: 34.1% vs 42.1% pedunculated, mean lesion size: 21.0 vs 24.7 mm). No difference in histologic prognostic factors were found between the two groups. Treatment choices were similar for both screen-detected, and non-screen-detected lesions: local excision in 65.9% vs 72.2% (incl. ER in 63.6% vs 63.2%, and minimally invasive local surgical resection in 2.3% vs 7.0%), and surgical oncologic resection in 34.1% vs 29.8%, respectively; p=0.167. Screen-detected colon cancers were more likely to be treated with surgical oncologic resection (43.3% vs 28.9%, p=0.218), while screen-detected rectal cancers were preferred to be treated with local excision (85.7% vs 68.4% [ER: 78.6% vs 47.4%], p=0.416) compared to non-screen-detected lesions.
During the follow-up, adverse outcomes (local recurrence and/or dissemination) occurred in two screen-detected, and in one non-screen-detected patient, p=0.797. Lymph node involvement rate was similar in those undergoing surgical oncologic resection in screen-detected, and non-screen-detected patients (6.7% vs 5.9%, respectively; p=0.927).

Conclusion

The incidence of submucosally invasive CRC rises with the implementation of colorectal screening program. There is no difference in the management and outcomes of screen-detected and non-screen-detected pT1 CRCs, but local excision, especially endoscopic resection is preferred for screen-detected rectal lesions.

Introduction

Colorectal cancer (CRC) is the most common cancer in Spain, with an estimated 44,573 new cases in 2025. The standard CRC screening strategy involves the immunological faecal occult blood test (FIT), followed by colonoscopy in positive cases. However, the low specificity of FIT results in a significant number of unnecessary colonoscopies, placing a high burden on healthcare systems. There is a growing need to explore alternative screening strategies that offer better cost-effectiveness ratios. The gut microbiota plays a key role in CRC carcinogenesis, and several bacterial species involved in this process have been identified. A diagnostic tool based on the combination of FIT (cut-off 100 ng/mL – FIT100) and a bacterial signature has been designed to detect CRC and advanced lesions (AL, defined as ≥1 cm and/or high-grade dysplasia and/or a hairy component). This tool uses qPCR to analyse the relative abundance of specific bacteria in the same stool sample used for FIT testing. Previous studies, including a proof-of-concept (N=172), confirmatory study (N=327), and clinical performance study (N=2,481), have validated the tool.

Aims & Methods

This study aims to evaluate the diagnostic performance of the bacterial signature applied to FIT100 positive participants and its potential to reduce unnecessary colonoscopies in the CRC screening program in Catalonia.
A prospective observational study was conducted in a multicentre cohort across five hospitals, including participants from the CRC screening program with a positive FIT100. Blinding was applied to the FIT, bacterial signature, colonoscopy, and biopsy. Colonoscopy-biopsy was used as the reference standard. The study included 1,453 participants, of which 48 were excluded from the analysis mainly because of poor sample conditions, resulting in a final sample of 1,405 participants. Sensitivity was defined as the proportion of true positives detected by the FIT that the bacterial signature also identifies as positive. Specificity was defined as the proportion of false positives of FIT that the bacterial signature correctly identifies as true negatives.

Results

From the 1,405 analysed cases, 44 were CRC, 472 AL, and 889 without AL. For CRC detection, the sensitivity was 95.5%, with a specificity of 18.4%. The reduction in false positives was 18.4%. For AL and CRC combined, the sensitivity was 82.6%, with a specificity of 18.4%.

Conclusion

The bacterial signature applied to FIT100 positive participants demonstrates high sensitivity for CRC detection while reducing unnecessary colonoscopies by minimizing false positives. Its implementation in the CRC screening protocol could improve the overall efficiency of the screening process. Future studies should focus on cost minimization and assess the tool's cost-effectiveness to ensure a favourable risk-benefit ratio for broader implementation.

Introduction

In 2018, a biennial fecal immunochemical test (FIT) screening program for colorectal cancer (CRC) was introduced in northern Portugal, targeting 1.1 million residents aged 50-74 years.

Aims & Methods

This study aimed to evaluate trends in CRC incidence, early diagnosis, and survival before and after the program's implementation.
Population-based retrospective cohort study in northern Portugal. Data on CRC cases diagnosed between 2014-2020 were retrieved from the Portuguese National Cancer Registry (RON). Early diagnosis was defined as stage I/II tumors. Net survival estimates for 2014–2016 vs. 2018-2020 were compared. Data from RON were linked to the FIT-based screening program of the Northern Portugal Regional Health Administration for the years 2018–2020 to assess screening outcomes.

Results

Between 2018 and 2020, the first 3 years of the program, 482,938 invitations for FIT screening were sent, resulting in an adherence rate of 34.4% (165,895). The negative predictive value of FIT was 99.95% (95% CI: 99.94–99.96). Overall, coverage by FIT and/or colonoscopy was 44.9%. The proportion of early cancers was significantly higher among individuals submitted to FIT screening (58.3%) or colonoscopy (62.8%) compared to unscreened individuals (49.2%) (p<0.001). Net survival rates at 1-year and 3-years were significantly higher among individuals who accepted FIT screening or underwent colonoscopy compared to those who remained unscreened (p<0.001).

Conclusion

Biennial FIT led to an increase in early diagnoses and improved survival compared to no screening shortly after its introduction. A health system's comprehensive capacity boosts population coverage and improves CRC outcomes.

Introduction

Previous studies showed that adhering to high-quality screening colonoscopy leads to markedly decreased incidence and mortality of colorectal cancer. However, more is needed to know about the impact of the duration of participation on quality parameters.

Aims & Methods

This study aims to evaluate the relationship between the duration of endoscopists' participation within the Austrian quality assurance program for screening colonoscopy and their quality parameters. A generalized linear mixed model, adjusted for sex and age, was utilized to evaluate the effect of the time elapsed since participation on quality parameters, such as adenoma detection rate (ADR), advanced adenoma detection rate (AADR) and carcinoma detection rate (CDR).

Results

392 endoscopists provided data from 326,445 screening colonoscopies from 2007 to 2022. Results showed that each year of participation in the quality assurance initiative led to a 1.02% increase in ADR (95% CI [1.004-1.034], p-value = 0.013) as well as a 1.17% increase in CDR (95% CI [1.107-1.245], p-value <0.001) adjusted for patients' age and sex. The advanced adenoma detection rate increased by 1.00% each year of participation (95% CI [0.983-1.023], p-value = 0.762).

Conclusion

The participation of endoscopists in the quality assurance initiative was associated with a significant increase in ADR and CDR for each year of participation. However, the increase in AADR was not statistically significant.