Colorectal cancer screening

Screening for colorectal cancer in Finland commenced in 2004 as a study. In 2014, there were 170 municipalities involved in the screening, which covered almost half of the target population. At present, there is no screening programme for colorectal cancer in Finland.

In the study, half of men and women aged 60-69 years were invited to take part in screening, whereas the other half did not receive the 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 further examination, colonoscopy. Cancers or severe precursors were found in about one in ten colonoscopies (1.).

An interim report was published in 2015 to examine the effect of screening on colorectal cancer mortality (2.). 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.

The screening programme is currently suspended. No new subjects are being invited to take part in the screening programme, but the follow-up monitoring of those whom had been invited  and whom had participated in the programme continues.

The European Union recommends the use of colorectal cancer screening by its member states (3.). New screening programmes have been launched in the Netherlands and in other Nordic countries. Finland should also consider initiating a screening programme for colorectal cancer by replacing the existing gFOBT test with the more accurate research-validated faecal immunochemical test (FIT). In addition, the previously observed mortality gap between men and women must be investigated.

The main indicators of randomised colorectal cancer screening programme can be found in screening statistics (in Finnish).

References

  1. 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.
  2. 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.
  3. European Colorectal Cancer Screening Guidelines Working Group. European guidelines for quality assurance in colorectal cancer screening and diagnosis: overview and introduction to the full supplement publication. Endoscopy 2013; 45: 51-9.