Article Text

Download PDFPDF
Original research
Synthetic indicator of the impact of colorectal cancer screening programmes on incidence rates
  1. Manuel Zorzi1,
  2. Marco Zappa2
  3. AIRTUM Working Group
    1. 1 Veneto Tumour Registry, Azienda Zero, Padova, Italy
    2. 2 Clinical Epidemiology Unit, ISPRO, Florence, Italy
    1. Correspondence to Dr Manuel Zorzi, Veneto Tumour Registry, Azienda Zero, Padova 35131, Italy; manuel.zorzi{at}


    Objective The impact of a screening programme on colorectal cancer (CRC) incidence in its target population depends on several variables, including coverage with invitations, participation rate, positivity rate of the screening test, compliance with an invitation to second-level assessment and endoscopists’ sensitivity. We propose a synthetic indicator that may account for all the variables influencing the potential impact of a screening programme on CRC incidence.

    Design We defined the ‘rate of advanced adenoma on the target population’ (AA-TAP) as the rate of patients who received a diagnosis of advanced adenoma within a screening programme, divided by the programme target population. We computed the AA-TAP for the CRC Italian screening programmes (biennial faecal immunochemical test, target population 50–69 year olds) using the data of the Italian National Survey from 2003 to 2016, overall and by region, and assessed the association between AA-TAP and CRC incidence fitting a linear regression between the trend of regional CRC incidence rates in 50–74 year old subjects and the cumulative AA-TAP.

    Results In 2016, the AA-TAP at a national level was 105×100 000, whereas significant differences were observed between the northern and central regions (respectively 126 and 149×100 000) and the South and Islands (36×100 000). The cumulative AA-TAP from 2004 to 2012 was significantly correlated with the difference between CRC incidence rates in 2013–2014 and those in 2003–2004 (p=0.009).

    Conclusion The AA-TAP summarises into a single indicator the potential impact of a screening programme in reducing CRC incidence rates.

    • colorectal cancer
    • colorectal cancer screening

    Statistics from


    • Contributors MZo and MZa: study concept and design, statistical analysis, interpretation of data and drafting of the manuscript. AIRTUM Working Group: acquisition of data. All authors: critical revision of the article for important intellectual content and final approval of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

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

    • Collaborators G Mazzoleni (Registro Tumori dell’Alto Adige), MA Ferrara (Registro Tumori Avellino), E Caputo (Registro Tumori di Bari), R Galasso (Registro Tumori Basilicata), A Citarella (Registro Tumori ASL Benevento), G Sampietro (Registro Tumori della ATS di Bergamo), M Magoni (Registro Tumori dell’ATS di Brescia), L Cavalieri d’Oro (Registro Tumori dell’ATS Brianza), A Ardizzone (Registro Tumori ASL Brindisi), A D’Argenzio (Registro Tumori ASL di Caserta), S Sciacca (Registro Tumori Integrato Catania - Messina - Enna), S Pisani (Registro Tumori della Provincia di Como), P Ricci (Registro Tumori Cremona e Mantova), A Giorno (Registro Tumori Cosenza e Crotone), S Ferretti (Registro Tumori della Romagna, sede di Ferrara), F Palma (Registro Tumori della Provincia di Foggia), D Serraino (Registro Tumori del Friuli Venezia Giulia), S Iacovacci (Registro Tumori di Popolazione della Provincia di Latina), F Quarta (Registro Tumori della Provincia di Lecce), RA Filiberti (Registro Tumori Regione Liguria), S Vitarelli (Registro Tumori Marche), AG Russo (Registro Tumori dell’ATS di Milano), B Caruso (Registro Tumori di Modena), G D’Orsi (Registro Tumori ASL Napoli2 Nord), M Fusco (Registro Tumori Napoli3 Sud), M Usala (Registro Tumori di Nuoro), F Vitale (Registro Tumori di Palermo e Provincia), M Michiara (Registro Tumori della Provincia di Parma), L Boschetti (Registro Tumori della Provincia di Pavia), G Chiaranda (Registro Tumori Piacenza), S Rosso (Registro Tumori Piemonte), R Tumino (Registro Tumori per le Province di Caltanissetta e Ragusa), L Mangone (Registro Tumori Reggiano), S Valenti Clemente (Registro Tumori Reggio Calabria), F Falcini (Registro Tumori della Romagna), AL Caiazzo (Registro Tumori di Popolazione della Asl Salerno), R Cesaraccio (Registro Tumori Sassari), A Madeddu (Registro Tumori di Siracusa), AC Fanetti (Registro Tumori di Sondrio), S Minerba (Registro Tumori di Taranto), A Caldarella (Registro Tumori Toscano), G Candela (Registro Tumori della Provincia di Trapani-Agrigento), S Piffer (Registro Tumori della Provincia di Trento), F Stracci (Registro Tumori Umbria), G Tagliabue (Registro Tumori della Provincia di Varese), M Rugge (Registro Tumori del Veneto), A Brustolin (Registro Tumori della Provincia di Viterbo), M Castelli (Registro Tumori della Regione Valle D’Aosta).

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.