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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

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