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Nereo Segnan MD MSc Epi
Center for Epidemiology and Prevention in Oncology, CPO Piedmont WHO Collaborative Center for Cancer Early Diagnosis and Screening
University Hospital “Città della Salute e della Scienza”, Turin, Italy
Cancer Screening in the European Union
Second Report:
Colorectal cancer Screening
Wien 14 October 2011
• No conflict of interest to declare
Second Report on Cancer Screening in the EU Co-financed by the EU Health Programme
-
Main collaborating institutions
• International Agency for Research on Cancer, Lyon, France (coordination)
• CPO Piemonte, University Hospital “Città della Salute e della Scienza”CPO, Turin, Italy
• Finnish Cancer Registry, Mass Screening Registry,
Helsinki, Finland
Authors
• A Ponti, A Anttila, G Ronco, C Senore, N Segnan, M Tomatis, P Basu,
M Primic-Žakelj, P Dean, J Dillner, M Fernan, M Elfström, S Lönnberg,
R Sankaranaryanan, I Soerjomataram, D Vale, L von Karsa
Scientific Committee*
• L Altenhofen, R Ancelle-Park, N Ascunce, H de Koning, E Lynge, O
Májek,
F Nicula, J Patnick, J Regula, S Törnberg, M Zappa
Over 80 Data providers from all 28 EU Member States*
*invited reviewers of full report,
and co-authors of publication in
peer-reviewed journal
Data Provider’s Workshop (22 Member States
Participating) – 16-17 Feb, 2016; IARC
Second Report on the Implementation of Council
Recommendations on Cancer Screening - objectives
• To document changes in approach to program
implementation compared to first report
• To collect more detailed information on program
organization
• To include selected performance parameters
– Key determinants of quality and impact recommended in the
European QA guidelines
– Suitable for comparison between Member States
Second Report – Standardized Data Output
Site Specific Questionnaires to collect information on
• Program organization, invitation, QA, financing, cost
• Screening tests, eligibility, screening interval, further assessment
Site Specific Tables on annual aggregated data stratified by age groups & initial vs subsequent screening
• Screening tests
• Further assessment recommendations
• Further assessment compliance
• Outcome of further assessment
o Detection rates
o Positive predictive values
Necessity of Regular Reporting on Cancer
Screening in the EU
• Current performance determines impact of screening
on burden of disease
• Impact is measurable only after many years
• Regular monitoring permits timely response to
potential problems and recognition of
opportunities for improvement
– Avoids unnecessary harm and cost
– Maximises benefit of screening
Web Based Data Collection
EU CRC screening
• Annual target population 50 -74 yrs:
69,636,000
• Invited: 23,343,000 (33.5%)
• Screened: 9,985,000 (14.2%)
0%
25%
50%
75%
100%
Table 4.15
N = Individuals screened of invited in the year
D = Individuals personally invited in the year
COLON - Participation rate (All ages)
FIT, 10 countries
N = 3,621,692
D = 7,313,175
Result = 49.5% (22.8% - 71.3%)
gFOBT, 6 countries
N = 5,352,356
D = 16,158,260
Result = 33.1% (4.5% - 66.6%)
0%
25%
50%
75%
100%
COLON - Participation rate (60-69 years) Table 4.15
N = Individuals screened of invited in the year
D = Individuals personally invited in the year
FIT, 8 countries
N = 1,736,995
D = 3,277,339
Result = 53.0% (28.7% - 74.0%)
gFOBT, 5 countries
N = 3,035,378
D = 7,316,925
Result = 41.5% (5.0% - 66.6%)
0%
5%
10%
15%
20
20
NA
15
-20
15
15
20
15
-47
20
16
-20
18
0
COLON – Screen positivity (60-69 years)
FIT, 11 countries
N = 144,089
D = 2,195,044
Result = 6.6% (3.1% - 10.6%)
gFOBT, 6 countries
N = 64701
D = 3140223
