Colorectal cancer screening
The colorectal cancer screening programme was launched again in Finland with a research-validated faecal immunochemical test (FIT). The screening started in voluntary municipalities and will be expanded into a national programme in a later phase (1). 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
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 (2).
An interim report was published in 2015 to examine the effect of screening on colorectal cancer mortality (3). 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 (4). 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).
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 Apeli Nevala for advice on data requests: email@example.com.
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)