engleski

The implementation of the National Program of Prevention and Early Detection of Colorectal Cancer in the Osijek-baranja County, Croatia

Background Colorectal cancer (CRC) is the third most prevalent human cancer worldwide, with 1 million estimated new cases annually . In the year before the National Program started in Osijek-Baranya County incidence was 77.4/100, 000 and mortality was 40.8/100, 000. The National Program of Prevention and Early Detection of Colorectal Cancer started on 1st November 2007. The 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 the percentage of diagnosed pre-clinical and localised cancers. Method The screening method for early detection of colorectal cancer is the Faecal Occult Blood Test (FOBT). A 2 yearly examination protocol is being applied in the asymptomatic population at average risk, aged 50-74. The target population accounts approximately 70, 000 people. The county institute is responsible for the invitation organization, coordination and the monitoring of the action, collecting and evaluating the 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 an educational brochure to ensure invited people are informed on the screening. Invited people have been asked to mail applied testing-cards back together with a filled out questionnaire. People testing positive are invited for colonoscopy in the Clinical Hospital Center Osijek. Results A total of 66.374 invitation letters have been sent until the end of January 2011 to people born 1933-1945, and 1952- 1957. According to the preliminary results, responding rates are very low (average 20.2%, 28.3% maximum). The percent of FOBT positive tests is 10.1% in Osijek-Baranya County. From all colonoscopy results 91.5% are pathological (including ca, polyps, diverticula, hemorrhoids etc.). There are 57 newly discovered carcinomas (7, 4% of those who underwent colonoscopy), 396 polyps, 83 diverticula. Although the responding rates are lower than expected, the main problem is the long waiting period for colonoscopy examination, which is approximately 3 months. It is the result of an insufficient number of colonoscopy and other medical personnel who performed colonoscopy. The high proportion of incorrect mailing addresses, which means that part of the population does not receive their invitation, contributes to the low response rate. Certainly the lack of a media campaign affects the lower responding rates. Despite the efforts of the Ministry and the Institute locally, the program will last for 4, instead of the planned 2 years. Conclusions The screening program is an important tool in the early diagnosis of colorectal cancer. The first experiences justify the implementation of the National Programme, and the experience gained during implementation will serve to improve the implementation of this and similar prevention programs.

colorectal cancer; national program; screening

nije evidentirano