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Stracci F, Ferrante M, Caldarella A, Francisci S, Fusco M, Gatta G, Serraino D, Mantovani W, Mazzucco W. Challenges of cancer registration and epidemiology in Italy. Cancer Epidemiol 2025; 96:102804. [PMID: 40132275 DOI: 10.1016/j.canep.2025.102804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2025] [Accepted: 03/13/2025] [Indexed: 03/27/2025]
Abstract
We outline the history and role of cancer registration in Italy. Since the '70s, local population-based registries were established, representing up to nowadays a valuable national surveillance network. In this framework, the Italian Association of Cancer Registries (AIRTUM) has been playing a central role, ensuring high data quality standards and supporting cancer registry-based research. Over the years, difficulties for cancer registration arose due to a strict and non-uniform application of data protection rules, to the gap in digitalization of health data primary sources, which feed population-based cancer registries (PBCRs), and, more recently, to the impact of COVID-19 pandemic. Indeed, the COVID-19 pandemic in Italy affected not only cancer surveillance but also cancer screening and access to care. Despite the above-mentioned limitations, an unprecedented coverage of cancer surveillance on the Italian population (about 80 %) was reached for the present study, representing a substantial contribution in the perspective of the long-lasting establishment of a national cancer registry. This commentary introduces a series of manuscripts updating the landscape of descriptive cancer epidemiology, highlighting at the same time the challenges of cancer registration, in Italy.
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Affiliation(s)
- Fabrizio Stracci
- Italian Network of Cancer Registries (AIRTUM), Italy; Public Health Section - Department of Medicine and Surgery University of Perugia, Perugia, Italy.
| | - Margherita Ferrante
- Italian Network of Cancer Registries (AIRTUM), Italy; Integrated Cancer Registry Catania-Messina-Enna, Hospital Hygiene, University Hospital G. Rodolico-San Marco, Via Santa Sofia 87, Catania 95123, Italy
| | - Adele Caldarella
- Italian Network of Cancer Registries (AIRTUM), Italy; Tuscany Cancer Registry - Clinical Epidemiology Unit Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Villa delle Rose Via Cosimo il Vecchio, 2, Florence 50139, Italy
| | - Silvia Francisci
- Italian Network of Cancer Registries (AIRTUM), Italy; National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità, Rome 00161, Italy
| | - Mario Fusco
- Italian Network of Cancer Registries (AIRTUM), Italy; Regional Reference Center for the Cancer Registry of the Campania Region, Italy
| | - Gemma Gatta
- Italian Network of Cancer Registries (AIRTUM), Italy; Evaluative Epidemiology Unit, Department of Epidemiology and Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Diego Serraino
- Italian Network of Cancer Registries (AIRTUM), Italy; CSOC Epidemiologia Oncologica, Centro di Riferimento Oncologico di Aviano CRO, IRCCS, Aviano, Italy
| | - William Mantovani
- Italian Network of Cancer Registries (AIRTUM), Italy; Department of Clinical and Evaluative Epidemiology, Healthcare Trust of Trento, Italy
| | - Walter Mazzucco
- Scientific Committee of the Italian Network of Cancer Registries (AIRTUM), Italy; Clinical Epidemiology and Cancer Registry Unit, Palermo University Hospital, Italy; PROMISE Department, University of Palermo, Italy
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Senore C, Doubeni C, Guittet L. FIT as a Comparator for Evaluating the Effectiveness of New Non-invasive CRC Screening Test. Dig Dis Sci 2025; 70:1625-1636. [PMID: 39560807 DOI: 10.1007/s10620-024-08718-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2024] [Accepted: 10/24/2024] [Indexed: 11/20/2024]
Abstract
Randomized Controlled Trials (RCT) demonstrated that guaiac-based fecal occult blood test (gFOBT), sigmoidoscopy, or colonoscopy are effective at reducing colorectal cancer (CRC) risk and mortality. Even if the impact of fecal immunochemical test (FIT) has not been evaluated within population-based RCT with mortality as the outcome, the results of comparative analyses with gFOBT provide strong indirect evidence of its effectiveness. Extensive information is also available on sensitivity and specificity of FIT, compared with gFOBT. FIT has almost universally replaced gFOBT in organized screening programs worldwide. Using FIT as a comparator is an efficient way to evaluate the effectiveness of new tests, with respect to test performance and relevant intermediate outcomes such as rates of interval cancer and late-stage cancer incidence. Direct comparison with FIT in the pre-screening evaluation of the accuracy of the new test will guide selection of the cut-off of the new test, and document the potential gain in sensitivity. Comparison in cross-sectional single-round screening evaluation can either use paired or parallel designs. Only parallel designs allow direct comparisons of participation rates. Relative accuracy can be derived in both designs with an assumption of similar colorectal cancer and precursor prevalence between groups in parallel designs. Finally, multiple-rounds prospective comparison will document potential effect on risk of CRC and precancerous lesions, and on absolute reductions in late-stage incidence as a proxy of mortality. This paper provides an overview of evidence and rationale for using FIT as a comparator for evaluating new non-invasive tests with repeated testing at short intervals.
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Affiliation(s)
- Carlo Senore
- Epidemiology and Screening Unit, CPO, University hospital Città della Salute e della Scienza, Turin, Italy
| | - Chyke Doubeni
- Department of Family and Community Medicine, Comprehensive Cancer Center-The James Cancer Hospital, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Lydia Guittet
- CHU Caen Normandie, INSERM ANTICIPE U1086, Université Caen Normandie, 14000, Caen, France.
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Mangone L, Marinelli F, Bisceglia I, Braghiroli MB, Banzi M, Damato A, Iori V, Pinto C, Cerullo L, Pellegri C, Zizzo M, Morabito F, Neri A, Giorgi Rossi P. Characteristics and Outcomes of Colorectal Cancer Patients Cared for by the Multidisciplinary Team in the Reggio Emilia Province, Italy. Cancers (Basel) 2024; 16:2390. [PMID: 39001450 PMCID: PMC11240821 DOI: 10.3390/cancers16132390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 06/25/2024] [Accepted: 06/27/2024] [Indexed: 07/16/2024] Open
Abstract
Colorectal cancer emerged as the third most prevalent malignancy worldwide, affecting nearly 2 million individuals in the year 2020. This study elucidates the pivotal role of a multidisciplinary team (MDT) in influencing the prognosis, as measured by relative survival rates, depending upon the stage and age. Cases recorded in an Italian Cancer Registry between 2017 and 2018 were included. Relative survival was reported at 1 and 3 years after diagnosis comparing MDT vs. no-MDT approaches. During the study period, 605 CRCs were recorded while 361 (59.7%) were taken care of by an MDT. Compared to no-MDT, MDT patients were younger with earlier stages and received more surgery. One year after diagnosis, survival was 78.7% (90% in MDT vs. 62% in no-MDT); stratifying by stage, in the MDT group there was no survival advantage for stage I (97.2% vs. 89.9%) and II (96.8% vs. 89.4%), but an advantage was observed for stage III (86.4% vs. 56.9%) and stage IV (63.7% vs. 27.4%). Similar values were observed at 3 years where a marked advantage was observed for stages III (69.9% vs. 35.1%) and IV (29.2% vs. 5.1%). The univariable analysis confirmed an excess risk in the no-MDT group (HR 2.6; 95% CI 2.0-3.3), also confirmed in the multivariable regression analysis (HR 2.0; 95% CI 1.5-2.5). Despite the increase in the number of MDT patients in 2018 (from 50% to 69%), this does not correspond to an improvement in outcome.
