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©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Sep 15, 2019; 11(9): 729-740
Published online Sep 15, 2019. doi: 10.4251/wjgo.v11.i9.729
Colorectal cancer fecal screening test completion after age 74, sources and outcomes in French program
Akoï Koïvogui, Christian Balamou, Raushan Rymzhanova, Tu Letrung, Hamou Ait Hadad, Zahida Brixi, Stéphane Cornelis, Hélène Delattre-Massy, Thomas Aparicio, Robert Benamouzig
Akoï Koïvogui, Comité Départemental des Cancers (CDC-93), CRCDC-IDF, Site de Seine-Saint-Denis, Bondy 93146, France
Christian Balamou, Office De Lutte contre les Cancers (ODLC-01), CRCDC-AURA, Site de l’Ain, Bourg-en-Bresse 01000, France
Raushan Rymzhanova, Association pour le Dépistage des Cancers (ADECA-FC), CRCDC-Bourgogne-Franche-Comté, Site de Franche-Comté, Besançon 25000, France
Tu Letrung, Prévention and Santé en Val-d’Oise (PSVO), Immeuble du Centaure, CRCDC-IDF, Site de Val-d’Oise, Cergy Saint Christophe 95800, France
Hamou Ait Hadad, Association pour le Dépistage des Maladies Cancéreuses (ADMC91), CRCDC-IDF, Site de l’Esonne, CMC De Bligny, Briis-sous-Forges 91640, France
Zahida Brixi, Association de dépistage organisé des cancers (ADOC94), CRCDC-IDF, Site de Val-de-Marne, Joinville-le-Pont 94340, France
Stéphane Cornelis, Association Icaunaise de Dépistage du Cancer (AIDEC), CRCDC-Bourgogne-Franche-Comté, Site de l’Yonne Saint-Georges-sur-Baulche 89000, France
Hélène Delattre-Massy, Association pour le Dépistage Organisé des cancers (ADOC92), CRCDC-IDF, Site des Hauts-de-Seine, Nanterre 92000, France
Thomas Aparicio, Robert Benamouzig, Service d’Hépato Gastro Entérologie, Hôpital Avicenne (AP-HP), Bobigny 93000, France
Author contributions: Koïvogui A and Benamouzig R designed the study; all authors contributed to writing the paper and had full control over preparation of manuscript; all authors approved the final draft manuscript.
Institutional review board statement: This study is co-signed by the heads of the structures involved, as such, no further Institutional Review Board was required.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous data that was obtained after each patient agreed to participate in screening campaigns.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: Data and materials are available when requested by e-mail. However, each request will be processed in accordance with French legislation on the availability of research data.
STROBE statement: The authors have read the STROBE Checklist, and the guidelines from the check list have been adopted in the preparation of this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Akoï Koïvogui, MD, MHSc, MSc, Doctor, Comité Départemental des Cancers (CDC-93), CRCDC-IDF, Site de Seine-Saint-Denis, 41 avenue de Verdun, Bondy 93146, France. aakoivogui@live.fr
Telephone: +33-1-55890931 Fax: +33-1-48020680
Received: March 12, 2019
Peer-review started: March 15, 2019
First decision: June 5, 2019
Revised: June 7, 2019
Accepted: July 26, 2019
Article in press: July 29, 2019
Published online: September 15, 2019
BACKGROUND
Elderly patients aged at least 75 years old (Elderly_75), represent 45% of colorectal cancer (CRC) incidence. As others, the French Colorectal Cancer Screening Program (CRCSP) does not include Elderly_75. To date, there is little evidence to justify stopping screening at 74 years of age.
AIM
To describe CRC fecal screening test completion after age 74, source (CRCSP/Provider ordered) and outcomes of these tests.
METHODS
The study concerned 18704 Elderly_75 residing in eleven French districts (Ain, Doubs, Essonne, Haute-Saone, Hauts-de-Seine, Jura, Seine-Saint-Denis, Territoire-de-Belfort, Val-de-Marne, Val-d’Oise, Yonne), having performed a CRC screening test between January 2008 and December 2017. The tests performed in a circumstance of delayed response to a solicitation (DRS) from the local cancer screening managing center (Managing-Center) were distinguished from the tests non-solicited by the Managing-Center, performed after a recommendation by a General Practitioner (GP) or other provider ordered (RGP). DRS was any test realized by an Elderly_75 following an initial invitation from the Managing-Center with a maximum 24 mo after this invitation. Any Non-DRS test was considered RGP. The outcomes of these tests were described according to the circumstances of test completion.
RESULTS
Of 18995 screening-tests were performed at ages: 75 (83.5%), 76-80 (13.4%) and > 80 (3.1%) years old. Elderly_75 performed the screening test in a circumstance of DRS (71.9%) or RGP (28.1%). The proportion of the tests that could not be analyzed and not restarted was 13.2%. For these unanalyzed tests, the reason was age-related in 78.0% of cases, related to the laboratory’s refusal to analyze the test of people aged ≥ 77. Reported colonoscopy completion rate was 81.3%. For those 575 people with reported colonoscopy, no complication was listed. 18.0% of the 366 Elderly_75 with lesions had no anteriority in the CRCSP. The neoplasia (124 Low-risk-polyps, 159 High-risk-polyps, 13 Unspecified-polyps and 70 CRCs) detection rate was 19.3/1000 Elderly_75 screened and the CRC detection rate was 3.7/1000 Elderly_75 screened.
CONCLUSION
The high rate of colonoscopy completion after a positive test and the high proportion of screened lesions observed suggest that the lengthening of the screening period could allow significant detection of CRC and polyps that occur in Elderly_75 excluded from CRCSP.
Core tip: Reported colonoscopy completion rate was 81.3% and the neoplasia detection rate was 19.3 per 1000 Elderly screened and the colorectal cancer detection rate was estimated at 3.7 per 1000 Elderly screened. These results remain significantly higher than that usually found in the French Colorectal Cancer Screening Program (CRCSP). The motivation to participate including for colonoscopy and the high proportion of screened lesions sufficiently demonstrate that the lengthening of the follow-up period in a screening program, up to about 80 years of age, could make it possible to detect many cases that occur after the exclusion of Elderly_75 from CRCSP.
