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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.

IMPACT OF COLORECTAL SCREENING ON THE MANAGEMENT OF T1 COLORECTAL CANCERS

Anna Fabian 1, Renáta Bor 1, Zsofia Bosze 1, Béla Vasas 2, Tibor Tóth 1, Péter Bacsur 3, Anita Balint 1, Bernadett Farkas 1, Klaudia Farkas 3, Emese Ivány 1, Dániel Magyar 1, Tamás Resál 1, Mariann Rutka 1, Tamás Molnár 1, Zoltán Szepes 1

1 University of Szeged, Albert Szent-Györgyi Clinical Center, Szeged, Hungary

2 University of Szeged, Szeged, Hungary

3 University of Szeged, Albert Szent-Györgyi Clinical Center, Szeged, Hungary|||USZ Translational Colorectal Research Group, Hungarian Centre of Excellence for Molecular Medicine, Szeged, Hungary

Conference

UEG Week Vienna 2024

Topics

Colorectal

Submission format

Abstract

Session

LOWER GI (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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Introduction

In Hungary, the population-based colorectal carcinoma (CRC) screening programme was introduced at the end of 2018, shortly before the start of the COVID-19 pandemic.

Aims & Methods

The aim of our retrospective cohort study was to evaluate the impact of two presumably opposing causal factors, COVID-19 pandemic and population-based screening, on the incidence and clinical characteristics of CRC. All patients with newly diagnosed CRC from 2014 to 2023 were included and categorized into pre-pandemic (confirmed between 2014-2019), pandemic (confirmed in 2020-2021) and post-pandemic (confirmed in 2022-2023) groups. The extended pre-pandemic period was required to assess the impact of the screening programme, further dividing it into screening-affected (2015, 2016, and 2019) and unaffected (2014, 2017, 2018) subgroups.

Results

A total of 2803 patients were diagnosed with CRC during the study period. The annual number of CRC cases was significantly lower in the pandemic subgroup compared to the pre-pandemic screened and post-pandemic subgroups (254/year, 295/year and 295/year, p=0.009). In addition, in the pandemic subgroup, the incidence rates of CRCs detected at localized stage were significantly lower compared to the other three groups (36.61%, 50.85%, 46.35% and 49.49%, p<0.001). Statistically significant difference in the rate of T1 tumors was only observed between the pandemic and the post-pandemic subgroups (7.09% and 12.20%, p=0.026). In the pandemic period, the annual number of colonoscopies decreased by 64.31% compared to the pre-pandemic period overall, however, the post-pandemic period (n=4574) saw a modest 8.70% increase relative to the pre-pandemic period, offering only partial compensation for the shortage experienced during the pandemic. Furthermore, the annual number of colonoscopies in the extended pre-pandemic subgroup with screening was higher by 20.06% compared to the pre-pandemic subgroup without screening (4591 examinations/year vs 3824 examinations/year) and it was almost the same as the post-pandemic subgroup (4574 examinations/year). Substantially fewer examinations were required to detect a CRC in the pandemic group compared to the pre-pandemic overall and post-pandemic groups (10.67, 15.56, 13.97 and 15.50 examinations, respectively), but within the extended pre-pandemic group, there was no relevant difference between the two subgroups in the mean number of colonoscopies required to detect a CRC (15.56 vs. 13.97).

Conclusion

Our study confirmed the negative impact of COVID-19 pandemic on the CRC epidemiology. The newly introduced population-based CRC screening has only been able to partially compensate this negative effect during pandemic period, however, was moderately compensated by during the pandemic period, but in the post-pandemic period it caused a favorable change in the clinical features of CRC. Our study demonstrates both the effectiveness of the screening programme and that by introducing non-invasive pre-screening of patients (e.g. iFOBT) in a pandemic situation, it can reduce its negative public health impact.

SHORT-TERM COMBINED IMPACT OF COVID-19 PANDEMIC AND POPULATION-BASED SCREENING ON THE INCIDENCE AND CLINICAL CHARACTERISTICS OF COLORECTAL CANCER – RETROSPECTIVE COHORT STUDY

Renáta Bor 1, Béla Vasas 1, Anna Fabian 1, Zsofia Bosze 1, Mónika Szűcs 1, Mariann Rutka 1, Dániel Magyar 1, Tibor Tóth 1, Anita Balint 1, Péter Bacsur 1, Tamás Resál 1, Klaudia Farkas 1, Tamás Molnár 1, Zoltán Szepes 1

1 University of Szeged, Szeged, Hungary

Conference

UEG Week Vienna 2024

Topics

Colorectal

Submission format

Abstract

Session

LOWER GI (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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Management of moderate-penetrance colorectal cancer susceptibility genes. Should we do screening?

