engleski

National Colorectal Cancer Screening Program in Croatia (2007-2010)

Introduction: Colorectal cancer (CRC) is a major public health burden among malignant diseases worldwide affecting over 1 million people each year. In Croatia it is the second cause of cancer mortality in men (N=1063, 49.77/100.000), as well as women (N=803, 34.89/100.000) in 2009. There is clear evidence that early detection and removal of CRC or its precursor lesions by population screening can reduce mortality and improve outcomes. In almost all of the developed EU countries some screening programs are organized. Methods: Croatian National population program for CRC screening was established by the Ministry of Health and Social Welfare and its implementation started at September, 2007. The coordinators in each county institute of public health are obliged to ensure performing of fecal occult blood testing (FOBT), followed by colonoscopy in all positive cases. The FOBT is performed by hypersensitive guaiac-based Hemognost card test with detection limit of 0.2 ml blood in 500 g of stool. The test and short questionnaire are delivered to home addresses of all citizens age 50–74 consecutively during two years. Each participant is required to fulfill the questionnaire, and send it together with the stool specimen on 3 test cards back to the institute for further analysis. According to 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. Results: Till the end of 2010 total of 1056694 individuals were invited to screening (born between 1933-1945. and 1952-1957.). 203 846 persons (19.3%) returned envelope with fulfilled questionnaire and 178 570 of them returned correctly done FOB test cards. Until now, 12 523 positive FOBT patients were found (7.2%). Colonoscopy was performed in 7 736 cases (compliance 62%). Screening has identified colorectal cancers in 462 patients (3.6% of FOBT-positive and 0.26% of all screened individuals). Polyps were found and removed in 3089 (39% of FOBT-positive) patients. Conclusion: Characteristics of Croatian CRC National program in first three years were: low percentage of returned FOBT, higher number of FOBT-positive tests than usually can be expected in normal population, and very high number of pathologic findings (polyps and cancers). These results suggest a need for further strengthening of Croatian CRC screening National program. Successful intervention strategies include organizational changes, improving colonoscopy network, providing reminders to users about screening opportunities, educational strategies to improve awareness of usefulness of CRC screening and multifactor interventions aimed at increasing participation rates.

CRC; National screening program; Croatia

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