Implementation of an organized colorectal cancer screening program through quantitative fecal immunochemical test followed by colonoscopy in an urban low-income community: Guidance and strategies

•This study describes the implementation of an organized colorectal cancer (CRC) screening in an urban low-income community.•Quantitative fecal immunochemical test (FIT) followed by colonoscopy is an efficacious strategy to improve the adenoma detection rate and CRC.•FIT followed by colonoscopy ensu...

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Published in:	Clinics (São Paulo, Brazil) Vol. 78; p. 100278
Main Authors:	Ribeiro, Ulysses, Safatle-Ribeiro, Adriana Vaz, Sorbello, Maurício, Kishi, Poliana Helena Rosolem, Cohend, Diane Dede, Mattar, Rejane, Castilho, Vera Lucia Pagliusi, Goncalves, Elenice Messias Do Nascimento, Kawaguti, Fábio, Marques, Carlos Frederico Sparapan, Alves, Venâncio Avancini Ferreira, Nahas, Sérgio Carlos, Eluf-Neto, José
Format:	Journal Article
Language:	English
Published:	United States Elsevier España, S.L.U 01-01-2023 Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo Faculdade de Medicina / USP
Subjects:	Adenocarcinoma - diagnosis Adenocarcinoma - surgery Adenoma Adenoma - diagnosis Adenoma - surgery Aged Brazil Colonoscopy Colorectal cancer Colorectal Neoplasms - diagnosis Colorectal Neoplasms - surgery Early Detection of Cancer Fecal immunochemical test Female Humans Male MEDICINE, GENERAL & INTERNAL Middle Aged Occult Blood Original Polyps Screening Brazil Screening Fecal immunochemical test Adenoma Polyps Colonoscopy Colorectal cancer
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Summary:	•This study describes the implementation of an organized colorectal cancer (CRC) screening in an urban low-income community.•Quantitative fecal immunochemical test (FIT) followed by colonoscopy is an efficacious strategy to improve the adenoma detection rate and CRC.•FIT followed by colonoscopy ensued a high participation rate, and high predictive positive value for adenoma and CRC. Fecal Immunochemical Test (FIT) followed by a colonoscopy is an efficacious strategy to improve the adenoma detection rate and Colorectal Cancer (CRC). There is no organized national screening program for CRC in Brazil. The aim of this research was to describe the implementation of an organized screening program for CRC through FIT followed by colonoscopy, in an urban low-income community of São Paulo city. The endpoints of the study were: FIT participation rate, FIT positivity rate, colonoscopy compliance rate, Positive Predictive Values (PPV) for adenoma and CRC, and the rate of complications. From May 2016 to October 2019, asymptomatic individuals, 50–75 years old, received a free kit to perform the FIT. Positive FIT (≥ 50 ng/mL) individuals were referred to colonoscopy. 10,057 individuals returned the stool sample for analysis, of which (98.2%) 9,881 were valid. Women represented 64.8% of the participants. 55.3% of individuals did not complete elementary school. Positive FIT was 7.8% (776/9881). The colonoscopy compliance rate was 68.9% (535/776). There were no major colonoscopy complications. Adenoma were detected in 63.2% (332/525) of individuals. Advanced adenomatous lesions were found in 31.4% (165/525). CRC was diagnosed in 5.9% (31/525), characterized as adenocarcinoma: in situ in 3.2% (1/31), intramucosal in 29% (9/31), and invasive in 67.7% (21/31). Endoscopic treatment with curative intent for CRC was performed in 45.2% (14/31) of the cases. Therefore, in an urban low-income community, an organized CRC screening using FIT followed by colonoscopy ensued a high participation rate, and high predictive positive value for both, adenoma and CRC.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1807-5932 1980-5322 1980-5322
DOI:	10.1016/j.clinsp.2023.100278