Introduction Incidence of CRC in the Czech Republic (CR)=7800–8200/in population of 10 M people. Approximately 50% of patients (pts.) die of CRC annualy, one of the reasons being late diagnosis (>50% pts diagnosed in stage 3/4). 5 year survival increased in CR by 10%/last decade: exceeds 60%, leading to increased prevalence of CRC by 64%. Alarming data is that 20.5% of these pts. are younger than 60 yrs. Screening programme (ScP) in CR was introduced in 2000 as opportunistic double-step programme based on GP provided gFOBT test. Screening colonocopies were introduced in 2009 and are evaluated by Czech Statistical Center. Currently: 225 screening centres (audited for quality and safety by Ministry of Health).
Methods Top 4 problems of ScP: 1. Insufficient coverage of target population (25% in 2011 × 45% to 65% is desirable). 2. Incomplete switch to iFOBT although the numbers are increasing (71% in 2013 iFOBT). Optimal cut-off for our population in Czech pilot study =75 ng/ml 3. Roughly 16% pts. in whom CRC was not their first cancer (probably reflects our "tunnel vision") 4. Measures of good quality colonoscopy are not regularly evaluated by all centres. Overall in CR, ADR in 2006–12= 33% for FOBT+colonoscopies and 25% for scr.colonoscopies.
Results Quality of colonoscopy is one of the crucial points of ScP success–results of our screening centre: Endoscopist No. of colonoscopies/yr--ADR2010–2011–2012–2013-Caecal int. rate
E1 457/277/243/383–40.3% >44.3% >34.6% >40.7% >99/99.3/97.1/100 E2 280/279/389/601–40.7% >32.2% >35.3% >40.5% >97.2/95/98.7/99.3 E3 227/174/162/160–23.6% >26.9% >27.0% >36.6% >93.5/92.5/89/85.7 E4 167/145/267/330–28.6% >19.6% >20.9% >19.0% 99.2/89.7/96.9/95 E5 (as of 2011)–/116/115/176–30.5% >28% >22.9% >–/86.3/91.3/93. It is advisable that endoscopists with ADR <20% measure their extubation time regularly. ADR (2013) of screening colonoscopies = 33.8% (M40.0%, F27.2%). Of interest is also a non-negligible number of adenomas in patients <50 years (11.1% in 2013). Future: Personalised invitation. To increase the effectiveness of ScP, in 2014 started system of population-wide personalised invitations. Health Insurance Companies invite clients who did not undergo any screening during last 5 years (birthday letter): uniform algorithm of invitations. Number of screen colonoscopies should increase by 20–30% and we expect some harvesting effect (increased incidence of CRC during first years). It should lead to earlier diagnosis and treatment of CRC and should bring savings.
Conclusion Opportunistic ScP in CR during last 3 years reached achievable limit and system of population-wide personalised invitation letters by health care payers should lead to increased uptake of screening colonoscopies. The necessity of good quality colonoscopy service for the community is also ´Conditio sine qua non´ for the programme to be effective.
Disclosure of Interest None Declared.