Dutch Describe Impact of Their National Biennial Fecal Immunochemical Test Screening Program
Douglas K. Rex, MD, MASGE, reviewing Krul MF, et al. Clin Gastroenterol Hepatol 2022 Sep 15.
In 2014, the Netherlands instituted a national program of every-other-year fecal immunochemical test (FIT) screening for colorectal cancer (CRC). Since the start of screening, within the screening age population of 55 to 75 years, 78.6% of CRC was clinically detected and 18.9% screen-detected, with 2.5% having an unknown method of detection.
After a sharp rise in CRC incidence due to screen-detected cancers, especially stage I lesions, the incidence of stages I to III CRC dropped, with stage II and IV incidence falling below the lowest prescreening incidence in 2018 and 2017, respectively.
As expected, survival in screen-detected tumors was better than clinically detected lesions. For stages III and IV CRC, screen-detected tumors were generally found earlier and were more treatable than clinically detected tumors. For example, stage III screen-detected tumors were more likely to have a T0-2 stage (36.2% vs 19.4%) as were screen-detected stage IV tumors (14.7% vs 10.4%). Further, screen-detected stage IV tumors were more likely to be N0 and have metastases in only a single organ. Screen-detected stage III and IV tumors were more likely to receive resection of the primary tumor, and stage IV screen-detected tumors were 14% more likely to undergo local therapy of metastases.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
Krul MF, Elferink MAG, Kok NFM, et al. Initial impact of national CRC screening on incidence and advanced colorectal cancer. Clin Gastroenterol Hepatol 2022 Sep 15. (Epub ahead of print) (https://doi.org/10.1016/j.cgh.2022.08.046)