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  • Appropriateness of endoscopic surveillance recommendations in organised colorectal cancer screening programmes based on the faecal immunochemical test

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Endoscopy
Original article
Appropriateness of endoscopic surveillance recommendations in organised colorectal cancer screening programmes based on the faecal immunochemical test
  1. Manuel Zorzi1,
  2. Carlo Senore2,
  3. Anna Turrin3,
  4. Paola Mantellini4,
  5. Carmen Beatriz Visioli4,
  6. Carlo Naldoni5,
  7. Priscilla Sassoli de’ Bianchi5,
  8. Chiara Fedato3,
  9. Emanuela Anghinoni6,
  10. Marco Zappa4,
  11. Cesare Hassan7,
  12. the Italian colorectal cancer screening survey group
    1. 1Registro Tumori del Veneto, Regione Veneto, Padova, Italy
    2. 2AOU Città della Salute e della Scienza, CPO Piemonte, Torino, Italy
    3. 3Settore promozione e sviluppo igiene e sanità pubblica, Regione Veneto, Venezia, Italy
    4. 4Istituto per lo Studio e la Prevenzione Oncologica, Firenze, Italy
    5. 5Assessorato alle politiche per la salute, Regione Emilia-Romagna, Bologna, Italy
    6. 6Servizio Medicina Preventiva nelle Comunità—AUSL Mantova, Mantova, Italy
    7. 7Unità di Gastroenterologia, Ospedale Nuovo Regina Margherita, Roma, Italy
    1. Correspondence to Dr Manuel Zorzi, Registro Tumori del Veneto, Regione del Veneto, Passaggio Gaudenzio 1, Padova 35131, Italy; manuel.zorzi{at}regione.veneto.it

    Abstract

    Objectives To assess the appropriateness of recommendations for endoscopic surveillance in organised colorectal cancer (CRC) screening programmes based on the faecal immunochemical test (FIT).

    Design 74 Italian CRC screening programmes provided aggregated data on the recommendations given after FIT-positive colonoscopies in 2011 and 2013. Index colonoscopies were divided into negative/no adenoma and low- risk, intermediate-risk and high-risk adenomas. Postcolonoscopy recommendations included a return to screening (FIT after 2 years or 5 years), an endoscopic surveillance after 6 months or after 1 year, 3 years or 5 years, surgery or other. We assessed the deviation from the postcolonoscopy recommendations of the European Guidelines in 2011 and 2013 and the correlation between overuse of endoscopic surveillance in 2011 and the process indicators associated with the endoscopic workload in 2013.

    Results 49 704 postcolonoscopy recommendations were analysed. High-risk, intermediate-risk and low-risk adenomas, and no adenomas were reported in 5.9%, 19.3%, 15.3% and 51.5% of the cases, respectively. Endoscopic surveillance was inappropriately recommended in 67.4% and 7%, respectively, of cases with low-risk and no adenoma. Overall, 37% of all endoscopic surveillance recommendations were inappropriate (6696/17 860). Overuse of endoscopic surveillance was positively correlated with the extension of invitations (correlation coefficient (cc) 0.29; p value 0.03) and with compliance with post-FIT+ colonoscopy (cc 0.25; p value 0.05), while it was negatively correlated with total colonoscopy waiting times longer than 60 days (cc −0.26; p value 0.05).

    Conclusions In organised screening programmes, a high rate of inappropriate recommendations for patients with low risk or no adenomas occurs, affecting the demand for endoscopic surveillance by a third.

    • COLORECTAL CANCER SCREENING
    • COLONOSCOPY

    https://doi.org/10.1136/gutjnl-2015-310139

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      Footnotes

      • Collaborators Italian colorectal cancer screening survey group: Manuela Di Giacomo (Direzione Politiche della Salute, Regione Abruzzo, Pescara), Angelo Sigillito (Azienda Ospedaliera San Carlo, Potenza), Liliana Rizzo (Dipartimento Tutela della salute e politiche sanitarie, Regione Calabria, Catanzaro), Giovanna Luciano (Osservatorio epidemiologico regionale, Assessorato alla Sanità, Regione Campania, Napoli), Carlo Naldoni (Assessorato alle politiche per la salute, Regione Emilia-Romagna, Bologna), Nora Coppola (Direzione Centrale salute, integrazione socio sanitaria, politiche sociali e famiglia, Regione Friuli Venezia Giulia, Trieste), Alessandra Barca (Regione Lazio, Roma), Gabriella Paoli (Settore comunicazione, ricerca, sistema informativo e coordinamento progetti in sanità, Regione Liguria, Genova), Luigina Bonelli (S.S. Prevenzione secondaria e screening, Istituto nazionale per la ricerca sul cancro, Genova), Liliana Coppola (Direzione generale salute, Regione Lombardia, Milano), Lucia Di Furia (Servizio Salute, Regione Marche, Ancona), Giuseppe Cecere (Ospedale Cardarelli, Regione Molise, Campobasso), Nereo Segnan (Centro per la Prevenzione Oncologica—CPO Piemonte, Torino), Antonio Fanolla (Osservatorio epidemiologico provinciale, assessorato alla Sanità, Provincia Autonoma di Bolzano, Bolzano), Silvano Piffer (Osservatorio epidemiologico, Azienda provinciale per i servizi sanitari, Provincia Autonoma di Trento, Trento), Cinzia Annatea Germinario (Università degli studi di Bari e Osservatorio Epidemiologico della Regione Puglia, Bari), Pierina Tanchis (Assessorato dell'Igiene e sanità e dell'assistenza sociale, Regione Sardegna, Cagliari), Gabriella Dardanoni (Dipartimento Attività sanitarie e Osservatorio epidemiologico dell'Assessorato alla salute, Regione Sicilia, Palermo), Paola Mantellini (Istituto per lo Studio e la Prevenzione Oncologica—ISPO, Firenze), Mariadonata Giaimo (Direzione Regionale Salute, Coesione sociale e Società della Conoscenza, Regione Umbria, Perugia), Gabriella Furfaro (Servizio promozione della salute, assessorato alla Sanità, salute e politiche sociali, Regione Valle d'Aosta, Aosta), Manuel Zorzi (Registro Tumori del Veneto, Padova)

      • Contributors AT, MZo, CH, CS: study concept and design and drafting of the manuscript; AT, MZo: acquisition of data, statistical analysis. All the authors: interpretation of data and critical revision of the article for important intellectual content and final approval of the article.

      • Competing interests None declared.

      • Provenance and peer review Not commissioned; externally peer reviewed.