Important Role of Health Surveillance Systems in Community-Based Colorectal Cancer Screening

A systematic review and comparative evaluation to develop and validate a comprehensive framework for cancer surveillance systems

BACKGROUND

The increasing global burden of cancer necessitates robust cancer surveillance systems to generate accurate and comprehensive data for effective public health interventions. Despite advancements, significant gaps remain in data standardization, interoperability, and adaptability to diverse healthcare settings. This study aims to develop and validate a comprehensive framework for cancer surveillance systems that addresses these gaps, ensuring enhanced global applicability and regional relevance.

METHODS

A systematic review was conducted following PRISMA guidelines, analyzing 13 studies selected from an initial pool of 1,085 articles retrieved from five major databases: PubMed, Embase, Scopus, Web of Science, and IEEE. Additionally, a comparative evaluation of 13 international cancer surveillance systems was performed to identify critical data elements and practices. Key indicators were extracted. A researcher-designed checklist consolidating these elements was validated through expert consultation with a response rate of 82% (n = 14), achieving high reliability (Cronbach's alpha = 0.849).

RESULTS

The proposed framework addresses critical gaps in existing cancer surveillance systems by integrating a comprehensive set of epidemiological indicators, including incidence, prevalence, mortality, survival rates, years lived with disability, and years of life lost, calculated using multiple standard populations for age-standardized rates. Furthermore, the framework incorporates key demographic filters such as age, sex, and geographic location to enable stratified analyses. It also includes advanced data elements, such as cancer type classification based on ICD-O standards, ensuring precision, consistency, and enhanced comparability across diverse cancer datasets.

CONCLUSION

The validated framework provides a structured and adaptable approach to cancer data collection and analysis, enhancing public health decision-making and resource allocation. By addressing current limitations, this study offers a significant advancement in cancer surveillance methodologies, with potential applications in diverse healthcare contexts globally.

CLINICAL TRIAL REGISTRATION

Clinical trial number: Not applicable.

The implementation of colorectal cancer screening interventions in low-and middle-income countries: a scoping review

BACKGROUND

Low- and middle-income countries (LMICs) experienced increasing rates of colorectal cancer (CRC) incidence in the last decade and lower 5-year survival rates compared to high-income countries (HICs) where the implementation of screening and treatment services have advanced. This review scoped and mapped the literature regarding the content, implementation and uptake of CRC screening interventions as well as opportunities and challenges for the implementation of CRC screening interventions in LMICs.

METHODS

We systematically followed a five-step scoping review framework to identify and review relevant literature about CRC screening in LMICs, written in the English language before February 2020. We searched Medline, Embase, Web of Science and Google Scholar for studies targeting the general, asymptomatic, at-risk adult population. The TIDieR tool and an implementation checklist were used to extract data from empirical studies; and we extracted data-informed insights from policy reviews and commentaries.

RESULTS

CRC screening interventions (n = 24 studies) were implemented in nine middle-income countries. Population-based screening programmes (n = 11) as well as small-scale screening interventions (n = 13) utilised various recruitment strategies. Interventions that recruited participants face-to-face (alone or in combination with other recruitment strategies) (10/15), opportunistic clinic-based screening interventions (5/6) and educational interventions combined with screening (3/4), seemed to be the strategies that consistently achieved an uptake of > 65% in LMICs. FOBT/FIT and colonoscopy uptake ranged between 14 and 100%. The most commonly reported implementation indicator was 'uptake/reach'. There was an absence of detail regarding implementation indicators and there is a need to improve reporting practice in order to disseminate learning about how to implement programmes.

CONCLUSION

Opportunities and challenges for the implementation of CRC screening programmes were related to the reporting of CRC cases and screening, cost-effective screening methods, knowledge about CRC and screening, staff resources and training, infrastructure of the health care system, financial resources, public health campaigns, policy commitment from governments, patient navigation, planning of screening programmes and quality assurance.

The role and utility of population-based cancer registries in cervical cancer surveillance and control

Population-based cancer registries (PBCR) are vital to the assessment of the cancer burden and in monitoring and evaluating national progress in cervical cancer surveillance and control. Yet the level of their development in countries exhibiting the highest cervical cancer incidence rates is suboptimal, and requires considerable investment if they are to document the impact of WHO global initiative to eliminate cervical cancer as a public health problem. As a starting point we propose a comprehensive cancer surveillance framework, positioning PBCR in relation to other health information systems that are required across the cancer control continuum. The key concepts of PBCR are revisited and their role in providing a situation analysis of the scale and profile of the cancer-specific incidence and survival, and their evolution over time is illustrated with specific examples. Linking cervical cancer data to screening and immunization information systems enables the development of a comprehensive set of measures capable of assessing the short- and long-term achievements and impact of the initiative. Such data form the basis of national and global estimates of the cancer burden and permit comparisons across countries, facilitating decision-making or triggering cancer control action. The initiation and sustainable development of PBCR must be an early step in the scale-up of cervical cancer control activities as a means to ensure progress is successfully monitored and appraised.