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Affiliation(s)
- Lucia Mangone
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (F.M.); (I.B.); (M.B.B.); (P.G.R.)
| | - Francesco Marinelli
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (F.M.); (I.B.); (M.B.B.); (P.G.R.)
| | - Isabella Bisceglia
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (F.M.); (I.B.); (M.B.B.); (P.G.R.)
| | - Maria Barbara Braghiroli
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (F.M.); (I.B.); (M.B.B.); (P.G.R.)
| | - Maria Banzi
- Medical Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy (A.D.); (C.P.)
| | - Angela Damato
- Medical Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy (A.D.); (C.P.)
| | - Veronica Iori
- Unit of Gastroenterology and Digestive Endoscopy, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy;
| | - Carmine Pinto
- Medical Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy (A.D.); (C.P.)
| | - Loredana Cerullo
- Quality and Accreditation Office, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (L.C.); (C.P.)
| | - Carlotta Pellegri
- Quality and Accreditation Office, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (L.C.); (C.P.)
| | - Maurizio Zizzo
- Unit of Surgical Oncology, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy;
| | - Fortunato Morabito
- Gruppo Amici Dell’Ematologia Foundation-GrADE, 42123 Reggio Emilia, Italy;
| | - Antonino Neri
- Scientific Directorate, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy;
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (F.M.); (I.B.); (M.B.B.); (P.G.R.)
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Kooyker A, de Jonge L, Toes-Zoutendijk E, Spaander M, van Vuuren H, Kuipers E, van Kemenade F, Ramakers C, Dekker E, Nagtegaal I, van Leerdam M, Lansdorp-Vogelaar I. Colorectal Cancer Stage Distribution at First and Repeat Fecal Immunochemical Test Screening. Clin Gastroenterol Hepatol 2023; 21:3424-3432.e2. [PMID: 37619823 DOI: 10.1016/j.cgh.2023.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND & AIMS For colorectal cancer (CRC) screening to be effective, it is important that screen-detected cancers are found at an early stage. Studies on stage distribution of screen-detected CRC at repeat screening of large population-based fecal immunochemical test (FIT)-based screening programs and the impact of FIT cut-off values on staging currently are lacking. METHODS We obtained data for FIT-positive participants (FIT cut-off, 47 μg hemoglobin/g feces) at their first or second (ie, repeat) screening from the Dutch National Screening Database from 2014 to 2018. Tumor characteristics were acquired through linkage with The Netherlands Cancer Registry. We compared stage at diagnosis (I-II vs III-IV) of CRCs detected at a first or second screening. In addition, we analyzed the hypothetical yield and stage distribution of CRC for different FIT cut-off values up to 250 μg hemoglobin/g feces. RESULTS At the first and second screenings, respectively, 15,755 and 3304 CRCs were detected. CRCs detected at the first or second screening were equally likely to be stages I to II (66.5% vs 67.7%; relative risk, 1.02; 95% CI, 1.00-1.05). A hypothetical increase of the FIT cut-off value from 47 μg to 250 μg resulted in a reduction of detected CRCs by 88.3% and 79.0% at the first or second screening, respectively. Even then, the majority of detected CRCs (63%-64%) still would be diagnosed at stages I to II. CONCLUSIONS FIT-based screening is effective in downstaging CRC, and also at repeat screening. Increasingly, the FIT cut-off level has a limited impact on the stage distribution of detected CRCs, although it greatly affects CRC detection and thus is important to keep low.
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Affiliation(s)
- Arthur Kooyker
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands.
| | - Lucie de Jonge
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Esther Toes-Zoutendijk
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Manon Spaander
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Hanneke van Vuuren
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ernst Kuipers
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Folkert van Kemenade
- Department of Pathology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Chris Ramakers
- Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, The Netherlands
| | - Iris Nagtegaal
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Monique van Leerdam
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands; Department of Gastrointestinal Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
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Zorzi M, Battagello J, Barbiellini Amidei C. Reply: Immortal time bias in a retrospective study examining colorectal cancer mortality according to adherence to colonoscopy. Gut 2023; 72:2190-2192. [PMID: 36332970 DOI: 10.1136/gutjnl-2022-328905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Manuel Zorzi
- Veneto Tumour Registry, Azienda Zero, Padova, Italy
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Wong MCS, Huang J, Liang PS. Is the practice of colorectal cancer screening questionable after the NordICC trial was published? Clin Transl Med 2023; 13:e1365. [PMID: 37792640 PMCID: PMC10550029 DOI: 10.1002/ctm2.1365] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/06/2023] [Indexed: 10/06/2023] Open
Affiliation(s)
- Martin C. S. Wong
- Centre for Health Education and Health PromotionJC School of Public Health and Primary CareFaculty of MedicineThe Chinese University of Hong KongHong KongChina
| | - Junjie Huang
- Centre for Health Education and Health PromotionJC School of Public Health and Primary CareFaculty of MedicineThe Chinese University of Hong KongHong KongChina
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7
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Krul MF, Elferink MAG, Kok NFM, Dekker E, Lansdorp-Vogelaar I, Meijer GA, Nagtegaal ID, Breekveldt ECH, Ruers TJM, van Leerdam ME, Kuhlmann KFD. Initial Impact of National CRC Screening on Incidence and Advanced Colorectal Cancer. Clin Gastroenterol Hepatol 2023; 21:797-807.e3. [PMID: 36116753 DOI: 10.1016/j.cgh.2022.08.046] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 08/24/2022] [Accepted: 08/26/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Screening for colorectal cancer (CRC) aims to decrease CRC incidence and mortality. Biennial fecal immunochemical test screening started in the Netherlands in 2014 for individuals 55-75 years of age. This study investigated the effect of screening on stage-specific incidence, with focus on stage III and IV CRC. METHODS Inhabitants diagnosed with CRC in 2009-2018 were included. CRC incidence per stage, year, and detection method (ie, screen-detected vs clinically detected) was evaluated. Patient, tumor, and treatment characteristics, and survival of patients with stage III and IV CRC, were compared according to the detection method. RESULTS Included were 140,649 CRCs in 136,882 patients. An initial peak of stage I-III CRC diagnoses after initiation of screening was followed by a continuous decrease within screening-eligible ages. Total CRC incidence remained higher than before screening, although stage II and IV CRC incidence decreased below prescreening levels. Screen-detected CRCs were significantly more frequently located in the left-sided colon (stage III; 43.7% vs 30.9%; stage IV: 45.1% vs 36.1%), and the primary tumor resection rate was higher (stage III colon: 99.8% vs 99.0%, rectum: 97.3% vs 89.7%; stage IV colon: 65.4% vs 56.6%, rectum: 47.3% vs 33.5%). Patients with screen-detected stage IV CRC had significantly more often single-organ metastases (74.5% vs 57.0%; P < .001) and more frequently received treatment with curative intent (colon: 41.3% vs 27.4%; rectum: 33.8% vs 24.6%). Overall survival significantly improved for patients with screen-detected CRCs (stage III: P < .001; stage IV: P < .001). CONCLUSIONS Five years after the start of a nationwide CRC screening program, a decrease in stage II and IV CRC incidence was observed. Patients with screen-detected stage III and stage IV CRC had less extensive disease and improved survival compared with those with clinically detected CRC.
