engleski

One year of implementation of The National Program of Early Detection of Colorectal Cancer in the Osijek-Baranya County, Croatia

Background: Both colorectal cancer incidence and mortality rates, in Croatia, are on the increase. Currently, it is ranking second in both men (after lungs) and women (after breast) with the total incidence rate of 62.4/100, 000 (2006). High mortality-rates have been recorded (40.6/100, 000, 2006), probably due to a low percent (less than 10%) of newly diagnosed cases with localized lesions. In the Osijek-Baranya County (Eastern Region), more rapid increase in mortality rates, compared to the whole of Croatia, can be observed. The Osijek-Baranya County has a long-lasting experience in performing activities on primary prevention and early detection of colorectal cancer. The East region of Croatia has been faced with the devastating effects of the war and the overwhelming poverty in the post-war period. Based on unfavourable statistics, The Croatian Government has passed the Conclusion on The National Program of the Prevention and Early Detection of Colorectal Cancer, which has started on 1st November 2007. Main goals of the Program are: to decrease prevalence of risk factors in the population, to reduce mortality rates by 15% 5 years after the Program started and to increase percentage of diagnosed pre-clinical and localised cancers. Methods: Conventional screening method for the early detection of colorectal cancer Faecal Occult Blood Test (FOBT) by 2 yearly examination protocol is being applied in asymptomatic population at average risk, aged 50-74 years. Target population accounts approximately 1, 200, 000 persons ; 600, 000 persons are expected to be tested every year with minimum coverage of 60%. The Croatian Public Health Institute in collaboration with the county institutes is responsible for the invitation organization, coordination and the monitoring of the action, collecting and evaluation of data. Invitation letters have been sent by mail. In an envelope, there are three testing-cards together with instructions for their use, questionnaire about risk factors and educational brochure to ensure invited persons be informed on the screening. Invited persons have been asked to mail applied testing-cards back, together with filled questionnaire. Persons testing positive have been invited for colonoscopy in the nearest endoscopic unit. Results: A total of 206 000 invitation letters have been sent until the end of January 2009 to persons born 1933- 1937. According to preliminary results, responding rates are low (average 20.5%, 38.5% maximum) ; in the Osijek-Baranya County 22, 8%. Estimations are based on the total number of envelopes mailed back, while some samples are useless. The percent of FOBT positive tests is 9.7%, and 11, 8% in Osijek-Baranya County. There are 123 newly discovered carcinomas (5, 6% of those who underwent colonoscopy), 25 in Osijek-Baranya County, 653 polyps, 102 in Osijek-Baranya County, 266 diverticula, 28 in Osijek-Baranya County. Conclusions: Initial analyses indicate a weak response, therefore, the activities which motivate the population for being tested, must be intensified. In order to achieve that, it is required to improve the collaboration with family doctors, a more intensive media campaign and simplified instructions. In order to maintain monitoring, appropriate software is necessary, currently it is inadequate.

Colorectal cancer; Early detection; National health program; Croatia

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