Colorectal Cancer: Open Access

Screening Colonoscopy Indeed Lowers the Stage of Diagnosed Colorectal Cancer – A Prospective Registration of the Findings by Screening Colonoscopy during the First Year of a National Screening Programme

Objective: A national screening programme for colorectal cancer was launched in Denmark March 2014. Citizens between the age of 50 and 74 are invited to participate by submitting a fecal sample which is examined by an immunochemical fecal occult blood test (i-FOBT), and those with a positive test are offered a colonoscopy. In this study we report the findings of the first year of screening colonoscopies.
Materials and methods: All citizens who had a screening colonoscopy performed at our endoscopy unit during the first 12 months of the screening programme entered the study. Details of the colonoscopies and findings of the procedures were recorded prospectively as well as the results of the related histopathological examinations and analyzed at the end of the study period. The stage of detected cancers were compared with cancers found in symptomatic patients referred in the same period of time, and also the observed key point outcome measures were compared with those estimated before starting the screening programme.
Results: Screening colonoscopy was performed in 905 citizens, which was 25% more than expected. There were no perforations, but 0.2% were re-admitted due to bleeding after polypectomy. Cancer was detected in 7.8%, which was a little less than expected, and 51.4% of these were Stage I and only 4.6% Stage IV. This distribution is significantly different from the distribution of stages in cancers diagnosed in symptomatic patients. From 1 to 37 polyps were detected and removed in 53.3% of the citizens. Of these 63.1% had intermediate or high risk polyps, which indicate later follow up colonoscopy, which is almost 50% more than expected.
Conclusion: A significantly larger number of patients with low stage cancer and a significantly lower number of patients with high stage cancer was detected by screening colonoscopy compared with cancers found in patients with symptoms of colorectal cancer. Furthermore the screening programme challenges the Endoscopy Unit due to an unexpectedly large number of i-FOBT positive citizens and unexpectedly many with polyps requiring colonoscopic follow up.

Author(s):

Tanja Linde Fris, Mogens Harrits Jepsen and Mogens R Madsen

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