Colonoscopic surveillance of first-degree relatives of colorectal cancer patients in a faecal occult blood screening programme.

BACKGROUND: In some Italian areas, colonoscopic surveillance of first-degree relatives (FDRs) of colorectal cancer (CRC) patients is provided as a part of local population-based faecal occult blood test (FOBT) screening programmes. The objective of the present study was to assess the feasibility and early results of this surveillance model. METHODS: Data from district screening centres were used to evaluate the process of identification and selection of eligible FDRs (residence in the Emilia-Romagna Region, age 40-75 years, no recent colonoscopy) of screen-detected CRC patients and the detected prevalence of disease. The probability for an FDR to undergo colonoscopy and to be diagnosed with CRC and advanced adenoma was estimated using the Kaplan-Meier method. The sex- and age-standardised ratio of detected prevalence to that expected based on results from a colonoscopy screening study of the Italian general population was estimated. RESULTS: Between 2005 and 2011, 9319 FDRs of 2437 screen-detected CRC patients (3.8 per patient) were identified and contacted. Their likelihood of being eligible for, and accepting, colonoscopy was 0.11 (95% confidence interval: 0.11-0.12). Among the 926 subjects undergoing colonoscopy, the prevalence of previous negative screening FOBT was 63%. Eleven CRCs (1.2%) and 100 advanced adenomas (10.8%) were detected. The standardised ratio of detected prevalence to that expected was 0.91 (95% confidence interval: 0.19-2.66) for CRC and 1.48 (1.04-2.05) for advanced adenoma. CONCLUSIONS: The procedure of selection of FDRs was extremely ineffective. Due to previous negative screening tests, the prevalence of disease was less than expected. A population-based FOBT screening programme is a highly unsuitable setting for the provision of surveillance to FDRs of CRC patients.

Compliance checking of cancer-screening Careflows: an approach based on Computational Logic.

Clinical guidelines and Careflow systems have been recently identified as a means to improve and standardize health care services. A number of ICT-based management solutions have been proposed, focussing on several aspects such as specification, process logs verification with respect to specification (compliance), enactment and administration of careflows. In this paper we introduce the GPROVE framework, based on Computational Logic, and focused on the (formal) specification of careflows and on the compliance verification of the process executions w.r.t. the specified models. In particular, we show its application to the Cancer Screening Guideline used by the sanitary organization of the Emilia Romagna region, discussing its formalization in GPROVE and the results of the compliance checking applied to logs of the screening process.

Follow-up of screening patients conservatively treated for cervical intraepithelial neoplasia grade 2-3.

OBJECTIVES: To evaluate the frequency and correlates of non-adherence to follow-up among patients conservatively treated for CIN2-3. STUDY DESIGN: Study population comprised 1560 patients aged 25-64 years from a screening programme in northern Italy. The regional standard protocol was used as a reference. Multinomial logistic regression analysis was used to estimate the odds ratio probability of a patient being lost to follow-up (no check-ups within 27 months of treatment) or incompletely followed-up (1-3 negative check-ups) versus having 4 negative check-ups. RESULTS: Three hundred twenty-six patients (21%) were lost to follow-up, 678 (43%) were incompletely followed-up, 352 (23%) presented for 4 negative check-ups and 204 (13%) were diagnosed with persistent disease. The probability of no or incomplete follow-up was greater for patients who lived in the urban district, who were treated in private settings (versus screening centres), who exhibited a visibile squamocolumnar junction on pre-treatment colposcopy, who were treated with cold knife excision and local destructive therapy (versus loop diathermy excision), and whose surgical specimens had positive excision margins. CONCLUSIONS: Adherence to the reference protocol was poor. Factors involved in follow-up failures require greater clinical attention.