Result = 2.1% (1.7% - 4.5%)
Table 4.18.1
N = Positive screening tests in the year
D = Individuals screened in the year with adequate test - test results available
« Positivity cut off µg/gr faeces
COLON – Detection rate of colorectal cancers (60-69 years)
FIT, 9 countries
N = 4501
D = 1923252
Result = 2.3‰ (1.3‰ - 4.1‰)
gFOBT, 5 countries
N = 3704
D = 3112437
Result = 1.2‰ (0.9‰ - 2.6‰)
Table 4.18.6
0
1
2
3
4
5
N = Colorectal cancers detected
D = Individuals screened in the year with adequate test - test results available
COLON – Detection rate of advanced adenomas (60-69 years)
FIT, 6 countries
N = 25958
D = 1889223
Result = 13.7‰ (5.8‰ - 27.5‰)
gFOBT, 5 countries
N = 6963
D = 3013386
Result = 2.3‰ (1.0‰ - 5.4‰)
Table 4.18.5
0
5
10
15
20
25
30
N = Advanced ademonas detected
D = Individuals screened in the year with adequate test - test results available
COLON – Detection rate of colorectal cancers (All ages)
FIT, 9 countries
N = 7519
D = 3751139
Result = 2.0‰ (1.2‰ - 4.9‰)
gFOBT, 6 countries
N = 6545
D = 5529765
Result = 1.2‰ (0.9‰ - 1.9‰)
Table 4.18.6
0
1
2
3
4
5
N = Colorectal cancers detected
D = Individuals screened in the year with adequate test - test results available
0
5
10
15
20
25
30
COLON – Detection rate of advanced adenomas (All ages)
FIT, 6 countries
N = 55059
D = 3713008
Result = 14.8‰ (7.4‰ - 27.0‰)
gFOBT, 5 countries
N = 12706
D = 5143744
Result = 2.5‰ (0.9‰ - 4.6‰)
Table 4.18.5
N = Advanced ademonas detected
D = Individuals screened in the year with adequate test - test results available
0%
25%
50%
75%
100%
COLON – Follow-up colonoscopy participation rate (All ages)
FIT, 11 countries
N = 187918
D = 266420
Result = 70.5% (36.3% - 92.2%)
gFOBT, 6 countries
N = 99037
D = 117844
Result = 84.0% (72.6% - 93.2%)
Table 4.18.2
N = Further colonoscopies performed
D = Data on further col. performance available
50%
60%
70%
80%
90%
100%
COLON – Completion rate follow-up colonoscopy (All ages)
FIT, 7 countries
N = 138412
D = 147090
Result = 94.1% (92.4% - 98.8%)
gFOBT, 4 countries
N = 54813
D = 56496
Result = 97.0% (91.0% - 97.6%)
Table 4.18.3
N = Further colonoscopies completed
D = Data on col. completion available
50-59 60-69
FIT gFOBT TC FIT gFOBT TC
Tests 1753K 1294K 12K 2195K 3140K -
Screen positivity 5,1% 2,0% 11,5% 6,6% 2,1% -
F.U. colonoscopy
participation rate 76,8% 83,1% 82,2% 75,0% 84,5% -
Completion rate
F.U. colonoscopy 93,9% 97,8% 97,2% 93,7% 96,8% 97,1%
Detection Rate
advanced adenoma 8,7‰ 2,5‰ 49,5‰ 13,7‰ 2,3‰ 72,4‰
Detection Rate
colorectal cancers 1,1‰ 0,6‰ 3,5‰ 2,3‰ 1,2‰ 8,1‰
gFOBT 50-59 years 60-69 years 70-74 years 75-79 years Total
N D % N D % N D % N D % N D %
Women 197 21.570 0,9%
Men 99 8.223 1,2% 125 8.444 1,5% 39 2.382 1,6% 263 19.049 1,4%
Women 145 33.382 0,4% 145 33.382 0,4%
Men 270 26.003 1,0% 270 26.003 1,0%
Women 1.791 580.408 0,3% 2.562 540.979 0,5% 1.060 179.799 0,6% 5.413 1.301.186 0,4%
Men 3.284 475.523 0,7% 4.289 444.355 1,0% 1.578 145.344 1,1% 9.151 1.065.222 0,9%
Women 173 36.491 0,5% 173 36.491 0,5%
Men 317 28.571 1,1% 317 28.571 1,1%
Women 3.234 906.530 0,4% 1.137 243.963 0,5% 4.371 1.150.602 0,4%
Men 5.533 800.172 0,7% 1.759 220.221 0,8% 7.292 1.020.427 0,7%
Women 289 114.173 0,3% 462 104.497 0,4% 203 41.272 0,5% 56 1.285 4,4% 1.010 261.227 0,4%
Men 647 101.622 0,6% 938 93.034 1,0% 364 34.366 1,1% 99 1.282 7,7% 2.048 230.304 0,9%
Women 131 54.636 0,2% 49 19.938 0,2% 180 74.574 0,2%
Men 285 47.491 0,6% 100 18.091 0,6% 385 65.582 0,6%
Total Women 2.150 703.595 0,3% 6.806 1.686.309 0,4% 2.477 487.734 0,5% 56 1.285 4,4% 11.489 2.879.032 0,4%
Total Men 4.030 585.368 0,7% 11.757 1.448.070 0,8% 3.840 420.404 0,9% 99 1.282 7,7% 19.726 2.455.158 0,8%
