Overall and stage-specific survival of patients with screen-detected colorectal cancer in European countries: A population-based study in 9 countries

Rafael Cardoso, Feng Guo, Thomas Heisser, Harlinde De Schutter, Nancy Van Damme, Mef Christina Nilbert, Jane Christensen, Anne Marie Bouvier, Véronique Bouvier, Guy Launoy, Anne Sophie Woronoff, Mélanie Cariou, Michel Robaszkiewicz, Patricia Delafosse, Florence Poncet, Paul M. Walsh, Carlo Senore, Stefano Rosso, Valery E.P.P. Lemmens, Marloes A.G. ElferinkSonja Tomšič, Tina Žagar, Arantza Lopez de Munain Marques, Rafael Marcos-Gragera, Montse Puigdemont, Jaume Galceran, Marià Carulla, Antonia Sánchez-Gil, María Dolores Chirlaque, Michael Hoffmeister, Hermann Brenner*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Background: An increasing proportion of colorectal cancers (CRCs) are detected through screening due to the availability of organised population-based programmes. We aimed to analyse survival probabilities of patients with screen-detected CRC in European countries. Methods: Data from CRC patients were obtained from 16 population-based cancer registries in nine European countries. We included patients with cancer diagnosed from the year organised CRC screening programmes were introduced until the most recent year with available data at the time of analysis, whose ages at diagnosis fell into the age groups targeted by screening. Patients were followed up with regards to vital status until 2016-2020 across the various countries. Overall and CRC-specific survival were analysed by mode of detection and stage at diagnosis for all countries combined and for each country separately using the Kaplan-Meier method. Findings: We included data from 228 134 patients, of whom 134 597 (aged 60-69 years at diagnosis targeted by screening in all countries) were considered in analyses for all countries combined. 22·3% (38 080/134 597) of patients had cancer detected through screening. Most screen-detected cancers were found at stages I-II (65·6% [12 772/19 469 included in stage-specific analyses]), while the majority of non-screen-detected cancers were found at stages III-IV (56·4% [31 882/56 543 included in stage-specific analyses]). Five-year overall and CRC-specific survival rates for patients with screen-detected cancer were 83·4% (95% CI 82·9-83·9) and 89·2% (88·8-89·7), respectively; for patients with non-screen-detected cancer, they were much lower (57·5% [57·2-57·8] and 65·7% [65·4-66·1], respectively). The favourable survival of patients with screen-detected cancer was also seen within each stage – five-year overall survival rates for patients with screen-detected stage I, II, III, and IV cancers were 92.4% (95% CI 91·6-93·1), 87·9% (86·6-89·1), 80·7% (79·3-82·0), and 32·3 (29·4-35·2), respectively. These patterns were also consistently seen for each individual country. Interpretation: Patients with cancer diagnosed at screening have a very favourable prognosis. In the rare case of detection of advanced stage cancer, survival probabilities are still much higher than those commonly reported for all patients regardless of mode of detection. Although these results cannot be taken to quantify screening effects, they provide useful and encouraging information for patients with screen-detected CRC and their physicians. Funding: This study was supported in part by grants from the German Federal Ministry of Education and Research and the German Cancer Aid.

Original languageEnglish
Article number100458
JournalThe Lancet Regional Health - Europe
Volume21
DOIs
Publication statusPublished - Oct 2022

Bibliographical note

Funding Information:
We are thankful to all cancer registries and their staff for the efforts in collecting and preparing the data for this study. Specifically, Belgian Cancer Registry (BCR), Danish Cancer Registry, Danish Colorectal Cancer Group Database, Danish Quality Database for Colon Cancer Screening, National Cancer Registration and Analysis Service (NCRAS) – Public Health England (data provided under the Open Government Licence: https://doi.org/10.25503/wd5j-e989 ), Digestive Cancer Registry of Burgundy, Digestive tumors registry of Calvados, Cancer Registry of Doubs, Digestive tumors registry of Finistere, Cancer registry of Isere, National Cancer Registry Ireland, Piedmont Cancer Registry, Netherlands Cancer Registry (IKNL), Slovenian Cancer Registry, Basque Cancer Registry, Girona Cancer Registry, Murcia Cancer Registry and Tarragona Cancer Registry. The centers for cancer screening responsible for the colorectal cancer screening programs in Flanders (Centrum voor Kankeropsporing, CvKO), Wallonia (Centre Communautaire de Référence, CCR) and Brussels (Brussels Prevention, Bruprev) provided BCR with data on colorectal cancer detection mode within existing data flows and legal frameworks. For their tasks regarding colorectal cancer screening, CvKO, CCR, Bruprev and BCR receive funding from the respective regional authorities.

Funding Information:
We are thankful to all cancer registries and their staff for the efforts in collecting and preparing the data for this study. Specifically, Belgian Cancer Registry (BCR), Danish Cancer Registry, Danish Colorectal Cancer Group Database, Danish Quality Database for Colon Cancer Screening, National Cancer Registration and Analysis Service (NCRAS) – Public Health England (data provided under the Open Government Licence: https://doi.org/10.25503/wd5j-e989), Digestive Cancer Registry of Burgundy, Digestive tumors registry of Calvados, Cancer Registry of Doubs, Digestive tumors registry of Finistere, Cancer registry of Isere, National Cancer Registry Ireland, Piedmont Cancer Registry, Netherlands Cancer Registry (IKNL), Slovenian Cancer Registry, Basque Cancer Registry, Girona Cancer Registry, Murcia Cancer Registry and Tarragona Cancer Registry. The centers for cancer screening responsible for the colorectal cancer screening programs in Flanders (Centrum voor Kankeropsporing, CvKO), Wallonia (Centre Communautaire de Référence, CCR) and Brussels (Brussels Prevention, Bruprev) provided BCR with data on colorectal cancer detection mode within existing data flows and legal frameworks. For their tasks regarding colorectal cancer screening, CvKO, CCR, Bruprev and BCR receive funding from the respective regional authorities.

Publisher Copyright:
© 2022 The Authors

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