Dutch Describe Impact of Their National Biennial Fecal Immunochemical Test Screening Program

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.