Table 4.21.4. Colorectal cancer screening programmes in the EU Performance indicators by country, age, gender and screening protocol Detection rate of adenomas (%)
Thank to
Partha Basu (IARC),
Mariano Tomatis, Antonio Ponti, Carlo
Senore (CPO Piemonte)
for providing slides and data
Thank you for your
attention
gFOBT 50-59 years 60-69 years 70-74 years 75-79 years Total
N D % N D % N D % N D % N D %
Women 70 9.014 0,8% 99 9.794 1,0% 28 2.762 1,0% 197 21.570 0,9%
Men 99 8.223 1,2% 125 8.444 1,5% 39 2.382 1,6% 263 19.049 1,4%
Women 145 33.382 0,4% 145 33.382 0,4%
Men 270 26.003 1,0% 270 26.003 1,0%
Women 1.791 580.408 0,3% 2.562 540.979 0,5% 1.060 179.799 0,6% 5.413 1.301.186 0,4%
Men 3.284 475.523 0,7% 4.289 444.355 1,0% 1.578 145.344 1,1% 9.151 1.065.222 0,9%
Women 173 36.491 0,5% 173 36.491 0,5%
Men 317 28.571 1,1% 317 28.571 1,1%
Women 3.234 906.530 0,4% 1.137 243.963 0,5% 4.371 1.150.602 0,4%
Men 5.533 800.172 0,7% 1.759 220.221 0,8% 7.292 1.020.427 0,7%
Women 289 114.173 0,3% 462 104.497 0,4% 203 41.272 0,5% 56 1.285 4,4% 1.010 261.227 0,4%
Men 647 101.622 0,6% 938 93.034 1,0% 364 34.366 1,1% 99 1.282 7,7% 2.048 230.304 0,9%
Women 131 54.636 0,2% 49 19.938 0,2% 180 74.574 0,2%
Men 285 47.491 0,6% 100 18.091 0,6% 385 65.582 0,6%
Total Women 2.150 703.595 0,3% 6.806 1.686.309 0,4% 2.477 487.734 0,5% 56 1.285 4,4% 11.489 2.879.032 0,4%
Total Men 4.030 585.368 0,7% 11.757 1.448.070 0,8% 3.840 420.404 0,9% 99 1.282 7,7% 19.726 2.455.158 0,8%
Table 4.21.4. Colorectal cancer screening programmes in the EU Performance indicators by country, age, gender and screening protocol Detection rate of adenomas (%)
FIT 50-59 years 60-69 years 70-74 years 75-79 years Total
N D % N D % N D % N D % N D %
Women 898 119.189 0,8% 1.443 129.721 1,1% 555 41.651 1,3% 286 24.976 1,1% 3.182 315.537 1,0%
Men 1.652 85.428 1,9% 2.308 90.206 2,6% 728 29.124 2,5% 334 15.414 2,2% 5.022 220.172 2,3%
Women 44 5.673 0,8% 46 5.801 0,8% 22 1.981 1,1% 112 13.455 0,8%
Men 45 4.392 1,0% 61 4.297 1,4% 37 1.464 2,5% 143 10.153 1,4%
Women 44 2.307 1,9% 45 2.149 2,1% 89 4.456 2,0%
Men 64 1.775 3,6% 99 1.629 6,1% 163 3.404 4,8%
Women 3.868 189.432 2,0% 2.925 80.347 3,6% 6.793 269.779 2,5%
Men 7.230 181.983 4,0% 4.623 72.373 6,4% 11.853 254.356 4,7%
Women 4.161 530.280 0,8% 6.198 532.458 1,2% 10.359 1.062.738 1,0%
Men 7.025 447.464 1,6% 10.579 459.329 2,3% 17.604 906.793 1,9%
Women 1.121 79.937 1,4% 1.244 58.766 2,1% 2.365 138.703 1,7%
Men 2.336 65.695 3,6% 2.390 47.550 5,0% 4.726 113.245 4,2%
Women 2.100 126.358 1,7% 2.928 115.171 2,5% 5.028 241.529 2,1%
Men 4.401 109.270 4,0% 5.585 98.160 5,7% 9.986 207.430 4,8%
Total Women 8.368 863.744 1,0% 11.904 844.066 1,4% 577 43.632 1,3% 286 24.976 1,1% 21.135 1.776.418 1,2%
Total Men 15.523 714.024 2,2% 21.022 701.171 3,0% 765 30.588 2,5% 334 15.414 2,2% 37.644 1.461.197 2,6%
Table 4.21.4. Colorectal cancer screening programmes in the EU Performance indicators by country, age, gender and screening protocol Detection rate of adenomas (%)
Endoscopy 50-59 years 60-69 years 70-74 years 75-79 years Total
N D % N D % N D % N D % N D %
Women 468 5.567 8,4% 468 5.567 8,4%
Men 954 5.996 15,9% 954 5.996 15,9%
Women 477 2.402 19,9% 522 2.365 22,1% 999 4.767 21,0%
Men 786 2.375 33,1% 833 2.170 38,4% 1.619 4.545 35,6%
Women 124 727 17,1% 255 1.142 22,3% 66 241 27,4% 19 108 17,6% 464 2.218 20,9%
Men 252 810 31,1% 420 1.134 37,0% 78 243 32,1% 35 99 35,4% 785 2.286 34,3%
Table 4.21.4. Colorectal cancer screening programmes in the EU Performance indicators by country, age, gender and screening protocol Detection rate of adenomas (%)
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