Introduction. Colorectal cancer (CRC) is the third most common cancer worldwide and CRC-related mortality can be effectively reduced by population-based screening. Screening uptake is a key indicator of performance, susceptible of several implementation methods. Participation in ASL Milano 1 area (northern Italy) is increasing thanks to reminder invitation sent to non-responders. Here we evaluate the implementation of another strategy among those proved to be effective.
Methods. In the years 2013-2014 we conducted an observational study in patients non-responder to first invitation and subsequent mailed reminder. A list of them was sent to their own GP, who had the task to evaluate possible exclusion criteria and make a reminder, either by personal interview, telephone call or via e-mail. Intervention could be conducted either by the GP himself or by an assistant. Primary outcomes were to assess the overall efficacy of the intervention and the efficacy of its single features (type of intervention and provider), measuring the consequent uptake of CRC screening.
Results. Participation in CRC screening was significantly higher (33%) in patients who received a reminder from GP, regardless of the type, vs those who did not (19%, p<0.01). No statistically significant difference was detected either by method or by provider of the intervention.
Discussion. The results of our study demonstrate that even a modest intervention can have a significant effect in improving compliance to screening for CRC, one of the cancers with highest incidence in developed countries, for which an effective treatment is available in case of early diagnosis.
Ferlay J, Soerjomataram I, Ervik M, et al. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11. ( http://globocan.iarc.fr )
AIOM/AIRTUM. (2013). I numeri del cancro in italia 2013.
Banca Dati www.tumori.net
Whitlock EP, Lin JS, Liles E, et al. Screening for colorectal cancer: a targeted, updated systematic review for the US Preventive Services Task Force. Ann Intern Med 2008;149(9):638â58
Kronborg O, Fenger C, Olsen J, et al. Randomised study of screening for colorectal cancer with faecal-occult-blood test. Lancet. 1996 Nov 30;348(9040):1467-71.
Hardcastle JD, Chamberlain JO, Robinson MH, et al. Randomised controlled trial of faecal-occult-blood screening for colorectal cancer. Lancet. 1996 Nov 30;348(9040):1472-7.
Asl Milano 1. Report of Colorectal Cancer Screening performance in Milano 1 district (2006-2012). February 2014. (http://www.aslmi1.mi.it/screening/screeningcolon.html )
Giorgi Rossi P, Camilloni L, Cogo C, et al. Methods to increase participation in cancer screening programmes. Epidemiol Prev. 2012 Jan;36 (Suppl 1):1-104.
Tinmouth J, Patel J, Austin PC, et al. Increasing participation in colorectal cancer screening: Results from a cluster randomized trial of directly mailed FOBT kits to previous non responders. Int J Cancer. 2014 Sep 6. [Epub ahead of print] PubMed PMID: 25195923.
Camilloni L, Ferroni E, Cendales BJ, et al. Methods to increase participation Working Group. Methods to increase participation in organised screening programs: a systematic review. BMC Public Health. 2013 May 13;13:464.
Jepson R, Clegg A, Forbes C, et al. The determinants of screening uptake and interventions for increasing uptake: a systematic review. Health Technol Assess 2000, 4:i-vii. 1â133.
Lee JK, Reis V, Liu S, et al. Improving fecal occult blood testing compliance using a mailed educational reminder. J Gen Intern Med 2009, 24:1192-1197.
Costanza ME, Luckmann R, Stoddard AM, et al. Using tailored telephone counseling to accelerate the adoption of colorectal cancer screening. Cancer Detect Prev., 31 (2007), pp. 191â198.
Sequist TD, Zaslavsky AM, Marshall R, et al. Patient and physician reminders to promote colorectal cancer screening: a randomized controlled trial. Arch Intern Med 2009;169(4):364â71.
Decreto Balduzzi Legge 8/2012 N. 189