Colorectal cancer screening
Colorectal cancer screening based on a new home test was launched in 2019 in voluntary municipalities.
During the first pilot year (April 2019 – April 2020), all men and women aged 60-66 in the participating municipalities were invited to the screening, a total of almost 28,000 people. An immunochemical fecal blood test (FIT) was used as a screening test. The cut-off value for test positivity was set lower for women than for men because one goal was to determine whether the use of gender-specific screening protocols reduces the differences in screening between men and women.
According to the first results published in February 2021 (1), participation in screening was at an excellent level. Nearly four of the five invitees participated in the screening, i.e., returned a stool sample to the screening laboratory. The participation rate of women (83%) was higher than that of men (75%.) The use of reminders clearly improved the participation in both sexes. The positivity rates were 2.4% for women and 2.8% for men. In total, 37 cases of colorectal cancer and 116 advanced adenomas were detected. The positive predictive values and the detection rates of advanced adenomas were higher in men than in women. Nonetheless, for cancer they were almost equal between sexes.
The study shows that gender-specific screening protocol with different cut-off values for men and women can be used in organised colorectal cancer screening. It is yet to be seen whether they are more effective than a uniform screening protocol.
In 2021, the target age group of the program will expand to 60-68 year olds. Monitoring of those invited and participating in the program will be actively continued.
The screening will be expanded into a national programme in a later phase (2). More information about the new programme can be found on Screening page.
Effectiveness and cost-effectiveness in colorectal cancer screening
The project, started in 2020, aims to analyze, improve, and predict the effectiveness and cost-effectiveness of the novel colorectal cancer screening program. This will be done using statistical multi-state models and simulations for event history data. Methodology developed will later be expanded to cover more screening programs.
Colorectal cancer screening 2004-2016
Screening for colorectal cancer in Finland was ongoing between years 2004-2016 in a research setting that eventually covered almost half of the target population. In the colorectal screening taking place between 2004-2016, half of men and women aged 60-69 years were invited to take part in screening, whereas the other half did not receive a screening invitation and were used as the control group. The guaiac-based faecal occult blood test (gFOBT) was used as the screening test.
Some 70% of those invited participated the screening i.e. sent a faecal sample to the screening laboratory. About 3% participants were referred for colonoscopy which is endoscopy of bowel. Cancers or severe precursors were found in about one in ten colonoscopies (3).
An interim report was published in 2015 to examine the effect of screening on colorectal cancer mortality (4). There was no difference between the subjects invited and the control group not invited for screening, after the median follow-up time of 4.5 years. Colorectal cancer mortality among men invited for screening was lower than their non-screened control group. In contrast colorectal cancer mortality among invited women was higher than their non-invited control group. However, screening reduced colorectal cancer mortality in participating municipalities when the dissemination of good practices was taken into account (5). The follow-up monitoring of those who had been invited and who had participated in the programme continues.
The main indicators of colorectal cancer screening programme ongoing in years 2004-2016 can be found in screening statistics (in Finnish).
Sarkeala T, Färkkilä M, Anttila A ym. Piloting gender-oriented colorectal cancer screening with a faecal immunochemical test: population-based registry study from Finland. BMJ Open 2021 doi:10.1136/bmjopen-2020-046667
Malila N, Anttila A, Hakama M. Colorectal cancer screening in Finland: details of the national screening programme implemented in Autumn 2004. J Med Screen 2005; 12: 28–32.
Pitkäniemi J, Seppä K, Hakama M ym. Effectiveness of screening for colorectal cancer with a faecal occult-blood test, in Finland. BMJ Open Gastro 2015; 2: e000034.
Miettinen J, Malila N, Hakama M ym. Spillover improved survival in non-invited patients of the colorectal cancer screening programme. J Med Screen 2018; 25: 134-40.
Lifestyle and quality of life impacts of colorectal cancer screening
The aim of the research was to investigate the impact of colorectal cancer screening on the health-related quality of life and lifestyle. This is achieved by combining information gathered by questionnaire and with data obtained from the Finnish Cancer Registry on screening and cancers.
The data were collected in 2010 and 2012 from randomly chosen men and women born in 1951. The questionnaire was sent to the same cohort a year before their first invitation for colorectal cancer screening and again the year following the screening invitation. Questionnaires were sent to more than 10 000 people in both study years.
The questionnaire covered lifestyle factors related to colorectal cancer, such as smoking, alcohol consumption, exercise and diet. Also knowledge of and worries about colorectal cancer and experienced bowel symptoms were asked. Half of the questionnaires also included additional questions about health-related quality of life (the 15D measure).
The research data is of international significance for its content and extent. If you are interested in using the questionnaire survey data, please contact Elli Hirvonen for advice on data requests: firstname.lastname@example.org.
Most important publications:
Lead researcher: Nea Malila
Research team: Sirpa Heinävaara, Sanni Helander, Maija Jäntti, Suvi Mäklin, Tytti Sarkeala
Funding: Cancer Foundation of Finland, grant for psychosocial cancer research for 2009
Collaborating institution: National Institute for Health and Welfare (THL)