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Affiliation(s)
- Myrtle F Krul
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
| | - Marloes A G Elferink
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands
| | - Niels F M Kok
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Gerrit A Meijer
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Iris D Nagtegaal
- Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Emilie C H Breekveldt
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Gastroenterology and Hepatology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Theo J M Ruers
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Monique E van Leerdam
- Department of Gastroenterology and Hepatology, Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Koert F D Kuhlmann
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
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Zorzi M, Urso EDL. Impact of colorectal cancer screening on incidence, mortality and surgery rates: Evidences from programs based on the fecal immunochemical test in Italy. Dig Liver Dis 2023; 55:336-341. [PMID: 35999134 DOI: 10.1016/j.dld.2022.08.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 07/25/2022] [Accepted: 08/01/2022] [Indexed: 12/24/2022]
Abstract
Fecal immunochemical tests (FIT) are among the most commonly used tests for colorectal cancer (CRC) screening programs worldwide. However, no randomised controlled trials have been carried out evaluating the impact of FIT-based screening programs (FIT-progr) on CRC incidence and mortality rates. Italian FIT-progr represent one of the most widespread and established experience worldwide. This paper reviews the evidence on the impact of FIT-progr on CRC incidence, tumor stage at diagnosis, mortality and surgery rates, deriving from Italian routine programs, i.e., outside the research setting. Unfortunately, the application of FIT-progr in Italy can be considered as an unplanned experimental model, due to the differences between Regions, both in health system management and adherence of the target population to the screening programs. The analysis of the manuscripts considered in the review, confirms that FIT-progr are effective in reducing CRC incidence and mortality rates and in improving the rate of endoscopic treatment of early invasive lesions. The review also highlights that FIT-progr are less performing for proximal colon than for distal colon and rectum.
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Affiliation(s)
- Manuel Zorzi
- Veneto Tumour Registry, Azienda Zero, Passaggio Gaudenzio 1, Padua 35131, Italy
| | - Emanuele Damiano Luca Urso
- Chirurgia Generale 3^, Department of Surgical, Oncological and Gastroenterological, Sciences, University of Padua, Via Giustiniani 2, Padua 35121, Italy.
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Tran TN, Hoeck S, De Schutter H, Janssens S, Peeters M, Van Hal G. The Impact of a Six-Year Existing Screening Programme Using the Faecal Immunochemical Test in Flanders (Belgium) on Colorectal Cancer Incidence, Mortality and Survival: A Population-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1654. [PMID: 36674409 PMCID: PMC9864341 DOI: 10.3390/ijerph20021654] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/08/2023] [Accepted: 01/13/2023] [Indexed: 06/17/2023]
Abstract
The faecal immunochemical test (FIT) has been increasingly used for organised colorectal cancer (CRC) screening. We assessed the impact of a six-year existing FIT screening programme in Flanders (Belgium) on CRC incidence, mortality and survival. The Flemish CRC screening programme started in 2013, targeting individuals aged 50-74 years. Joinpoint regression was used to investigate trends of age-standardised CRC incidence and mortality among individuals aged 50-79 years (2004-2019). Their 5-year relative survival was calculated using the Ederer II method. We found that FIT screening significantly reduced CRC incidence, especially that of advanced-stage CRCs (69.8/100,000 in 2012 vs. 51.1/100,000 in 2019), with a greater impact in men. Mortality started to decline in men two years after organised screening implementation (annual reduction of 9.3% after 2015 vs. 2.2% before 2015). The 5-year relative survival was significantly higher in screen-detected (93.8%) and lower in FIT non-participant CRCs (61.9%) vs. FIT interval cancers and CRCs in never-invited cases (67.6% and 66.7%, respectively). Organised FIT screening in Flanders clearly reduced CRC incidence (especially advanced-stage) and mortality (in men, but not yet in women). Survival is significantly better in screen-detected cases vs. CRCs in unscreened people. Our findings support the implementation of FIT organised screening and the continued effort to increase uptake.
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Affiliation(s)
- Thuy Ngan Tran
- Centre for Cancer Detection, 8000 Bruges, Belgium
- Family Medicine and Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
| | - Sarah Hoeck
- Centre for Cancer Detection, 8000 Bruges, Belgium
- Family Medicine and Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
| | | | - Sharon Janssens
- Research Department, Belgian Cancer Registry, 1210 Brussels, Belgium
| | - Marc Peeters
- Department of Oncology, Antwerp University Hospital, 2650 Edegem, Belgium
- Integrated Personalized & Precision Oncology Network (IPPON), University of Antwerp, 2610 Antwerp, Belgium
| | - Guido Van Hal
- Centre for Cancer Detection, 8000 Bruges, Belgium
- Family Medicine and Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
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10
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Mazzucco W, Stracci F, Gatta G, D’Argenzio A, Bidoli E, Carone S, Vitarelli S, Castelli M, Fruscione S, Vitale F. Cancer registries and data protection in the age of health digital interoperability in Europe: The perspective of the Italian Network of Cancer Registries (AIRTUM). Front Oncol 2022; 12:1052057. [PMID: 36561514 PMCID: PMC9763571 DOI: 10.3389/fonc.2022.1052057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- Walter Mazzucco
- Department of Oncology and Public Health, Executive Board of the Italian Network of Cancer Registries (AIRTUM), Milan, Italy
- Clinical Epidemiology Unit and Palermo Province Cancer Registry, University Hospital “P. Giaccone”, Palermo, Italy
- College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Fabrizio Stracci
- Department of Oncology and Public Health, Executive Board of the Italian Network of Cancer Registries (AIRTUM), Milan, Italy
- Umbria Regional Cancer Registry, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Gemma Gatta
- Department of Oncology and Public Health, Executive Board of the Italian Network of Cancer Registries (AIRTUM), Milan, Italy
- Research Department, IRCCS Foundation National Institute Tumor, Milan, Italy
| | - Angelo D’Argenzio
- Department of Oncology and Public Health, Executive Board of the Italian Network of Cancer Registries (AIRTUM), Milan, Italy
- Regional Epidemiological Observatory - Campania Region, Naples, Italy
| | - Ettore Bidoli
- Department of Oncology and Public Health, Executive Board of the Italian Network of Cancer Registries (AIRTUM), Milan, Italy
- Friuli-Venezia-Giulia Regional Cancer Registry, IRCCS Oncological Reference Centre of Aviano (CRO), Aviano, Italy
| | - Simona Carone
- Department of Oncology and Public Health, Executive Board of the Italian Network of Cancer Registries (AIRTUM), Milan, Italy
- Apulia Regional Cancer Registry, Local health agency of Taranto, Taranto, Italy
| | - Susanna Vitarelli
- Department of Oncology and Public Health, Executive Board of the Italian Network of Cancer Registries (AIRTUM), Milan, Italy
- Marche Regional Cancer Registry, University of Camerino, Camerino, Italy
| | - Maurizio Castelli
- Department of Oncology and Public Health, Executive Board of the Italian Network of Cancer Registries (AIRTUM), Milan, Italy
- Valle d’Aosta Cancer Registry, Local health agency of Valle d’Aosta, Aosta, Italy
| | - Santo Fruscione
- Clinical Epidemiology Unit and Palermo Province Cancer Registry, University Hospital “P. Giaccone”, Palermo, Italy
| | - Francesco Vitale
- Clinical Epidemiology Unit and Palermo Province Cancer Registry, University Hospital “P. Giaccone”, Palermo, Italy
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11
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Mangone L, Marinelli F, Bisceglia I, Braghiroli MB, Damato A, Pinto C. Five-year relative survival by stage of breast and colon cancers in northern Italy. Front Oncol 2022; 12:982461. [PMID: 36387150 PMCID: PMC9659859 DOI: 10.3389/fonc.2022.982461] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/13/2022] [Indexed: 11/30/2022] Open
Abstract
The aim of this study is to present the 5-year relative survival by stage of breast and colorectal cancer patients in a northern Italian province. For the period 2013-2015, cases were selected from the Reggio Emilia Cancer Registry. Breast cancer patients were divided into 3 age groups: <45, 45-74 (the target screening population) and 74+. Colorectal cancers patients were classified into <50, 50-69 (the target screening population), and over 69 years. Carcinomas in situ and unknown stage were both excluded from the survival analyses. The five-year relative survival was estimated using the Pohar Perme method. During the period examined, 1,450 breast cancers and 992 colorectal cancer cases were registered. Analyzing in detail the patients with breast cancer for the entire 2013-2015 period, we noted that 50.4% were in stage I, 33.6% in stage II, 10.8% in stage III and 3.8% in stage IV. The stage was unknown in only 1.3% of patients (19 cases). The stage data of patients with colorectal cancer showed 24.5% were in stage I, 26.1% in stage II, 23.4% in stage III, and 24.6% in stage IV, and 1.4% unknown. Breast cancer 5-year survival was 100%, 89.7%, 71.4%, and 29.1% for stages I, II, III and IV, respectively and for colon cancer 96.7%, 83.4%, 70.8% and 16.2%, respectively.The presence of cancer screening, associated with effective treatments, account for the high survival rate of early-stage breast and colon cancers.