Leticia Moreira Ruiz 1

1 Hospital Clinic de Barcelona, Gava, Spain

Event

UEG Postgraduate Teaching Programme Berlin 2025

Topics

Colorectal Digestive Oncology Pancreas Stomach & H. Pylori

Session

Hereditary GI cancer syndromes: Surveillance strategies

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Introduction

Participation in colorectal cancer (CRC) screening programs significantly vary with 36–71% fecal occult blood test (FOBT) uptake rates, and compliance with referral for colonoscopy ranging 64–92% in Europe. The Hungarian population-based colorectal cancer (CRC) screening program (EFOP-1.8.1-VEKOP-15-2016-00001) was launched in 2019 among asymptomatic individuals between the ages of 50 and 70 with average risk of CRC.

Aims & Methods

The aim of this study was to assess the adherence to Hungarian population-based CRC screening program (EFOP-1.8.1-VEKOP-15-2016-00001), and to determine influencing demographic factors. This observational, non-interventional cohort study retrospectively analyzed participation data of the Hungarian population-based CRC screening program between 2019 and 2022, prospectively collected in National Public Health Institute’s registry. Data were analyzed as that of 13/02/2023. Gender and type of residence (municipality, town, city with county rights, and capital) were investigated as demographic parameters potentially influencing adherence rates with logistic regression.

Results

Of 1,819,664 invited individuals, 377,552 returned the screening kit, resulting in 20.8% adherence to FOBT. 36,995 individuals (9.8%) had non-negative results. 20,902 individuals (56.5%) were reported to undergo screening colonoscopy.
Adherence rates to FOBT decreased over the years since the initiation of the screening program: yearly rates for returning screening kits from 2019 to 2022 were 32.1%, 24.8%, 18.8%, and 14.1%, respectively. In contrast, adherence rates to screening colonoscopy showed less variation over the years (58.9%, 52.7%, 52.3%, 55.62% from 2019 to 2022). Average kit returning time over the years was as follows: 99.2±0.2 days, 66.6±0.3 days, 56.0±0.5 days, and 68.0±0.1 days, from 2019 to 2022, respectively. Over the years, colonoscopy was performed following the FOBT results after an average of 85.5±0.9 days, 93.8±1.5 days, 56.6±2.0 days, and 52.8±0.4 days. Female gender was associated with higher adherence to returning screening kits (22.4% vs. 18.8%). Attendance rates at screening colonoscopies were 57.2% for males and 55.5% for females. Screening kits were returned by 19.1% of individuals living in municipalities, 20.5% of those living in towns, 23.5% of those living in cities with county rights and 19.8% of those living in the capital. Attendance rates at colonoscopy according to type of residence were the following: 57.8% for individuals from municipalities, 53.9% for those from towns, 60.3% for those from cities with county rights, and only 50.2% for those from the capital. Adherence rates to FOBT tests were significantly influenced by both gender and type of residence, while attendance rates at screening colonoscopy was only influenced by type of residence.

Conclusion

Adherence rates to Hungarian CRC screening program are somewhat lower than in other European countries. Although adherence rates to FOBT gradually decreased since the initiation of the CRC screening program, adherence rates to screening colonoscopy remained stable. Socio-demographic factors influence screening adherence.

ADHERENCE TO THE HUNGARIAN POPULATION-BASED COLORECTAL SCREENING PROGRAM AND POTENTIAL INFLUENCING DEMOGRAPHIC FACTORS

Anna Fabian 1, Renáta Bor 1, Béla Vasas 1, Zsofia Bosze 1, Mónika Szűcs 1, Tibor Tóth 1, Anita Balint 1, Péter Bacsur 1, Klaudia Farkas 1, Tamás Resál 1, Mariann Rutka 1, Tamás Molnár 1, Zoltán Szepes 1

1 University of Szeged, Szeged, Hungary

Conference

UEG Week Copenhagen 2023

Topics

Colorectal

Submission format

Abstract

Session

PP 06 Other lower GI disorders (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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Introduction

Colonoscopy and polypectomy reduce the incidence of colorectal carcinoma (CRC), however it does not entirely prevent the emergence of tumours. Post-colonoscopy CRC (PCCRC) is defined when a tumour is detected in a short follow-up period after an index colonoscopy, where no malignancies were found. This period is hard to define however, as the World Endoscopy Organisation (WEO) does not have a unified decision on this subject, the most widespread period is a five-year long.

