European CRC screening needs to be revised

The results of a nationwide, company-based colorectal cancer (CRC) screening initiative among healthcare provider employees revealed inconsistent quality and performance and a wide variability in adenoma detection rates (ADR) and reporting standards. According to the authors, CRC prevention, screening, and quality control must be revised.

“In Europe, CRC screening is inconsistent, and participation rates vary from 1% to 73%,” claimed Dr Julian Prosenz (Karl Landsteiner University of Health Sciences, Austria) [1]. “In Austria, there is opportunistic screening, but the uptake is unknown, and there is no mandatory quality assurance.” Dr Prosenz and co-investigators designed a study to investigate step-wise CRC screening among public healthcare provider employees between 50 and 65 years. The step-by-step screening process included an initial stool test (faecal immunochemical test [FIT] and M2 Pyruvate Kinase [M2PK]), and, if positive, a follow-up colonoscopy carried out by unselected endoscopists across the state. The study aimed to assess the performance and quality of this screening intervention.

In total, 10,239 employees were invited to join the screening (of which 74% were women) and 3,063 stool tests were analysed. The participation rate was higher among women (25%) than men (18%). In total, 747 stool tests turned out positive, 179 with a positive FIT test and 593 with a positive M2PK test. The initial acceptance rate for performing a follow-up colonoscopy was just below 80% (n=517). Most colonoscopies were performed by office-based physicians (66%), and the remaining were performed at a hospital (34%). Internists/gastroenterologists performed 59% of the procedures, and surgeons performed 41%.

No high-grade dysplasia or CRC was detected. The ADR was 20.5%, which is lower than the standard set by the European Society of Gastrointestinal Endoscopy (ESGE) for screening colonoscopy (25%). There were also differences in detection rates between office-based endoscopists (18.5%), and hospital endoscopists (24.3%). Furthermore, quality metrics such as Boston Bowel Preparation Scale (BBPS) >5 (88%), complete colonoscopy (85%), polyp size reported (48%), and PARIS/NICE/JNET classification reported (27%) did not meet the required ESGE standards (see Figure).

Figure: Quality metrics: study results versus required standards



BBPS, Boston Bowel Preparation Scale.

In short, the current corporate-based CRC screening intervention yielded a participation rate of 23%, and 72% of the employees with a positive test underwent colonoscopy. “The participation rate is low, given that there was promotion of this study and repeated invitations,” added Dr Prosenz. Finally, the performance measures showed inconsistent quality and a wide variability in ADR and reporting standards.

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   1. Prosenz J, et al. Results of a state-wide CRC screening initiative for 10,000 eligible health-care provider employees. LB09, UEG Week 2023, 14–17 October, Copenhagen, Denmark.

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Posted on 7 December, 202328 March, 2024