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Affiliation(s)
- Lucia Mangone
- Epidemiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Via Amendola 2, Reggio Emilia, Italy
- *Correspondence: Lucia Mangone,
| | - Francesco Marinelli
- Epidemiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Via Amendola 2, Reggio Emilia, Italy
| | - Isabella Bisceglia
- Epidemiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Via Amendola 2, Reggio Emilia, Italy
| | - Maria Barbara Braghiroli
- Epidemiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Via Amendola 2, Reggio Emilia, Italy
| | - Angela Damato
- Medical Oncology Unit, Comprehensive Cancer Center, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Viale Risorgimento 80, Reggio Emilia, Italy
- Department of Biotechnologies, University of Siena, Siena, Italy
| | - Carmine Pinto
- Medical Oncology Unit, Comprehensive Cancer Center, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Viale Risorgimento 80, Reggio Emilia, Italy
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Pancheri S, Pertile R, Armelao F, Rizzello RV, Piffer S, Zorzi M, Guzzinati S, Ferro A, Mantovani W, de Pretis G. A comprehensive assessment of the impact of a colorectal cancer screening program in a northern Italian area. Dig Liver Dis 2022; 54:400-406. [PMID: 33853757 DOI: 10.1016/j.dld.2021.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/03/2021] [Accepted: 03/11/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The impact of a faecal immunochemical test-based colorectal cancer (CRC) screening program in terms of patient prognosis could be affected by lead-time bias, which artificially increases the survival of screen-detected patients due to the early diagnosis. AIMS To provide a description of the impact of the CRC screening program in the Trentino Region (Italy), including the Cure Fraction (CF), a prognostic indicator not affected by lead-time bias. METHODS The program started in 2008, inviting the resident population aged 50-69 years. In this retrospective cohort study, 1,697 CRC diagnosed between 2003 and 2014 in patients aged 50-69 years were classified as pre-screening (PS), screen-detected (SD), interval cancers (IC) and not-screen-detected (NSD). We compared groups by stage at diagnosis and CF. Trends in CRC mortality were reported. RESULTS The proportion of stage I among SD cases was 51%, higher than PS (19%; OR 4.66, 95%CI 3.50-6.20), NSD (20.6%; OR 3.96, 95%CI 2.95-5.32) and IC (33.3%; OR 2.11, 95%CI 1.10-4.04). The CF of PS, NSD and SD cases was respectively 57% (95%CI 54-60%), 60% (95%CI 58-63%) and 93% (95%CI 89-96%). CRC mortality dropped from 40.7 to 25.6\100,000. CONCLUSION The program significantly improved the prognosis of patients, decreasing CRC mortality and incidence of advanced CRCs.
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Affiliation(s)
- Serena Pancheri
- Governance Department, Azienda Provinciale per i Servizi Sanitari, Viale Degasperi 79, Trento Italy
| | - Riccardo Pertile
- Department of Clinical and Evaluative Epidemiology, Azienda Provinciale per i Servizi Sanitari, Viale Verona, Trento, Italy
| | - Franco Armelao
- Gastroenterology Department, Azienda Provinciale per i Servizi Sanitari, Largo Medaglie d'Oro, Trento 38123, Italy.
| | - Roberto Vito Rizzello
- Department of Clinical and Evaluative Epidemiology, Azienda Provinciale per i Servizi Sanitari, Viale Verona, Trento, Italy
| | - Silvano Piffer
- Department of Clinical and Evaluative Epidemiology, Azienda Provinciale per i Servizi Sanitari, Viale Verona, Trento, Italy
| | - Manuel Zorzi
- Veneto Tumour Registry, Azienda Zero, Padova, Italy
| | | | - Antonio Ferro
- Department of Prevention, Azienda Provinciale per i Servizi Sanitari, Viale Verona, Trento, Italy
| | - William Mantovani
- Department of Prevention, Azienda Provinciale per i Servizi Sanitari, Viale Verona, Trento, Italy
| | - Giovanni de Pretis
- Gastroenterology Department, Azienda Provinciale per i Servizi Sanitari, Largo Medaglie d'Oro, Trento 38123, Italy
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13
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Luu XQ, Lee K, Jun JK, Suh M, Jung KW, Choi KS. Effect of colorectal cancer screening on long-term survival of colorectal cancer patients: Results of the Korea National Cancer Screening Program. Int J Cancer 2022; 150:1958-1967. [PMID: 35099813 DOI: 10.1002/ijc.33953] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/27/2021] [Accepted: 01/13/2022] [Indexed: 11/08/2022]
Abstract
The Korea National Cancer Screening Program (KNCSP) provides fecal immunochemical test-based colorectal cancer (CRC) screening for people aged ≥50 years. This study aimed to investigate the long-term survival effects of CRC screening based on screening history and interval time since screening. The study cohort was obtained by linking three national databases, namely the Korea Central Cancer Registry, KNCSP database, and Death Certificate. We included 32 509 CRC patients diagnosed in 2008-2009, who underwent CRC screening via the KNCSP between 2004 and 2009. The patients were followed-up until 2019, and their survival was assessed according to their CRC screening history. Cox proportional hazards regression was used to compare time to deaths among CRC patients according to CRC screening history, after adjusting for covariates. Of the 32 509 patients, 20 022 (61.5%) patients were alive by the end of 2019. Long-term survival was significantly higher among screened patients (68.2%) than non-screened (57.2%) individuals. Compared with never-screened patients, the hazard ratio (HR) for CRC-specific death in screened patients was 0.77 (95% CI%, 0.73-0.80). Lowest HR was observed in screened, localized CRC patients (HR, 0.48; 95% CI, 0.42-0.56); HR for CRC-specific death was the lowest in patients screened within 12 months of diagnosis (HR, 0.70; 95% CI, 0.66-0.74), following which, the HRs increased with increasing time interval. CRC screening was positively associated with favorable prognosis in CRC patients aged 50-79 years. The effects on long-term survival according to interval time was the best among individuals screened within one year before diagnosis. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Xuan Quy Luu
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea
| | - Kyeongmin Lee
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea
| | - Jae Kwan Jun
- National Cancer Control Institute, National Cancer Center, Goyang, South Korea
| | - Mina Suh
- National Cancer Control Institute, National Cancer Center, Goyang, South Korea
| | - Kyu-Won Jung
- National Cancer Control Institute, National Cancer Center, Goyang, South Korea
| | - Kui Son Choi
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea
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Tran TN, Peeters M, Hoeck S, Van Hal G, Janssens S, De Schutter H. Optimizing the colorectal cancer screening programme using faecal immunochemical test (FIT) in Flanders, Belgium from the “interval cancer” perspective. Br J Cancer 2022; 126:1091-1099. [PMID: 35022524 PMCID: PMC8980044 DOI: 10.1038/s41416-021-01694-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 12/07/2021] [Accepted: 12/23/2021] [Indexed: 12/24/2022] Open
Abstract
Background Interval cancer (IC) is a critical issue in colorectal cancer (CRC) screening. We identified factors associated with ICs after faecal immunochemical test (FIT) screening and explored the impact of lowering FIT cut-off or shortening screening interval on FIT-ICs in Flanders. Methods FIT participants diagnosed with a CRC during 2013–2018 were included. Factors associated with FIT-ICs were identified using logistic regression. Distributions of FIT results among FIT-ICs were examined. Results In total, 10,122 screen-detected CRCs and 1534 FIT-ICs were included (FIT-IC proportion of 13%). FIT-ICs occurred more frequently in women (OR 1.58 [95% CI 1.41–1.76]) and ages 70–74 (OR 1.35 [1.14–1.59]). FIT-ICs were more often right-sided (OR 3.53 [2.98–4.20]), advanced stage (stage IV: OR 7.15 [5.76–8.88]), and high grade (poorly/undifferentiated: OR 2.57 [2.08–3.18]). The majority (83–92%) of FIT-ICs would still be missed if FIT cut-off was lowered from 15 to 10 µg Hb/g or screening interval was shortened from 2 to 1 year. Conclusions FIT-ICs were more common in women, older age, right-sided location, advanced stage and high grade. In Flanders, lowering FIT cut-off (to 10 µg Hb/g) or shortening screening interval (to 1 year) would have a minimal impact on FIT-ICs.
