5246 - Reaching sustainable oncology care via the National Cancer Control Program (NCCP)

Background

The NCCP is a program of activities for efficient action in the field of cancer control adopted by our Government and based on recommendations of WHO and European Partnership Action Against Cancer. It was initiated due to high cancer incidence and mortality in our country. We report achievements of our 3 organized, population-based screening programs (SP).

Methods

1. Cervical Cancer (CerC) SP, started 2003, conventional cytology, 3 years interval, age 20–64, participation 72%. 2. Colorectal Cancer (CRC) SP, started 2009, immunochemical fecal occult blood test, follow up colonoscopy if positive, age 50-74, 2 years interval, participation 62%. 3. Breast Cancer (BC) SP, started 2008 in central region, countrywide in 2018, mammography every 2 years, age 50-69, participation 73%. Outcome measures: 1. Incidence for CerC and CRC for all pts diagnosed in Slovenia from SP start. 2. Stage distribution, net survival and hazard ratio (HR) of death for screen vs not screen detected cancers diagnosed with CerC, CRC and BC from 2011-2015 for all invited patients to the SPs.

Results

CerC incidence was reduced from 2003 to 2017 by 62% (from 211 cases/year to 85), CRC from 2010 to 2015 by 21% (from 1729 cases/year to 1357). A significant (p < 0.0001) stage shift in screen detected vs not screen detected cancers was achieved. The stage shift percentages (screen detected/not screen detected) for the three SP are: for CerC stage I 81/41; stage II 16/30; stage III 3/19; stage IV 1/10, for CRC stage I 45/14; stage II 19/24; stage III 29/33; stage IV 8/30 and for BC stage I 66/40; stage II 26/35 stage III 8/18; stage IV 1/7. 5-year net survival for screen detected pts with CerC, CRC and BC was 92.1%, 88.4% and 100% and in not screen detected 63.7%, 57.1%, 85.3% respectively. The risk of death described by hazard ratio is in screened detected cancers 4-5 times lower: CerC HR 0.18 (0.11 – 0.28), CRC HR 0.26 (0.23-0.29) and BC HR 0.17 (0.10-0.31).

Conclusions

High quality SPs have a significant impact on incidence, stage and survival and are the basis of sustainable oncology care. They are even more essential in countries with limited human and financial resources. Pts with screen detected cancers are diagnosed in earlier stages and have lower probability to die from cancer.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.