Aims & Methods

Our aims were to define the incidence of PCCRC at the University of Szeged, and to identify factors that could influence its detection. Patients diagnosed with CRC between 01.01.2020. and 31.12.2023 were involved. For PCCRC, we used 5-, 3- and 1-year cut-off point. We also investigated the indicators of quality colonoscopy as a predictor and assessed the adherence to guidelines regarding the management of the involved patients.

Results

Overall, 3900 CRCs were diagnosed during the study period, the ratio of PCCRC was 3.82% (N=149), 3.08 (N=120), and 1.13% (N=44) with 5-year, 3-year, and 1-year cut-off, respectively. Regarding PCCRC etiology, 64.5% (N=111) of the cases were missed lesions, 9.4% (N=14) were due to incomplete polypectomy and 16.11% (N=24) were de novo lesions. 40% (N=60) was localized on the right side of the colon, 33% (N=49) was on the left, 30% (N=45) in the rectum. Duplex tumours were detected in 5 cases. From the indicators of quality colonoscopy, coecal intubation was documented in 79% (N=117) of the cases, and adequate bowel preparation was achieved in 76% (N=113), both of which does not reach the required minimum value set by the guidelines. There was no substantial difference between the ratios of CRCs and missed lesion PCCRCs regarding lymph node involvement (grade III) and distant metastases (grade IV) (27.24% vs 23.42% and 26.30% vs 22.52%). Adherence to the adequate follow-up strategy stated by the guidelines currently in effect regarding the results of the index colonoscopy was 60.40% (N=90), negligence of the patients was responsible in 32.20% (N=19) in the non-adherent cases.

Conclusion

The incidence of PCCRC in our institution correlates with the data available worldwide. 75% of PCCRCs are missed lesions, and every third examination was carried out with insufficient bowel preparation and/or without coecal intubation and with inadequate follow-up strategy. The incidence of PCCRC can be lowered with quality colonoscopy and strict adherence to guidelines.

INCIDENCE OF POST-COLONOSCOPY COLORECTAL CARCINOMA AT THE UNIVERSITY OF SZEGED – RETROSPECTIVE COHORT STUDY

Zsofia Bosze 1, Anna Fabian 1, Péter Bacsur 2, Tamás Resál 1, Anita Balint 1, Mariann Rutka 1, Tibor Tóth 1, Bernadett Farkas 1, Emese Ivány 1, Dániel Magyar 1, Klaudia Farkas 2, Tamás Molnár 1, Zoltán Szepes 1, Renáta Bor 1

1 University of Szeged, Albert Szent-Györgyi Clinical Center, Szeged, Hungary

2 University of Szeged, Albert Szent-Györgyi Clinical Center, Szeged, Hungary|||HCEMM-USZ Translational Colorectal Research Group, Szeged, Hungary

Conference

UEG Week Vienna 2024

Topics

Colorectal

Submission format

Abstract

Session

LOWER GI (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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Introduction

The Hungarian population-based colorectal cancer (CRC) screening program (EFOP-1.8.1-VEKOP-15-2016-00001) was launched in 2019 among asymptomatic individuals between the ages of 50 and 70 with average risk of CRC.

Aims & Methods

Aim of the study was to retrospectively assess the quality indicators and results of screening colonoscopies performed during the initial five-year period of screening program (from 2019 to 2023). Our non-interventional, observational cohort study retrospectively analyzed clinical records of screening colonoscopies which were prospectively collected in the registry of National Public Health Institute. The quality indicators and results of examinations was determined based on cecal intubation rate, polyp, adenoma and cancer detection rates (PDR, ADR, and CDR), proportion of photo-documentation and sedation.

