1359PD_PR - Incidence of colorectal neoplasia in a high risk population screened for colorectal cancer. Result of 5 consecutives mass screening campaigns in a...

Date 27 September 2014
Event ESMO 2014
Session Challenges in cancer screening and care: dealing with the issues of access and cost of therapy
Topics Aetiology, Epidemiology, Screening and Prevention
Colon and Rectal Cancer
Basic Scientific Principles
Presenter Sylvain Manfredi
Citation Annals of Oncology (2014) 25 (5): 1-41. 10.1093/annonc/mdu438
Authors S. Manfredi1, J.F. Bretagne1, G. Durand2, C. Piette2, G. Mallard2, J. Faivre3
  • 1Disease Of The Digestive Tract, CHU Pontchaillou, 35000 - Rennes/FR
  • 2Adeci 35, adeci 35, 35000 - rennes/FR
  • 3Gastroenterology, CHU dijon, 21000 - dijon/FR

 

Abstract

Aim

Colorectal cancer mass screening with FOBT is implemented to screen average risk population aged 50–74 years. Some colorectal neoplasia history is revealed by the pre-screening procedure. Patients were so excluded from FOBT screening and then a screening colonoscopy was offered. We studied this population at high risk colorectal neoplasia naïve for previous colorectal exploration, from 5 consecutive colorectal cancer screening campaigns.

Methods

Variables: age, campaign, source of exclusion (general practitioner (GP) or gastroenterologist), colonoscopy completion rate, positive predictive value (PPV) of neoplasia (cancer, advanced adenoma, adenoma).

Results

1179 patients studied (0.1-0.3% of the target population), mean age 59.7 years. Colonoscopy performed for 889 patients, complete in 97.5% of cases. In 68.1% of cases the history was revealed by the GP. Colonoscopy was achieved in 70% of cases when history was detected by the GP and in 87% when detected by the gastroenterologist. 253 Colorectal neoplasias were diagnosed; 35 cancers (TNM stage 0-1: 74%, TNM stage 2: 9%, TNM stage 3: 14%, TNM stage 4: 3%), 14 resected endoscopically; one or more adenomas diagnosed in 219 patients and a total of 347 adenomas resected, endoscopically in 98.5% of cases. The average number of adenoma per patient was 2.1 (1 to 50) and the average size was 7.2 mm (1 to 75). Size was ≥10 mm for 38% of cases, 38.3% had a villous component and 7.9% were high grade dysplasia. A total of 209 advanced adenomas (size ≥ 10 mm and/or villous component and/or high grade dysplasia and/or number ≥ 3) were diagnosed in 122 patients. PPV of cancer was 3.9%, PPV of advanced adenoma was 12.9%, and PPV of adenoma was 25%.

Conclusions

In this population with a history of colorectal neoplasia revealed by the mass screening campaign, the rate of participation in screening is very high (75.5%). The PPV of neoplasia is lower than in the average risk population selected by a positive FOBT (PPV of cancer range 7.5 to 10%, PPV of advanced adenoma range 15 to 27% and PPV of adenoma range 32 to 37% in our administrative area). This population might probably also benefit from screening with FOBT.

Disclosure

All authors have declared no conflicts of interest.