Proportion and stage distribution of screen-detected and non-screen-detected colorectal cancer in nine European countries: an international, population-based study

Rafael Cardoso, Feng Guo, Thomas Heisser, Harlinde De Schutter, Nancy Van Damme, Mef Christina Nilbert, Anne Julie Tybjerg, 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

2 Citations (Scopus)

Abstract

Background: The effects of recently implemented colorectal cancer screening programmes in Europe on colorectal cancer mortality will take several years to be fully known. We aimed to analyse the characteristics and parameters of screening programmes, proportions of colorectal cancers detected through screening, and stage distribution in screen-detected and non-screen-detected colorectal cancers to provide a timely assessment of the potential effects of screening programmes in several European countries. Methods: We conducted this population-based study in nine European countries for which data on mode of detection were available (Belgium, Denmark, England, France, Italy, Ireland, the Netherlands, Slovenia, and Spain). Data from 16 population-based cancer registries were included. Patients were included if they were diagnosed with colorectal cancer from the year that organised colorectal cancer screening programmes were implemented in each country until the latest year with available data at the time of analysis, and if their age at diagnosis fell within the age groups targeted by the programmes. Data collected included sex, age at diagnosis, date of diagnosis, topography, morphology, clinical and pathological TNM information based on the edition in place at time of diagnosis, and mode of detection (ie, screen detected or non-screen detected). If stage information was not available, patients were not included in stage-specific analyses. The primary outcome was proportion and stage distribution of screen-detected versus non-screen detected colorectal cancers. Findings: 228 667 colorectal cancer cases were included in the analyses. Proportions of screen-detected cancers varied widely across countries and regions. The highest proportions (40–60%) were found in Slovenia and the Basque Country in Spain, where FIT-based programmes were fully rolled out, and participation rates were higher than 50%. A similar proportion of screen-detected cancers was also found for the Netherlands in 2015, where participation was over 70%, even though the programme had not yet been fully rolled out to all age groups. In most other countries and regions, proportions of screen-detected cancers were below 30%. Compared with non-screen-detected cancers, screen-detected cancers were much more often found in the distal colon (range 34·5–51·1% screen detected vs 26·4–35·7% non-screen detected) and less often in the proximal colon (19·5–29·9% screen detected vs 24·9–32·8% non-screen detected) p≤0·02 for each country, more often at stage I (35·7–52·7% screen detected vs 13·2–24·9% non-screen detected), and less often at stage IV (5·8–12·5% screen detected vs 22·5–31·9% non-screen detected) p<0·0001 for each country. Interpretation: The proportion of colorectal cancer cases detected by screening varied widely between countries. However, in all countries, screen-detected cancers had a more favourable stage distribution than cancers detected otherwise. There is still much need and scope for improving early detection of cancer across all segments of the colorectum, and particularly in the proximal colon and rectum. Funding: Deutsche Krebshilfe.

Original languageEnglish
Pages (from-to)711-723
Number of pages13
JournalThe Lancet Gastroenterology and Hepatology
Volume7
Issue number8
DOIs
Publication statusPublished - 1 Aug 2022

Bibliographical note

Funding Information:
This work was supported in part by a grant from Deutsche Krebshilfe (German Cancer Aid, 70112095). We thank all cancer registries and their staff for their efforts in collecting and preparing the data for this study, specifically, Belgian Cancer Registry, Danish Cancer Registry, Danish Colorectal Cancer Group Database, Danish Quality Database for Colon Cancer Screening, National Cancer Registration and Analysis Service—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, Slovenian Cancer Registry, Basque Cancer Registry, Girona Cancer Registry, Murcia Cancer Registry, and Tarragona Cancer Registry. The centres for cancer screening responsible for the colorectal cancer screening programmes in Flanders (Centrum voor Kankeropsporing, CvKO), Wallonia (Centre Communautaire de Référence, CCR), and Brussels (Brussels Prevention, Bruprev) provided the Belgian Cancer Registry (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:
This work was supported in part by a grant from Deutsche Krebshilfe (German Cancer Aid, 70112095). We thank all cancer registries and their staff for their efforts in collecting and preparing the data for this study, specifically, Belgian Cancer Registry, Danish Cancer Registry, Danish Colorectal Cancer Group Database, Danish Quality Database for Colon Cancer Screening, National Cancer Registration and Analysis Service—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, Slovenian Cancer Registry, Basque Cancer Registry, Girona Cancer Registry, Murcia Cancer Registry, and Tarragona Cancer Registry. The centres for cancer screening responsible for the colorectal cancer screening programmes in Flanders (Centrum voor Kankeropsporing, CvKO), Wallonia (Centre Communautaire de Référence, CCR), and Brussels (Brussels Prevention, Bruprev) provided the Belgian Cancer Registry (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 Elsevier Ltd

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