The performance of colorectal cancer screening in Brazil: the first two years of the implementation program in Barretos Cancer Hospital

Abstract

Colorectal cancer (CRC) is the second most common cancer in Brazil. Yet, a nationally organized colorectal screening program is not implemented. Barretos Cancer Hospital (BCH) is one of the largest Brazilian institution, which cares for underserved patients. BCH developed a FIT-based organized CRC screening program to improve CRC outcomes. This study aims to present the quality/performance measures of the first two years of the FIT-based CRC screening program and its impact on the CRC disease stage. Between 2015 and 2017, a total of 6,737 individuals attending the Outpatient Department of Prevention or the Mobile Unit of BCH, which visits 18 cities of Barretos county, aged 50 to 65 years old, were personally invited by a health agent/ nurse practitioner. Exclusion criteria were personal history of CRC, adenomatous polyps, inflammatory bowel disease, and colonoscopy or flexible sigmoidoscopy performed in the past five years. European Union (EU) guidelines for CRC screening programs were evaluated. Overall, 92.8% returned the FIT, with an inadequate examination rate of 1.5%. Among the 6,253 adequately tested, 12.5% had a positive result. The colonoscopy compliance and completion rates were 84.6 and 98.2%, respectively. The PPVs were 60.0%, 16.5%, and 5.6% for adenoma, advanced adenoma and cancer, respectively. Stage distribution of screen-detected cancers shows earlier stages than clinically diagnosed CRC cancers reported at BCH and Brazilian cancer registries. Our CRC screening program achieved desirable quality metrics, aligned with the EU Guidelines. The observed shift towards earlier CRC stages suggests an exciting opportunity to improve CRC-related cancers in Brazil.