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Significant decrease in interval colorectal cancer incidence after implementing immunochemical testing in a multiple-round guaiac-based screening programme. Br J Cancer 2021; 125:1494-1502. [PMID: 34511603 DOI: 10.1038/s41416-021-01546-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/04/2021] [Accepted: 09/03/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND AND AIMS We aimed to evaluate the effects of switching to faecal immunochemical testing (FIT) on the cumulative 2-year incidence rate of interval cancers, interval cancer rate and test sensitivity within a mature population-based colorectal cancer screening programme consisting of six rounds of biennial guaiac faecal occult blood testing (gFOBT). METHODS The FIT results were compared with those of gFOBT used in each of the previous two rounds. For the three rounds analysed, 279,041 tests were performed by 156,186 individuals. Logistic regression analysis was used to determine interval cancer risk factors (Poisson regression) and to compare the sensitivity of FIT to gFOBT. RESULTS There were 612 cases of screen-detected cancers and 209 cases of interval cancers. The sex- and age-adjusted cumulative 2-year incidence rates of interval cancers were 55.7 (95% CI, 45.3-68.5), 42.4 (95% CI, 32.6-55.2) and 15.8 (95% CI, 10.9-22.8) per 100,000 person-years after the last two rounds of gFOBT and FIT, respectively. The FIT/gFOBT incidence rate ratio was 0.38 [95% CI, 0.27-0.54] (P < 0.001). Sex- and age-adjusted sensitivity was significantly higher with FIT than with gFOBT (OR = 6.70 [95% CI, 4.48-10.01], P < 0.0001). CONCLUSIONS This population-based study revealed a dramatic decrease in the cumulative incidence rates of interval cancers after switching from gFOBT to FIT. These data provide an additional incentive for countries still using gFOBT to switch to FIT.
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16
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Balamou C, Koïvogui A, Rodrigue CM, Clerc A, Piccotti C, Deloraine A, Exbrayat C. Prediction of the severity of colorectal lesion by fecal hemoglobin concentration observed during previous test in the French screening program. World J Gastroenterol 2021; 27:5272-5287. [PMID: 34497450 PMCID: PMC8384754 DOI: 10.3748/wjg.v27.i31.5272] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/03/2021] [Accepted: 07/20/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The rate of positive tests using fecal immunochemical test (FIT) does not decrease with subsequent campaigns, but the positive predictive value of advanced neoplasia significantly decreases in subsequent campaign after a first negative test. A relationship between the fecal hemoglobin concentration (Fhb) and the opportunity to detect a colorectal cancer in subsequent campaign has been shown.
AIM To predict the severity of colorectal lesions based on Fhb measured during previous colorectal cancer screening campaign.
METHODS This etiological study included 293750 patients aged 50-74, living in Auvergne-Rhône-Alpes (France). These patients completed at least two FIT [test(-1) and test(0)] between June 2015 and December 2019. Delay between test(-1) and test(0) was > 1 year and test(-1) result was negative (< 150 ngHb/mL). The severity of colorectal lesions diagnosed at test(0) was described according to Fhb measured at test(-1) [Fhb(-1)]. The relationship between the severity classified in seven ordinal categories and the predictive factors was analyzed in an ordered multivariate polytomous regression model.
RESULTS The test(0) positive rate was 4.0%, and the colonoscopy completion rate was 97.1% in 11594 patients who showed a positive test(0). The colonoscopy detection rate was 77.7% in those 11254 patients who underwent a colonoscopy. A total of 8748 colorectal lesions were detected (including 2182 low-risk-polyps, 2400 high-risk-polyp, and 502 colorectal cancer). The colonoscopy detection rate varied significantly with Fhb(-1) [0 ngHb/mL: 75.6%, (0-50 ngHb/mL): 77.3%, (50-100 ngHb/mL): 88.7%, (100-150 ngHb/mL): 90.3%; P = 0.001]. People with a Fhb(-1) within (100-150 ngHb/mL) (P = 0.001) were 2.6 (2.2; 3.0) times more likely to have a high severity level compared to those having a Fhb(-1) value of zero. This risk was reduced by 20% in patients aged 55-59 compared to those aged < 55 [adjusted odds ratio: 0.8 (0.6; 1.0)].
CONCLUSION The study showed that higher Fhb(-1) is correlated to an increased risk of severity of colorectal lesions. This risk of severity increased among first-time participants (age < 55) and the elderly (≥ 70). To avoid the loss of chance in these age groups, the FIT positivity threshold should be reduced to 100 ngHb/mL. The other alternative would be to reduce the time between the two tests in these age groups from the current 2 years to 1 year.