Results

Total of 27,021 colonoscopies were performed during the initial five-year period of CRC screening program. Cecal intubation rate was 92.54%, from which 66.77% of cases were confirmed by cecal image documentations. The causes of incomplete colonoscopies were inadequate bowel cleansing (n=172, 11.48%), anatomical reasons (n=369, 24.63%) and malignant colonic obstruction (n=178, 11.88%), and only in 191 cases (12.75%), the examination had discontinued due to patients’ intolerance. Total of 17,981 patients (66.54%) of participants received some kind of sedation. The result of colonoscopy was non-negative in 80.83% of cases. At least one polyp was found (PDR) in 56.56% (n=15,282) of participants among which the largest polyp was located in rectosigmoid colon in 64.92% of cases and the polyp size was higher than 1 cm in 34.69% of cases. Morphological features of polyps could not be assessed due to inappropriate colonoscopy reports in registry. A total of 36,829 polyps were found, of which 30,494 were removed during the registered examinations, becoming polyp-free 82.15% of patients (polypectomy per colonoscopy 1,13). The ADR was 33.53%, where the most relevant lesion histological types were tubular, tubulovillous, villous and serrated in 67.46%, 22.83%, 3.60% and 2.92% respectively. CRC was found in 5.51% of participants from which the most cancers were located in the sigmoid colon (n=578, 38,82%) and rectum (n=458, 30,76%). The data of registry to description of polyp morphology, usage of advanced imaging assessment, polyp retrieval rate and the image documentation were often missing or inappropriate.

Conclusion

Cecal intubation, polyp and adenoma detection rates of screening colonoscopies of Hungarian CRC screening program are satisfactory according to guideline of European Society of Gastrointestinal Endoscopy, however, the description of polyp morphology, usage of advanced imaging assessment, polyp retrieval rate and the image documentation are inappropriate yet, therefore the evaluation was not possible. The aim for the future is to improve the quality of data input to the register.

QUALITY INDICATORS AND RESULTS OF COLONOSCOPY EXAMINATIONS IN INITIAL FIVE-YEAR PERIOD OF HUNGARIAN POPULATION-BASED COLORECTAL CANCER SCREENING PROGRAM

Renáta Bor 1, Anna Fabian 1, Béla Vasas 1, Dániel Magyar 1, Zsofia Bosze 1, Tibor Tóth 1, Anita Balint 1, Tamás Resál 1, Péter Bacsur 1, Klaudia Farkas 1, Tamás Molnár 1, Zoltán Szepes 1

1 University of Szeged, Szeged, Hungary

Conference

UEG Week Vienna 2024

Topics

Colorectal

Submission format

Abstract

Session

LOWER GI (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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Introduction

Deep submucosal invasion is not considered an independent risk factor for lymph node metastasis in T1 colorectal cancer (CRC). This study aimed to evaluate the feasibility and effectiveness of diagnostic endoscopic resection for T1 CRCs with deep invasion.

Aims & Methods

This retrospective study included consecutive patients with T1 CRC who underwent either endoscopic submucosal dissection (ESD) or endoscopic mucosal resection (EMR). Pedunculated lesions (Paris classification Ip) were excluded. Low-risk T1 CRCs were defined as lesions with submucosal invasion ≥1000 µm that were resected en bloc with R0 margins and lacked lymphovascular invasion (LVI), high-grade budding (>BD1), or poor differentiation. These lesions were considered eligible for expanded curative resection.

Results

A total of 123 T1 CRC lesions in 121 patients were resected endoscopically (26 by EMR, 97 by ESD). The overall en bloc and R0 resection rates were 89.4% (100/123) and 65.9% (81/123), respectively. For T1b CRCs, these rates were 86.7% (52/60) and 56.7% (34/60). No perforations occurred. Expanded curative resection was achieved in 26.7% (16/60) of T1b cases. Among non-curatively resected T1b lesions, 50.0% (30/60) had LVI, 41.7% (25/60) had positive or indeterminate vertical margins (VM1/VMX), and 13.3% (8/60) showed significant tumor budding.

Conclusion

Diagnostic endoscopic resection for T1 CRCs with deep submucosal invasion is feasible and safe, with a notable rate of expanded curative resection. This strategy may support accurate pathological evaluation and informed treatment planning in selected patients.

FEASIBILITY AND EFFECTIVENESS OF DIAGNOSTIC ENDOSCOPIC RESECTION FOR T1 COLORECTAL CANCER WITH DEEP INVASION

Tomoaki Matsumura 1, Kenichiro Okimoto 1, Tsubasa Ishikawa 1, Hirotaka Oura 1

1 Chiba University Hospital, Chiba, Japan

Conference

UEG Week Berlin 2025

Topics

Colorectal

Submission format

Abstract

Session

LOWER GI (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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