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FIRST TWO AND HALF YEAR OF NATIONAL SCREENING PROGRAM FOR COLORECTAL CANCERS IN REPUBLIC CROATIA

FIRST TWO AND HALF YEAR OF NATIONAL SCREENING PROGRAM FOR COLORECTAL CANCERS IN REPUBLIC CROATIA. Miroslava Katicic 1 , Milan Kujundzic 2 , Davor Stimac 3 , Marija Strnad 4 , Danica Kramaric 4 , Valerija Stamenic 4 , Nataša Antoljak 5 , Mirko Samija 6 , .

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FIRST TWO AND HALF YEAR OF NATIONAL SCREENING PROGRAM FOR COLORECTAL CANCERS IN REPUBLIC CROATIA

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  1. FIRST TWO AND HALF YEAR OF NATIONAL SCREENING PROGRAM FOR COLORECTAL CANCERS IN REPUBLIC CROATIA Miroslava Katicic1, Milan Kujundzic2, Davor Stimac3, Marija Strnad4, Danica Kramaric4, Valerija Stamenic4, Nataša Antoljak5, Mirko Samija6, 1University Hospital Merkur, Zagreb, Croatia 2University Hospital Dubrava, Zagreb, Croatia 3University Center Rijeka, Croatia 4Ministry of Health and Social Welfere, Zagreb, Croatia 5Croatian National Insitute of Public Health, Zagreb, Croatia 6University Hospital for tumors, Zagreb, Croatia

  2. Background (I) • Average rates of CRC incidence and mortality in Croatia are parallel to those in developed countries with unfortunately clear increase in incidence rate during the last 30 ys, for 364 percent from 1970 till 2004. What makes the situation in Croatia even worse in comparison to developed countries, is the high mortality rate, steadily reaching 60–70% of incidence rate.

  3. Fig. 1. DIGESTIVE ORGAN CANCER INCIDENCE, 1970-2003- Share in total incidence 28% +C-433% +R-329% -23% +183% +10% +151% +77% Croatian National Institute of Public Health Prof. Marija Strnad, M.D., Ph.D.

  4. Fig. 2. Incidence and mortality of CRCin Repoblic Croatia, 1970-2005 The Croatian Institute for Public Health Prof. dr. sc. Marija Strnad

  5. Background (II) • The incidence rate CRC/100 000 inhabitants 65/100 000 (2005), • The mortality rate 40.6/100 000 (2006) • Incidence increases rapidly for the group aged 60 and older. • Main reason: the most cases of cancer are detected too late at an advanced stage with poor prognosis • Less than 10% of CRC are limited to bowel wall in the time of diagnosis. • Five-years relative survival is only 49% for men and 50% for women.

  6. Aim National screening program for colorectal cancers started in September 2007. Campaign targets: • Reducing colorectal cancer mortality • Cancer detection; • Detection and cure all precancerous colorectal lesions; • Detection of other colorectal diseases characterized by occult bleeding; • Compliance of 60%. Study population: all inhabitants of Republic Croatia aged 50 – 75 who are at an average risk for CRC.

  7. Croatian model for CRC screening CROATIAN PUBLIC HEALTH INSTITUTE MINISTRY OF HEALTH AND WELFARE COLONOSCOPY PATHOLOGY (PHD) PUBLIC HEALTH INSTITUTE GENERAL PHYSICIAN MALE AND FEMALE AT AGE 50-74 YRS.

  8. 1. Croatian National program for CRC screening was established by Ministry of Health and Social Welfare and has been implemented since the September 2007. MINISTRY OF HEALTH AND WELFARE

  9. 2. The network of coordinators in each county institute of public health are obliged to ensure performing of fecal occult blood testing (FOBT.) The FOBT is performed by guaiac-based Hemognost card test with detection limit of 0.2 ml blood in 500 g of stool. CROATIAN PUBLIC HEALTH INSTITUTE PUBLIC HEALTH INSTITUTE

  10. 3. MALE AND FEMALE AT AGE 50-74 YRS. Test and short questionnaire are delivered to home address of all citizens age 50–74 consecutively during two years. Each participant has to fulfill the questionnaire, and send it together with test specimen back to the institute for further analysis.

  11. 4. COLONOSCOPY PATHOLOGY (PHD) • Colonoscopy will be offered and organised for all FOBT- positive persons.

  12. Methods Anticipated numeric data of campaign: Total Croatian inhabitants - 4 600 000; aged 50–74 - 1 200 000. According screening results of other authors, it was expected that 4% FOBT positive cases would be found in normal risk population and model calculations pointed out a need for 24000 colonoscopies per year.

  13. From study will be excluded patients with: • already known CRC • other tumours spread to the colorectum • benigne tumours such as lipoma, fibroma, haemangioma... • already detected polyps who had undergone polypectomy and who are under regular follow-up

  14. Results • Distributed (since September 2007.) letters • (epidemiological questioner, FOBT tester)307.206 • Returned 23,3% 10,2 – 36,8% • Positive FOBT 9,1% 3,8 – 29,9% • Colonoscopy • already done2651 (compliance 70,3%)

  15. 36,8% 23,7% 23,4% 22,2% 26,0% 34,7% 30,0% 28,9% 31,2% 25,1% 16,8% 28,1% 25,0% 22,1% 29,0% 10,2% 20,0% 16,0% 25,8% 20,9% Fig. 3. Number of returned FOBT from different counties 23,3%

  16. Colonoscopy findings (Preliminary report) Normal 564 (21,3%) 10 – 42% Noduli haemorrh. 477 (17,8%) 14 – 32% Diverticulosis 318 (12,1) 8 – 34% Polyps928 (34,2%) 23 – 60% Cancers182 (4,1%) 2 –12%

  17. Conclusion • Characteristics of Croatian campaign in first year: • low percentage of returned FOBT • high number of pathologic findings (polyps and cancers) • Main problems: • very old population (population aged over 65ys) • low Programs budget • The ultimate goal: • to increase general awareness about CRC and the value of screening. • to increase compliance • to decreasing the fear from examination

  18. Public Health Institutes are responsible for Program coordination. • CRC Screening Program Committee • Prof. Dr. Milan Kujundžić – gastroenterologist (President) • Prof. Dr. Miroslava Katičić – gastroenterologist • Prof. Dr. Davor Štimac – gastroenterologist • Prof. Dr. Marija Strnad - epidemiologist • Prof. Dr. Mirko Šamija – oncologist • Prof. Dr. Zdravko Ebling – general practitioner • Doc. Dr. Nataša Antoljak – epidemiologist • Dr. Valerija Stamenić – Ministry od Health RC representative • Dr. Danica Kramarić – Ministry od Health RC representative

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