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Affiliation(s)
- Christian Balamou
- Site de l'Ain, Centre Régional de Coordination des Dépistages des Cancers en Auvergne-Rhône-Alpes, Bourg-en-Bresse 01000, France
| | - Akoï Koïvogui
- Site de Seine-Saint-Denis, Centre Régional de Coordination des Dépistages des Cancers en Ile-de-France, Bondy 93146, France
| | - Christelle M Rodrigue
- Site de l'Ain, Centre Régional de Coordination des Dépistages des Cancers en Auvergne-Rhône-Alpes, Bourg-en-Bresse 01000, France
| | - Aurélie Clerc
- Sites Savoie & Haute Savoie, Centre Régional de Coordination des Dépistages des Cancers en Auvergne-Rhône-Alpes, Chambéry 73000, France
| | - Claire Piccotti
- Site de Drôme Ardèche, Centre Régional de Coordination des Dépistages des Cancers en Auvergne-Rhône-Alpes, Valence 26000, France
| | - Anne Deloraine
- Sites Savoie & Haute Savoie, Centre Régional de Coordination des Dépistages des Cancers en Auvergne-Rhône-Alpes, Chambéry 73000, France
| | - Catherine Exbrayat
- Site Isère & Drôme-Ardèche, Centre Régional de Coordination des Dépistages des Cancers en Auvergne-Rhône-Alpes, Meylan 38240, France
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17
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Ricciardiello L, Ferrari C, Cameletti M, Gaianill F, Buttitta F, Bazzoli F, Luigi de'Angelis G, Malesci A, Laghi L. Impact of SARS-CoV-2 Pandemic on Colorectal Cancer Screening Delay: Effect on Stage Shift and Increased Mortality. Clin Gastroenterol Hepatol 2021; 19:1410-1417.e9. [PMID: 32898707 PMCID: PMC7474804 DOI: 10.1016/j.cgh.2020.09.008] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 09/01/2020] [Accepted: 09/01/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The SARS-CoV-2 pandemic had a sudden, dramatic impact on healthcare. In Italy, since the beginning of the pandemic, colorectal cancer (CRC) screening programs have been forcefully suspended. We aimed to evaluate whether screening procedure delays can affect the outcomes of CRC screening. METHODS We built a procedural model considering delays in the time to colonoscopy and estimating the effect on mortality due to up-stage migration of patients. The number of expected CRC cases was computed by using the data of the Italian screened population. Estimates of the effects of delay to colonoscopy on CRC stage, and of stage on mortality were assessed by a meta-analytic approach. RESULTS With a delay of 0-3 months, 74% of CRC is expected to be stage I-II, while with a delay of 4-6 months there would be a 2%-increase for stage I-II and a concomitant decrease for stage III-IV (P = .068). Compared to baseline (0-3 months), moderate (7-12 months) and long (> 12 months) delays would lead to a significant increase in advanced CRC (from 26% to 29% and 33%, respectively; P = .008 and P < .001, respectively). We estimated a significant increase in the total number of deaths (+12.0%) when moving from a 0-3-months to a >12-month delay (P = .005), and a significant change in mortality distribution by stage when comparing the baseline with the >12-months (P < .001). CONCLUSIONS Screening delays beyond 4-6 months would significantly increase advanced CRC cases, and also mortality if lasting beyond 12 months. Our data highlight the need to reorganize efforts against high-impact diseases such as CRC, considering possible future waves of SARS-CoV-2 or other pandemics.
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Affiliation(s)
- Luigi Ricciardiello
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy.
| | - Clarissa Ferrari
- Unit of Statistics, IRCCS Istituto Centro San Giovanni di Dio, Fatebenefratelli, Brescia, Italy
| | - Michela Cameletti
- Department of Management, Economics and Quantitative Methods, University of Bergamo, Bergamo, Italy
| | - Federica Gaianill
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, Parma, Italy
| | - Francesco Buttitta
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Franco Bazzoli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Gian Luigi de'Angelis
- Department of Medicine and Surgery, University of Parma, Parma, Italy; Gastroenterology and Endoscopy Unit, University Hospital of Parma, Parma, Italy
| | - Alberto Malesci
- Department of Gastroenterology, Humanitas Research Institute and Humanitas University, Rozzano, Italy
| | - Luigi Laghi
- Department of Medicine and Surgery, University of Parma, Parma, Italy; Laboratory of Molecular Gastroenterology, Humanitas Clinical and Research Centre, Rozzano, Italy.
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Mangone L, Pinto C, Mancuso P, Ottone M, Bisceglia I, Chiaranda G, Michiara M, Vicentini M, Carrozzi G, Ferretti S, Falcini F, Hassan C, Rossi PG. Colon cancer survival differs from right side to left side and lymph node harvest number matter. BMC Public Health 2021; 21:906. [PMID: 33980174 PMCID: PMC8117551 DOI: 10.1186/s12889-021-10746-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 02/19/2021] [Indexed: 12/11/2022] Open
Abstract
Background Right-sided colorectal cancer (CRC) has worse survival than does left-sided CRC. The objective of this study was to further assess the impact of right-side location on survival and the role of the extent of lymphadenectomy. Methods All CRCs diagnosed between 2000 and 2012 in Emilia-Romagna Region, Italy, were included. Data for stage, grade, histology, screening history, and number of removed lymph nodes (LN) were collected. Multivariable Cox regression models were used to estimate hazard ratios (HR), with relative 95% confidence intervals (95%CI), of right vs. left colon and of removing < 12, 12–21 or > 21 lymph nodes by cancer site. Results During the study period, 29,358 patients were registered (8828 right colon, 18,852 left colon, 1678 transverse). Patients with right cancer were more often older, females, with advanced stage and high grade, and higher number of removed LNs. Five-year survival was lower in the right than in the left colon (55.2% vs 59.7%). In multivariable analysis, right colon showed a lower survival when adjusting for age, sex, and screening status (HR 1.12, 95%CI 1.04–1.21). Stratification by number of lymph nodes removed (12–21 or > 21) was associated with better survival in right colon (HR 0.54, 95%CI 0.40–0.72 and HR 0.40, 95%CI 0.30–0.55, respectively) compared to left colon (HR 0.89, 95%CI 0.76–1.06 and HR 0.83, 95%CI 0.69–1.01, respectively). Conclusions This study confirms that right CRC has worse survival; the association is not due to screening status. An adequate removal of lymph nodes is associated with better survival, although the direction of the association in terms of causal links is not clear. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10746-4.
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Affiliation(s)
- Lucia Mangone
- Epidemiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Via Amendola 2, 42122, Reggio Emilia, MD, Italy.
| | - Carmine Pinto
- Medical Oncology, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, MD, Italy
| | - Pamela Mancuso
- Epidemiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Via Amendola 2, 42122, Reggio Emilia, MD, Italy
| | - Marta Ottone
- Epidemiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Via Amendola 2, 42122, Reggio Emilia, MD, Italy
| | - Isabella Bisceglia
- Epidemiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Via Amendola 2, 42122, Reggio Emilia, MD, Italy
| | | | - Maria Michiara
- Medical Oncology Unit, University Hospital of Parma, Parma, MD, Italy
| | - Massimo Vicentini
- Epidemiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Via Amendola 2, 42122, Reggio Emilia, MD, Italy
| | - Giuliano Carrozzi
- Epidemiology Unit, Azienda Unità Sanitaria Locale, Via Martiniana 21, Baggiovara, 41126, Modena, MD, Italy
| | - Stefano Ferretti
- Romagna Cancer Registry - Section of Ferrara. Local Health Unit, University of Ferrara, Ferrara, MD, Italy
| | - Fabio Falcini
- Romagna Cancer Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola (Forlì), Italy-Azienda Usl della Romagna, Forlì, MD, Italy
| | - Cesare Hassan
- Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, MD, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Via Amendola 2, 42122, Reggio Emilia, MD, Italy
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Besutti G, Damato A, Venturelli F, Bonelli C, Vicentini M, Monelli F, Mancuso P, Ligabue G, Pattacini P, Pinto C, Giorgi Rossi P. Baseline liver steatosis has no impact on liver metastases and overall survival in rectal cancer patients. BMC Cancer 2021; 21:253. [PMID: 33750342 PMCID: PMC7941741 DOI: 10.1186/s12885-021-07980-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/24/2021] [Indexed: 01/15/2023] Open
Abstract
Background The liver is one of the most frequent sites of metastases in rectal cancer. This study aimed to evaluate how the development of synchronous or metachronous liver metastasis and overall survival are impacted by baseline liver steatosis and chemotherapy-induced liver damage in rectal cancer patients. Methods Patients diagnosed with stage II to IV rectal cancer between 2010 and 2016 in our province with suitable baseline CT scan were included. Data on cancer diagnosis, staging, therapy, outcomes and liver function were collected. CT scans were retrospectively reviewed to assess baseline steatosis (liver density < 48 HU and/or liver-to-spleen ratio < 1.1). Among patients without baseline steatosis and treated with neoadjuvant chemotherapy, chemotherapy-induced liver damage was defined as steatosis appearance, ≥ 10% liver volume increase, or significant increase in liver function tests. Results We included 283 stage II to IV rectal cancer patients with suitable CT scan (41% females; mean age 68 ± 14 years). Steatosis was present at baseline in 90 (31.8%) patients, synchronous liver metastasis in 42 (15%) patients and metachronous liver metastasis in 26 (11%); 152 (54%) deaths were registered. The prevalence of synchronous liver metastasis was higher in patients with steatosis (19% vs 13%), while the incidence of metachronous liver metastasis was similar. After correcting for age, sex, stage, and year of diagnosis, steatosis was not associated with metachronous liver metastasis nor with overall survival. In a small analysis of 63 patients without baseline steatosis and treated with neoadjuvant chemotherapy, chemotherapy-induced liver damage was associated with higher incidence of metachronous liver metastasis and worse survival, results which need to be confirmed by larger studies. Conclusions Our data suggest that rectal cancer patients with steatosis had a similar occurrence of metastases during follow-up, even if the burden of liver metastases at diagnosis was slightly higher, compatible with chance. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-07980-9.
