Current results of colorectal cancer screening and potential value of colon capsule endoscopy in the Czech Republic

Czech version

Authors: Ngo O. ^1,2; Chloupková R. ^1,2; Suchánek Š. ³; Zavoral M. ³; Dušek L. ^1,2; Májek O. ^1,2
Authors‘ workplace: Ústav zdravotnických informací a statistiky ČR, Praha ¹; Institut biostatistiky a analýz, LF MU, Brno ²; Interní klinika 1. LF UK a ÚVN – VFN Praha ³
Published in: Gastroent Hepatol 2019; 73(5): 387-391
Category: Gastrointestinal Oncology: Original Article
doi: https://doi.org/10.14735/amgh2019387

Overview

Backgrounds: In an international comparison, the Czech Republic has the highest incidence and mortality from colorectal cancer. A screening program is an essential part of prevention policy in the CR. Continuous monitoring of the screening process is essential to improve the quality of detection. The aim of the paper is to evaluate the performance of screening with respect to the potential value of colon capsule endoscopy.

Material and Methods: Data on preventive colonoscopies and data from health insurance companies to 2018 were used to evaluate key performance indicators with respect to colon capsule endoscopy, such as fecal ocult blood test (FOBT) positivity, positive predictive value of FOBT, and waiting time for colonoscopy after a positive test.

Results: Since 2014, the number of preventive colonoscopies has increased. The low positive predictive value of FOBT (about 40%) may be associated with high FOBT positivity (about 6–7%) and possibly unnecessary colonoscopies. These facts were associated with a significant increase in waiting times for follow-up colonoscopy after a positive test.

Conclusion: The evaluation of the performance indicators of FOBT and follow-up colonoscopies confirmed the relatively low positive predictive value of FOBT. Many colonoscopies have been therefore performed unnecessarily. Colon capsule endoscopy, which could be used as a „filter” test in individuals with a positive FOBT, may have the potential to reduce the number of colonoscopies required.

Keywords:

colonoscopy – colorectal cancer – mass screening – performance indicators – colon capsule endoscopy

Sources

1. Ferlay J, Ervik M, Lam F et al. Global cancer observatory: cancer today. [online]. Available from: https: //gco.iarc.fr/today.

2. Dušek L, Mužík J, Kubásek M et al. Epidemiologie zhoubných nádorů v České republice. [online]. Available from: http: //www.svod.cz.

3. Kim PJ, Plescia J, Clevers H et al. Survivin and molecular pathogenesis of colorectal cancer. Lancet 2003; 362 (9379): 205–209. doi: 10.1016/S0140-6736 (03) 13910-4.

4. Stewart BW, Wild C (eds). World Cancer report 2014. Lyon: International Agency for Research on Cancer 2014.

5. Official Journal of the European Union 2003. European Council. Council Recommendation of 2 December 2003 on cancer screening. [online]. Available from: http: //eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri= OJ: L: 2003: 327: 0034: 0038: EN: PDF.

6. Zavoral M, Suchanek S, Zavada F et al. Colorectal cancer screening in Europe. World J Gastroenterol 2009; 15 (47): 5907–5915. 10.3748/ wjg.15.5907.

7. Ponti A, Anttila A, Ronco G. Cancer screening in the European Union (2017). Report of the implementation of the council Recommendation on cancer screening. Inernational Agency for Research on Cancer 2017. [online]. Available from: https: //screening.iarc.fr/EUreport.php.

8. Suchanek S, Majek O, Vojtechova G et al. Colorectal cancer prevention in the Czech Republic: time trends in performance indicators and current situation after 10 years of screening. Eur J Cancer Prev 2014; 23 (1): 18–26. doi: 10.1097/CEJ.0b013e328364f203.

9. van Rossum LG, van Rijn AF, Laheij RJ et al. Random comparison of guaiac and immunochemical fecal occult blood tests for colorectal cancer in a screening population. Gastroenterology 2008; 135 (1): 82–90. doi: 10.1053/j.gastro.2008.03.040.

10. Grega T, Májek O, Ngo O et al. Současné principy screeningu kolorektálního karcinomu – od oportunního k populačnímu screeningovému programu. Gastroent Hepatol 2016; 70 (5): 383–392. doi: 10.14735/amgh2016 383.

11. Zavoral M, Vojtěchová G, Májek O et al. Population colorectal cancer screening in the Czech Republic. Cas Lek Cesk 2016; 155 (1): 7–12.

12. Ngo O, Bučková B, Suchánek Š et al. Účast české populace na screeningu kolorektálního karcinomu – vývoj a aktuální stav. Gastroent Hepatol 2017; 71 (5): 377–383. doi: 10.14735/amgh2017377.

13. Dušek L, Májek O, Blaha M et al. Koncepce populačního screeningu v České republice, metodika a první výsledky adresného zvaní občanů do preventivních onkologických programů. Klin Onkol 2014; 27 (Suppl 2): 2S59–2S68. doi: 10.14735/amko20142S59.

14. Ngo O, Chloupková R, Ambrožová M et al. Evaluation of the personalized invitation of Czech citizens to screening programs. Časopis Lékařů Čes 2019; 158 (3–4): 147–150.

15. Segnan N, Patnick J, L von Karsa (eds). European guidelines for quality assurance in colorectal cancer screening and diagnosis. 1st ed. Luxembourg: Publications Office ot the European Union 2010.

16. OECD. Survival and mortality for colorectal cancer. In: Health at a Glance 2013. [online]. Available from: https: //www.oecd.org/els/health-systems/Health-at-a-Glance-2013.pdf.

17. Dušek L, Májek O, Mužík J et al. Epidemiologie a populační screening nádorů tlustého střeva a konečníku v ČR na podkladě nově dostupných dat. Gastroent Hepatol 2015; 69 (6): 509–517. doi: 10.14735/amgh2015 509.

18. Zavoral M, Suchanek S, Majek O et al. Colorectal cancer screening: 20 years of development and recent progress. World J Gastroenterol 2014; 20 (14): 3825–3834. doi: 10.3748/wjg.v20.i14.3825.

19. Kobaek-Larsen M, Kroijer R, Dyrvig AK et al. Back-to-back colon capsule endoscopy and optical colonoscopy in colorectal cancer screening individuals. Colorectal Dis 2018; 20 (6): 479–485. doi: 10.1111/codi.13965.

20. Holleran G, Leen R, O’Morain C et al. Colon capsule endoscopy as possible filter test for colonoscopy selection in a screening population with positive fecal immunology. Endoscopy 2014; 46 (6): 473–478. doi: 10.1055/s-0034-1365 402.

21. Rex DK, Adler SN, Aisenberg J et al. Accuracy of capsule colonoscopy in detecting colorectal polyps in a screening population. Gastroenterology 2015; 148 (5): 948–957. doi: 10.1053/j.gastro.2015.01.025.

22. Voška M, Grega T, Vojtěchová G et al. Porovnání účinnosti kolonické kapslové endoskopie a optické koloskopie u osob s pozitivním imunochemickým testem na okultní krvácení do stolice – multicentrická, prospektivní studie. Gastroenterol Hepatol 2018; 72 (4): 298–303. doi: 10.14735/amgh2018298.