Implementation of an organized colorectal cancer screening program through quantitative fecal immunochemical test followed by colonoscopy in an urban low-income community: Guidance and strategies

Author(s):Show less -

Ulysses Ribeiro Jr. ; Adriana Vaz Safatle-Ribeiro ; Maurício Sorbello ^[3] ; Poliana Helena Rosolem Kishi ^[4] ; Diane Dede Cohend ^[5] ; Rejane Mattar ^[6] ; Vera Lucia Pagliusi Castilho ^[7] ; Elenice Messias Do Nascimento Goncalves ^[8] ; Fábio Kawaguti ^[9] ; Carlos Frederico Sparapan Marques ; Venâncio Avancini Ferreira Alves ^[11] ; Sérgio Carlos Nahas ; José Eluf-Neto

• Document type: Journal article
• Source: Clinics; v. 78, 2023-10-20.

Abstract

Abstract Fecal Immunochemical Test (FIT) followed by a colonoscopy is an efficacious strategy to improve the adenoma detection rate and Colorectal Cancer (CRC). There is no organized national screening program for CRC in Brazil. The aim of this research was to describe the implementation of an organized screening program for CRC through FIT followed by colonoscopy, in an urban low-income community of São Paulo city. The endpoints of the study were: FIT participation rate, FIT positivity rate, colonoscopy compliance rate, Positive Predictive Values (PPV) for adenoma and CRC, and the rate of complications. From May 2016 to October 2019, asymptomatic individuals, 50-75 years old, received a free kit to perform the FIT. Positive FIT (≥ 50 ng/mL) individuals were referred to colonoscopy. 10,057 individuals returned the stool sample for analysis, of which (98.2%) 9,881 were valid. Women represented 64.8% of the participants. 55.3% of individuals did not complete elementary school. Positive FIT was 7.8% (776/9881). The colonoscopy compliance rate was 68.9% (535/776). There were no major colonoscopy complications. Adenoma were detected in 63.2% (332/525) of individuals. Advanced adenomatous lesions were found in 31.4% (165/525). CRC was diagnosed in 5.9% (31/525), characterized as adenocarcinoma: in situ in 3.2% (1/31), intramucosal in 29% (9/31), and invasive in 67.7% (21/31). Endoscopic treatment with curative intent for CRC was performed in 45.2% (14/31) of the cases. Therefore, in an urban low-income community, an organized CRC screening using FIT followed by colonoscopy ensued a high participation rate, and high predictive positive value for both, adenoma and CRC. (AU)

• FAPESP's process: 14/50112-2 - Colorectal cancer screening: a pilot study using Fecal Immunochemical Test (FIT)
• Grantee: José Eluf Neto
• Support Opportunities: Research Grants - Research in Public Policies for the National Health Care System (PP-SUS)