Outcomes and cost evaluation of the first two rounds of a colorectal cancer screening program based on immunochemical fecal occult blood test in northern Italy.

BACKGROUND AND STUDY AIMS: Colorectal cancer (CRC) screening aims to reduce mortality by detecting cancers at an early stage and removing adenomatous polyps at an acceptable cost. The aim of the current study were to assess the outcomes and costs of the first two biennial rounds of a population-based CRC screening program using the immunochemical fecal occult blood test (i-FOBT) in a northern Italian province. METHODS: All residents aged 50 - 69 years were invited to take part in a biennial screening program using a 1-day i-FOBT, followed by colonoscopy in positive individuals. The i-FOBT uptake, compliance to colonoscopy, detection rate for cancer or advanced adenomas according to age and sex, and direct cost analysis were carried out separately for the 1st and 2nd rounds of screening. RESULTS: In 78 083 (1st round) and 81 619 (2nd round) individuals who were invited to screening, the participation rates were 49.7 % and 54.4 % and i-FOBT positivity rates were 6.2 % and 5.8 %, respectively. Detection rates for cancer and advanced adenomas were lower in the 2nd screening compared with the 1st one (1.6‰ vs. 2.5‰ for cancers and 15.8‰ vs. 17.9‰ for advanced adenomas, respectively), whereas positive predictive values for cancer and advanced adenoma were similar in both rounds. In 165 adenocarcinomas detected, 52 % were Dukes' stage A and 21 % were stage B. All cost indicators were slightly higher in the 1st round of screening compared with the 2nd. The direct cost per cancer or advanced adenoma detection was similar in the two rounds (€â€Š1252 and €â€Š1260, respectively). CONCLUSIONS: Compliance and diagnostic yield of i-FOBT screening were satisfactory. Most detected cancers were at a very early stage. Program costs were reasonable and did not increase with repeat screening. Screening could contribute to decreasing the cost of CRC care by improving the stage at diagnosis.

[Contact thermography in breast pathology. A critical review]. / Termografia a contatto in senologia. Revisione critica.

The paper reports the Authors' experience in over 12,000 patients affected by manifest or presumed breast pathologies examined using contact thermography and assess the number of correct responses. This technique proved reliable in patients aged under 30 with benign pathologies or palpable nodules. On the other hand, it was not reliable in the case of pathologies with negative objectivity, and therefore in the context of screening programmes for the early diagnosis of tumours.

[Mechanical staplers. Personal experience]. / Suturatrici meccaniche. Esperienza personale.

The Authors briefly summarise their experience of using various types of mechanical staplers in abdominal and thoracic surgery with excellent results both in general and in terms of reducing operating times.

[Hemobilia secondary to percutaneous hepatic biopsy. Report of a clinical case]. / Emobilia secondaria a biopsia epatica percutanea. Discussione di un caso clinico.

The increasingly frequent use of invasive diagnostic and therapeutic procedures concerning the hepatobiliary system has led to a rise in the incidence of hemobilia as well as altering its etiological status. The authors report a clinical case of hemobilia secondary to percutaneous hepatic biopsy which was brought to their attention. This is followed by a short discussion of the etiopatogenesis and diagnostic and therapeutic strategies with special reference to the ratio between the advantages/limits of the methods now available.

[Castleman's disease with abdominal localization. Report of an unusual case]. / Malattia di Castleman a localizzazione addominale. Descrizione di un caso inusuale.

Castleman's disease is an unusual condition characterized by uncontrolled growth of lymphoid tissue. The first case was recorded by Castleman in 1956. In this paper a case of the above-mentioned disease is reported with regard to its unusual clinica-histologic aspect (localized form of plasmacellular type) and surgical therapeutic strategies.

[Rare metastases]. / Le metastasi rare.

The paper reports a number of cases of uncommon metastasis confirmed by histological tests in surgical biopsies; following a brief discussion of the literature on this topic and in particular on the basis of an earlier study by one of the authors, the paper affirms that metastasis is related to general and local biological factors, that the diffusion of neoplastic cells is an early and generalised phenomenon opposed by organic defence mechanisms, and that the concept of uncommon metastasis should be revised, without resorting to fixed anatomical references, according to a general "impregnation" of tumour cells.