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Affiliation(s)
- Giulia Besutti
- Clinical and Experimental Medicine PhD program, University of Modena and Reggio Emilia, Modena, Italy.,Radiology Unit, Department of Diagnostic Imaging and Laboratory Medicine, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Angela Damato
- Medical Oncology Unit, AUSL-IRCCS of Reggio Emilia, Viale Risorgimento 80, 42123, Reggio Emilia, Italy.,Department of Medical Biotechnologies, University of Siena, Strada delle Scotte 4, 53100, Siena, Italy
| | - Francesco Venturelli
- Epidemiology Unit, AUSL-IRCCS of Reggio Emilia, Via Amendola 2, 42122, Reggio Emilia, Italy
| | - Candida Bonelli
- Medical Oncology Unit, AUSL-IRCCS of Reggio Emilia, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Massimo Vicentini
- Epidemiology Unit, AUSL-IRCCS of Reggio Emilia, Via Amendola 2, 42122, Reggio Emilia, Italy
| | - Filippo Monelli
- Clinical and Experimental Medicine PhD program, University of Modena and Reggio Emilia, Modena, Italy. .,Radiology Unit, Department of Diagnostic Imaging and Laboratory Medicine, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
| | - Pamela Mancuso
- Epidemiology Unit, AUSL-IRCCS of Reggio Emilia, Via Amendola 2, 42122, Reggio Emilia, Italy
| | - Guido Ligabue
- Department of Radiology, Azienda Ospedaliero-Universitaria Policlinico di Modena, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - Pierpaolo Pattacini
- Radiology Unit, Department of Diagnostic Imaging and Laboratory Medicine, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Carmine Pinto
- Medical Oncology Unit, AUSL-IRCCS of Reggio Emilia, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, AUSL-IRCCS of Reggio Emilia, Via Amendola 2, 42122, Reggio Emilia, Italy
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20
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Ferlizza E, Solmi R, Sgarzi M, Ricciardiello L, Lauriola M. The Roadmap of Colorectal Cancer Screening. Cancers (Basel) 2021; 13:1101. [PMID: 33806465 PMCID: PMC7961708 DOI: 10.3390/cancers13051101] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 02/24/2021] [Accepted: 02/27/2021] [Indexed: 12/24/2022] Open
Abstract
Colorectal cancer (CRC) is the third most common form of cancer in terms of incidence and the second in terms of mortality worldwide. CRC develops over several years, thus highlighting the importance of early diagnosis. National screening programs based on fecal occult blood tests and subsequent colonoscopy have reduced the incidence and mortality, however improvements are needed since the participation rate remains low and the tests present a high number of false positive results. This review provides an overview of the CRC screening globally and the state of the art in approaches aimed at improving accuracy and participation in CRC screening, also considering the need for gender and age differentiation. New fecal tests and biomarkers such as DNA methylation, mutation or integrity, proteins and microRNAs are explored, including recent investigations into fecal microbiota. Liquid biopsy approaches, involving novel biomarkers and panels, such as circulating mRNA, micro- and long-non-coding RNA, DNA, proteins and extracellular vesicles are discussed. The approaches reported are based on quantitative PCR methods that could be easily applied to routine screening, or arrays and sequencing assays that should be better exploited to describe and identify candidate biomarkers in blood samples.
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Affiliation(s)
- Enea Ferlizza
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 40138 Bologna, Italy; (R.S.); (M.S); (M.L.)
| | - Rossella Solmi
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 40138 Bologna, Italy; (R.S.); (M.S); (M.L.)
| | - Michela Sgarzi
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 40138 Bologna, Italy; (R.S.); (M.S); (M.L.)
| | - Luigi Ricciardiello
- Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy;
| | - Mattia Lauriola
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 40138 Bologna, Italy; (R.S.); (M.S); (M.L.)
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21
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Senore C, Zorzi M. Do We Need a New Paradigm for Assessing the Accuracy of Fecal Immunochemical Test Screening? Clin Gastroenterol Hepatol 2020; 18:2873-2875. [PMID: 32289539 DOI: 10.1016/j.cgh.2020.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 03/28/2020] [Accepted: 04/03/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Carlo Senore
- Epidemiology and Screening Unit-CPO, University Hospital Città della Salute e della Scienza, Turin, Italy
| | - Manuel Zorzi
- Veneto Tumour Registry, Azienda Zero, Padua, Italy
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22
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Cancerona: Challenges of Cancer Management in Times of COVID-19 Pandemic. ACTA ACUST UNITED AC 2020; 2:2005-2014. [PMID: 33015555 PMCID: PMC7524598 DOI: 10.1007/s42399-020-00549-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2020] [Indexed: 02/06/2023]
Abstract
Coronavirus disease 2019 (COVID-19) has infected millions of people worldwide and emerged to be the biggest global health threat claiming hundreds of thousands of lives at exponential rates. The severity of the disease increases with old age and presence of underlying health conditions, such as cancer. Managing cancer patients under these circumstances is rather challenging, given their compromised immunity and the overwhelmed health care services by COVID-19 community transmission. Thus, it is prudent to establish common guidelines for the monitoring and treatment of cancer patients. In this review, we comprehensively investigate the various aspects of cancer care during the COVID-19 pandemic, discuss challenges faced while treating cancer patients, and propose potential approaches to manage COVID-19 among this vulnerable population. We also discuss molecular aberrations and genetic changes associated with cancer and their role in affecting the virus' infectivity and severity. Lastly, we shed light on therapeutic approaches that can encompass both diseases without compromising one over the other.
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23
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Minicozzi P, Vicentini M, Innos K, Castro C, Guevara M, Stracci F, Carmona-Garcia M, Rodriguez-Barranco M, Vanschoenbeek K, Rapiti E, Katalinic A, Marcos-Gragera R, Van Eycken L, Sánchez MJ, Bielska-Lasota M, Rossi PG, Sant M. Comorbidities, timing of treatments, and chemotherapy use influence outcomes in stage III colon cancer: A population-based European study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2020; 46:1151-1159. [PMID: 32147427 DOI: 10.1016/j.ejso.2020.02.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/21/2020] [Accepted: 02/18/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION For stage III colon cancer (CC), surgery followed by chemotherapy is the main curative approach, although optimum times between diagnosis and surgery, and surgery and chemotherapy, have not been established. MATERIALS AND METHODS We analysed a population-based sample of 1912 stage III CC cases diagnosed in eight European countries in 2009-2013 aiming to estimate: (i) odds of receiving postoperative chemotherapy, overall and within eight weeks of surgery; (ii) risks of death/relapse, according to treatment, Charlson Comorbidity Index, time from diagnosis to surgery for emergency and elective cases, and time from surgery to chemotherapy; and (iii) time-trends in chemotherapy use. RESULTS Overall, 97% of cases received surgery and 65% postoperative chemotherapy, with 71% of these receiving chemotherapy within eight weeks of surgery. Risks of death and relapse were higher for cases starting chemotherapy with delay, but better than for cases not given chemotherapy. Fewer patients with high comorbidities received chemotherapy than those with low (P < 0.001). Chemotherapy timing did not vary (P = 0.250) between high and low comorbidity cases. Electively-operated cases with low comorbidities received surgery more promptly than high comorbidity cases. Risks of death and relapse were lower for elective cases given surgery after four weeks than cases given surgery within a week. High comorbidities were always independently associated with poorer outcomes. Chemotherapy use increased over time. CONCLUSIONS Our data indicate that promptly-administered postoperative chemotherapy maximizes its benefit, and that careful assessment of comorbidities is important before treatment. The survival benefit associated with slightly delayed elective surgery deserves further investigation.
