Comments on: Recommendations on colorectal cancer (CRC)screening in the European Union. Advisory Committee on Cancer Prevention. Eur J Cancer 2000, 36, 1473-1478

Colorectal cancer fecal screening test completion after age 74, sources and outcomes in French program

BACKGROUND

Elderly patients aged at least 75 years old (Elderly_75), represent 45% of colorectal cancer (CRC) incidence. As others, the French Colorectal Cancer Screening Program (CRCSP) does not include Elderly_75. To date, there is little evidence to justify stopping screening at 74 years of age.

AIM

To describe CRC fecal screening test completion after age 74, source (CRCSP/Provider ordered) and outcomes of these tests.

METHODS

The study concerned 18704 Elderly_75 residing in eleven French districts (Ain, Doubs, Essonne, Haute-Saone, Hauts-de-Seine, Jura, Seine-Saint-Denis, Territoire-de-Belfort, Val-de-Marne, Val-d’Oise, Yonne), having performed a CRC screening test between January 2008 and December 2017. The tests performed in a circumstance of delayed response to a solicitation (DRS) from the local cancer screening managing center (Managing-Center) were distinguished from the tests non-solicited by the Managing-Center, performed after a recommendation by a General Practitioner (GP) or other provider ordered (RGP). DRS was any test realized by an Elderly_75 following an initial invitation from the Managing-Center with a maximum 24 mo after this invitation. Any Non-DRS test was considered RGP. The outcomes of these tests were described according to the circumstances of test completion.

RESULTS

Of 18995 screening-tests were performed at ages: 75 (83.5%), 76-80 (13.4%) and > 80 (3.1%) years old. Elderly_75 performed the screening test in a circumstance of DRS (71.9%) or RGP (28.1%). The proportion of the tests that could not be analyzed and not restarted was 13.2%. For these unanalyzed tests, the reason was age-related in 78.0% of cases, related to the laboratory’s refusal to analyze the test of people aged ≥ 77. Reported colonoscopy completion rate was 81.3%. For those 575 people with reported colonoscopy, no complication was listed. 18.0% of the 366 Elderly_75 with lesions had no anteriority in the CRCSP. The neoplasia (124 Low-risk-polyps, 159 High-risk-polyps, 13 Unspecified-polyps and 70 CRCs) detection rate was 19.3/1000 Elderly_75 screened and the CRC detection rate was 3.7/1000 Elderly_75 screened.

CONCLUSION

The high rate of colonoscopy completion after a positive test and the high proportion of screened lesions observed suggest that the lengthening of the screening period could allow significant detection of CRC and polyps that occur in Elderly_75 excluded from CRCSP.

Practice of opportunistic PSA screening in the Florence District

The widespread use of the prostate-specific antigen (PSA) test had a great impact on the rise of incidence of prostate cancer. The magnitude of opportunistic screening by PSA varies across countries, being highest in the US, and considerably lower in Europe. To estimate the opportunistic use of PSA over the period of one year (2000) in the District of Florence, we analysed the Regional Database of diagnostic exams. According to the Regional Database, subjects having at least one PSA test during the year 2000 ranged from 5.8 to 6.7%, 8.8-10.8%, 11.7-15.0%, 16.5-22.3%, 18.0-24.3%, 17.0-23.8% and 14.1-18.3% in the 50-54, 55-59, 60-64, 65-69, 70-74, 75-79 and >79 years age groups, respectively. Minimum and maximum values are reported according to exclusion or inclusion of PSA determinations with incomplete subject identification data. Such a high use of PSA should deserve special attention from both the medical and health care provider community. The aim of the present study was to evaluate the frequency of opportunistic screening by PSA in the District of Florence in the general population.