Quality Control in the Slovenian National Colorectal Cancer Screening Program.

OBJECTIVES: The objective of the study was to assess the impact of an internal quality indicator (QI) audit on the quality level of colonoscopies in the National Colorectal Cancer Screening Program (NCCSP). DESIGN: Sixty-eight colonoscopists from 29 endoscopic centres participated in the NCCSP from April 2009 to January 2015. Controlled QIs were the percentage of total colonoscopies, adenoma detection rate (ADR), mean adenoma per procedure (MAP), mean adenoma per positive procedure (MAP+), right-sided ADR, sessile serrated lesion (SSL) detection rate, and patient responses to post-procedural questionnaires. A group of 3 expert endoscopists from the NCCSP Council performed 91 inspections and provided education. RESULTS: A total of 891.364 (58.2%) Slovenian citizens participated in the first 3 screening rounds of the NCCSP. Among 46.552 (6%) positive individuals, 42.866 (92.1%) underwent first colonoscopies. Total colonoscopies were performed in 98% of endoscopies (p = 0.459 between cycles), mean ADR was 51.8% (p = 0.872 between cycles), mean percentage of adenoma in the right colon was 37.5% (p = 0.227 between cycles), mean MAP was 1.1 (p = 0.981 between cycles), mean MAP+ was 2.0 (p = 0.824 between cycles), and mean SSL detection rate was 3% (p < 0.001). We observed great difference in QIs between endoscopists and a significant increase in MAP, ADR in the right colon, and SSL per endoscopist during the 6-year period. Due to quality underperformance, 3 endoscopic centres (10.3%) and 13 endoscopists (19.1%) were excluded from the program. CONCLUSIONS: The success of the NCCSP is related to the quality of colonoscopies performed. To ensure the proper quality level, regular audit and permanent education are needed.

The impact of 6 years of the National Colorectal Cancer Screening Program on colorectal cancer incidence and 5-year survival.

We aimed to assess the impact of the first three rounds of the National Colorectal Cancer Screening Program (NCCSP) on CRC incidence and mortality in Slovenia. In NCCSP, we use two fecal immune tests (FITs) and if test is positive patient is referred to colonoscopy. From 2009, we invite Slovenian residents aged 50-69 years, one screening round takes 2 years. The response rate was from 56.9 to 59.9%. FIT was positive in 6.0-6.2% (more in older patients and in men; P < 0.05). The adenoma detection rate was >51.3% (more in men; P < 0.01). In NCCSP, 70.3% of all cancers diagnosed were in stages I and II, while 20.7% of all CRC were found in polyps resected during colonoscopies. Patients with positive first FIT have odds ratio 2.19 [95% confidence interval (CI), 2.06-2.32] for advanced neoplasia and cancer compared to patients with two negative FITs. The incidence rate for CRC has dropped significantly after 6 years in population and in men (P < 0.01) but not in women. Five-year CRC survival was 31.3% higher if cancer was diagnosed in NCCSP (P < 0.05). After 6 years of NCCSP, the incidence rate for CRC has dropped significantly (P < 0.01). Hazard ratio for death from CRC was 3.84 higher (95% CI, 3.36-4.40; P < 0.001) in patients with cancer detected outside the program.

Salt intake of the Slovene population assessed by 24 h urinary sodium excretion.

OBJECTIVE: To investigate average sodium excretion in 24 h urine as a marker for salt intake in the Slovene population. DESIGN: Salt intake was determined by measuring sodium excretion in 24 h urine collected from a representative sample of geographically diverse Slovene adults. SETTING: Slovenia. SUBJECTS: A random sample of 600 adults aged 25-65 years was generated from census data. The effective sample yield was 143 people, 42·7 % men and 57·3 % women. RESULTS: Urinary sodium excretion was significantly higher in men (220·9 (sd 86·0) mmol Na/d) than in women (169·8 (sd 73·8) mmol Na/d); t test = 14·5, P < 0·001. Average salt intake was 11·3 (sd 4·9) g/d, higher in men than in women (13·0 (sd 5·1) v. 9·9 (sd 4·3) g/d, respectively). Average intakes of salt among regions were not significantly different. Salt intake increases slightly with increasing age, but there was no significant correlation between age and salt intake. Salt intake was increased with BMI (r = 0·384, P < 0·001). CONCLUSIONS: Salt intake in Slovene adults, especially in men, exceeds the WHO recommended population nutrient intake goal of 5 g by more than twofold. A national programme for reducing salt intake in Slovenia needs to be implemented through systematic efforts including public education and involving the health-care sector and the food industry.