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Affiliation(s)
- Pamela Minicozzi
- Analytical Epidemiology and Health Impact Unit, Research Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Massimo Vicentini
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Kaire Innos
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Clara Castro
- Cancer Epidemiology Group, IPO Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal; EpiUnit, Institute of Public Health, University of Porto, Porto, Portugal
| | - Marcela Guevara
- Navarra Public Health Institute, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Fabrizio Stracci
- Department of Experimental Medicine, Section of Public Health, University of Perugia, Perugia, Italy; Umbria Cancer Registry, Perugia, Italy
| | - MaCarmen Carmona-Garcia
- Medical Oncology Department, Catalan Institute of Oncology, Universitary Hospital Dr Josep Trueta, Girona, Spain; Descriptive Epidemiology, Genetics and Cancer Prevention Group, Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Miguel Rodriguez-Barranco
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Andalusian School of Public Health (EASP), Granada, Spain; Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain
| | | | - Elisabetta Rapiti
- Geneva Cancer Registry, Global Health Institute, University of Geneva, Switzerland
| | | | - Rafael Marcos-Gragera
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Descriptive Epidemiology, Genetics and Cancer Prevention Group, Biomedical Research Institute (IDIBGI), Girona, Spain; School of Medicine, University of Girona (UdG), Girona, Spain; Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health Government of Catalonia, Catalan Institute of Oncology, Girona, Spain
| | | | - Maria José Sánchez
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Andalusian School of Public Health (EASP), Granada, Spain; Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain; Universidad de Granada (UGR), Granada, Spain
| | | | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Milena Sant
- Analytical Epidemiology and Health Impact Unit, Research Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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24
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Del Vecchio Blanco G, Calabrese E, Biancone L, Monteleone G, Paoluzi OA. The impact of COVID-19 pandemic in the colorectal cancer prevention. Int J Colorectal Dis 2020; 35:1951-1954. [PMID: 32500432 PMCID: PMC7271141 DOI: 10.1007/s00384-020-03635-6] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) has led to a policy of severe restrictions in almost all countries strongly involved by the pandemic. National Health System is among activities suffering from the COVID-19 and the lockdown. AIM To evaluate the impact of COVID-19 in colorectal cancer (CRC) prevention. METHODS We report the change in the hospital organization to meet the growing healthcare needs determined by COVID-19. The limitations of CRC prevention secondary to COVID-19 and their effects on the healthcare are analyzed considering the features of the CRC screening programs in the average-risk population and endoscopic surveillance in patients with inflammatory bowel diseases (IBD). RESULTS The interruption of CRC prevention may lead to a delayed diagnosis of CRC, possibly in a more advanced stage. The economic burden and the impact on workload for gastroenterologists, surgeons, and oncologists will be greater as long as the CRC prevention remains suspended. To respond to the increased demand for colonoscopy once COVID-19 will be under control, we should optimize the resources. It will be necessary to stratify the CRC risk and reach an order of priority. It should be implemented the number of health workers, equipment, and spaces dedicated to performing colonoscopy for screening purpose and in subjects with alarm symptoms in the shortest time. To this aim, the funds earmarked for healthcare should be increased. CONCLUSION The economic impact will be dramatic, but COVID-19 is the demonstration that healthcare has to be the primary goal of humans.
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Affiliation(s)
- Giovanna Del Vecchio Blanco
- grid.6530.00000 0001 2300 0941Gastroenterology Unit, Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Emma Calabrese
- grid.6530.00000 0001 2300 0941Gastroenterology Unit, Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Livia Biancone
- grid.6530.00000 0001 2300 0941Gastroenterology Unit, Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Giovanni Monteleone
- grid.6530.00000 0001 2300 0941Gastroenterology Unit, Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Omero Alessandro Paoluzi
- grid.6530.00000 0001 2300 0941Gastroenterology Unit, Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
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25
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Phisalprapa P, Supakankunti S, Chaiyakunapruk N. Cost-effectiveness and budget impact analyses of colorectal cancer screenings in a low- and middle-income country: example from Thailand. J Med Econ 2019; 22:1351-1361. [PMID: 31560247 DOI: 10.1080/13696998.2019.1674065] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Objectives: Colorectal cancer (CRC) screening programs have been reported to be cost-effective in many high-income countries. However, there was no such study in low- and middle-income countries. This study aimed to evaluate cost-effectiveness and budget impact of CRC screening modalities for average-risk persons in Thailand.Methods: A decision tree coupled with a Markov model was used to estimate lifetime costs and health benefits of fecal immunochemical test (FIT) and colonoscopy using a societal perspective. The input parameters were obtained from a CRC screening project at a Thai tertiary care hospital, Thai health care costs and databases, and systematic literature review. Results were reported as incremental cost-effectiveness ratios (ICERs) in 2017 US Dollars (USD) per quality-adjusted life year (QALY) gained. Sensitivity analyses were performed to assess the influence of parameter uncertainty. Finally, budget impact analysis was conducted.Results: At the Thai ceiling threshold of societal willingness-to-pay of 4,706 USD, the screening colonoscopy every 10 years and annual FIT, starting at age 50, was cost-effective, as compared to no screening resulting in 15.09 and 15.00 QALYs with the ICERs of 600.20 and 509.84 USD/QALY gained, respectively. Colonoscopy every 10 years and annual FIT could prevent 17.9% and 5.7% of early stage cancer and 27.8% and 9.2% of late stage cancer per 100,000 screening over lifetime when compared to no screening, respectively. The colonoscopy screening was cost-effective with the ICER of 646.53 USD/QALY gained when compared to FIT. The probabilities of being cost-effective for the colonoscopy and FIT were 75% and 25%, respectively. Budget impact analysis showed the colonoscopy screening required an 8-times higher budget than FIT.Conclusions: Colonoscopy offers the best value for money of CRC screenings in Thailand. Annual FIT is potentially feasible since it requires less resources. Our findings can be used as part of evidence for informing policy decision making.Key points for decision makersThere was a lack of cost-effective study of colorectal cancer screening programs in low- and middle-income countries.This study evaluated lifetime health outcomes and costs, and the cost-effectiveness of colorectal screening options for average-risk persons in Thailand.Colonoscopy screening every 10 years is cost-effective with high probability of being cost-effective as compared with annual fecal immunochemical test.Screening by annual fecal immunochemical test is more feasible in terms of human resource and budgetary burden.Colorectal screening programs provides an opportunity for early diagnosis and treatments to prevent advance colorectal stages and avoid higher consequent costs.This study contributes a new evidence-based knowledge for Thailand and can be used to support policy decision making process.
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Affiliation(s)
- Pochamana Phisalprapa
- Faculty of Economics, Chulalongkorn University, Bangkok, Thailand
- Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
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