engleski

First results of national screening program for colorectal cancers in Republic Croatia

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. The incidence rate CRC/100 000 inhabitants - 65/100 000 (2005), and 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 and at advanced stage with poor prognosis. Five-years relative survival is 49% for men and 50% for women. Methods: National screening program for colorectal cancers started in September 2007. Study population: all inhabitants of Republic Croatia aged 50 – 75 who are at an average risk for CRC. Campaign targets: 1. Reducing colorectal cancer mortality 2. Cancer detection ; 3. Detection and cure all precancerous colorectal lesions ; 4. Detection of other colorectal diseases characterized by occult bleeding ; 5. Compliance of 60%. Plan of investigation: In the first two years the questionnaire (and FOBT) will be distributed to all people in Republic Croatia aged between 50 and 75 ys. Colonoscopy will be offered and organised for all FOBT- positive persons. For all FOBT-negative people, new FOBT and colonoscopy for positive patients will be repeated every two years. Anticipated numeric data of campaign: Total Croatian inhabitants - 4 600 000 ; aged 50– 74 - 1 200 000. Public Health Institutes are responsible for Program coordination. From September to February - distributed over 93.312 pcs. Returned from different counties: 23, 3% (10, 2 – 36, 6%) ; positive FOBT: 10, 9% (3, 8 – 32, 9%) ; Colonoscopy ordered 1559 ; already done 1062 ; canceled 219 ; Colonoscopy findings (preliminary report): Normal finding: 407 (38, 3%) ; Pathological findings (mostly polyps): 638 (58, 9%) ; Cancers: 58 (5, 5%). Characteristics of Croatian campaign in those first ten months showed low percentage of returned FOBT, with high number of pathologic findings (polyps and cancers). Main problems: very old population (we started with population aged 74 and 70 ys) and low Programs budget. The ultimate goal is to increase general awareness about CRC and the value of screening. That would increase compliance among people while decreasing the fear from examination. In that way colonoscopy would become an ordinary and acceptable diagnostic method as it is already for example mammography in breast cancer screening program.

CRC; National screening programm

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