Social inequalities in a population based colorectal cancer screening programme in the Basque Country

Background: Despite the high participation rates in the Basque Country, colorectal cancer screening programme (Spain), there is still a part of the population that has never participated. Since it is essential to ensure equal access to health services, it is necessary to identify the determinants of health and socio-economic factors related to non-participation in the screening programme.Methods: Cross sectional descriptive study including all invited population in a complete round between 2015 and the first trimester of 2017. Health risk factors available in medical records and their control have been analyzed using univariate and multivariate analyses.Results: 515,388 people were invited at the programme with a 71.9% of fecal immunochemical test participation rate. Factors that increase the risk of non-participation are: being men (OR = 1.10, 95% CI 1.09–1.12); younger than 60 (OR = 1.18, 95% CI 1.17–1.20); smoker (OR = 1.20, 95% CI 1.18–1.22); hypertensive (OR = 1.14, 95% CI 1.12–1.15) and diabetic (OR = 1.40, 95% CI 1.36–1.43); having severe comorbidity (OR = 2.09, 95% CI 2.00–2.19) and very high deprivation (OR = 1.15, 95% CI 1.12–1.17), as well as making <6 appointments to Primary Care in 3 years (OR = 2.39, 95% CI 2.33–2.45). Still, the area under the curve (AUC) indicates that there are more factors related to non-participation.Conclusions: The participation in the Basque Country colorectal cancer-screening Programme is related to some risk factors controlled by Primary Care among others. Therefore, the involvement of these professionals could improve, not only the adherence to the CRC screening, but also other health styles and preventive interventions.

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Adverse events of colonoscopy in a colorectal cancer screening programme with faecal immunochemical test: a population-based community-based observational study

10.1101/2020.05.09.20086389 ◽

2020 ◽

Author(s):

Bernard Denis ◽

Isabelle Gendre ◽

Sarah Weber ◽

Philippe Perrin

Keyword(s):

Colorectal Cancer ◽

Cancer Screening ◽

Adverse Events ◽

Observational Study ◽

Colorectal Cancer Screening ◽

Screening Programme ◽

Population Based ◽

Community Based ◽

Cancer Screening Programme ◽

Immunochemical Test

ABSTRACTObjectivesColonoscopy is considered a safe examination, serious complications being uncommon. Our study aimed to assess the adverse events of colonoscopy in a colorectal cancer screening programme with faecal immunochemical test (FIT) and to compare them with those of a previous programme with guaiac-based faecal occult blood test (gFOBT).DesignRetrospective observational studySettingPopulation-based community-based colorectal cancer screening programme organised in Alsace, part of the national French programme, with FIT from 2015 to 2018 and gFOBT from 2003 to 2014.ParticipantsAll residents aged 50 – 74 years having a colonoscopy performed for a positive FOBT.Main outcome measuresAdverse events were recorded through prospective voluntary reporting by community gastroenterologists and retrospective postal surveys addressed to persons screened.ResultsOf 9576 colonoscopies performed for a positive FIT, 6194 (64.7%) were therapeutic. Overall, 180 adverse events were recorded (18.8‰, 95% CI 16.1-21.5), 114 of them (11.9‰, 95% CI 9.7-14.1) requiring hospitalisation, 55 (5.7‰, 95% CI 4.2-7.3) hospitalisation >24hrs, and 8 (0.8‰, 95% CI 0.3-1.4) surgery. The main complications requiring hospitalisation were perforation (n=18, 1.9‰, 95% CI 1.0-2.7) and bleeding (n=31, 3.2‰, 95% CI 2.1-4.4). We observed one death (1 / 27,000 colonoscopies). Overall, 52 persons harbouring at least one adenoma ≥ 10 mm were detected for one adverse event requiring hospitalisation >24hrs. The rate of adverse events remained stable between gFOBT and FIT programmes.ConclusionsThe harms of colonoscopy in a colorectal cancer screening programme with FIT are more frequent than usually estimated, here six adverse events requiring hospitalisation >24hrs (three bleedings, two perforations), one necessitating surgery and 50 minor complications per 1000 colonoscopies. The price to be paid to save lives through colorectal cancer screening programmes is higher than what is stated in most pilots. Today, comparison between series dealing with colonoscopy-related adverse events is almost impossible.

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