Ontario's ColonCancerCheck: Results from Canada's first province-wide colorectal cancer screening program
Menée en Ontario à partir de données de registres régionaux portant sur plus de trois millions de personnes, cette étude évalue la performance d'un programme de dépistage du cancer colorectal comportant un test biennal de recherche de sang occulte dans les selles pour les personnes âgées de 50 à 74 ans et une coloscopie pour les personnes présentant un risque élevé de développer la maladie
Background : ColonCancerCheck (CCC), Canada's first province-wide colorectal cancer (CRC) screening program, was publicly launched in Ontario in April 2008. The objective of this paper is to report on key indicators of CCC Program performance since its inception.
Methods : The CCC Program recommends biennial gFOBT for persons 50 to 74 years of age at average risk for CRC and colonoscopy for those at increased risk. Opportunistic screening with colonoscopy is available in Ontario. Five data sources were used to compute indicators of program performance during 2008-11. The indicators computed were FOBT participation, overdue for screening, FOBT positivity, positive predictive value (PPV) of FOBT for CRC, diagnostic follow-up, and CRC detection rate.
Results : In 2011, FOBT participation was 29.8% and 46.8% of the target population was overdue for screening. FOBT positivity was higher among men (5.1%) than women (3.5%), and the PPV of FOBT for cancer was 4.3% in 2011. Follow-up colonoscopy within six months of a positive FOBT was completed by 74.6% of Program participants in 2011. The cancer detection rates for FOBT and for colonoscopy in those with a family history were 1.3 per 1,000 and 4.0 per 1,000, respectively, in 2011.
Conclusions : These results provide an early indication of Program performance and provide findings relevant to other organized CRC screening programs. Impact: The greater cancer detection rate in those at increased risk due to family history who undergo colonoscopy screening suggests that a strategy of risk stratification will enhance the impact of FOBT-based screening programs.
Cancer Epidemiology Biomarkers & Prevention , résumé, 2014