Colorectal cancer screening

Screening for colorectal cancer in Finland was ongoing between years 2004-2016 in a research setting that covered almost half of the target population in its widest. In year 2019 screening will start again in volunteering municipalities and will be widened into a national programme in a later phase.

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 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 colonoscopy which is endoscopy of bowel. 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. However, screening reduced colorectal cancer mortality in participating municipalities when the dissemination of good practices was taken into account. (3.) 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 (4.). New screening programmes have been launched in the Netherlands and in other Nordic countries. The screening programme will be launched again also in Finland with the more usable and research-validated faecal immunochemical test (FIT) (5.). The screening will start in voluntary municipalities and will be widened into a national programme in a later phase.

Finnish Cancer Registry has planned the restarting screening programme in collaboration with Ministry of Social Affairs and Health and a group of clinical experts.

All men and women aged 60-66 years in the municipalities that offer screening will receive an invitation to screening during the first year. The screening test will be sent to them along with the invitation. The test can be taken at home and one stool sample is sufficient. When the programme has reached its full scope, all people aged 60-75 years will receive an invitation to screening every 2 years.

The main indicators of randomised colorectal cancer screening programme ongoing in years 2004-2016 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. Miettinen J, Malila N, Hakama M ym. Spillover improved survival in non-invited patients of the colorectal cancer screening programme. J Med Screen 2017; Jan 1:969141317718220.
  4. 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.
  5. International Agency for Research on Cancer Handbook Working Group. The IARC Perspective on Colorectal Cancer Screening. N. Engl J Med 2018; 378;18