Comparative evaluation of two colorectal cancer screening campaigns using different faecal occult blood tests in a French area.

OBJECTIVE: The aim of this study was to compare quality performance of the first colorectal cancer (CRC) screening campaigns (C) with the OC Sensor® Faecal Immunological Test (FIT) (C7 from 2016 to 2017) and the Hemoccult® guaiac-based test (C1 from 2004 to 2006). METHODS: The participation rate of the eligible population, screening fecal occult blood test (FOBT) performance indices, CRC and adenoma detection rate and time interval between test positivity and colonoscopy were studied. RESULTS: In C7, 35.9 % of the eligible population completed the screening process versus 47.6 % in C1 (p < 0.0001). The positivity rate was of 4.3 % for OC Sensor® FIT and 2.3 % for Hemoccult® test (p < 0.0001). A total of 3,252 colonoscopies were performed in C7 versus 2,005 in C1; 246 CRCs and 1,160 advanced adenomas (AA) were detected in C7 compared to 140 CRCs and 491 AA in C1 (p < 0.0001). The FOBT cancer detection rate increased significantly from 1.4 ‰ to 2.9 ‰ between the two campaigns, as did the FOBT AA detection rate, from 5.7 ‰ to 13.7 ‰. During C7, the mean time for colonoscopy after a positive FIT result was 84.3 days [95 % CI: 77.9-90.7]. There was no significant difference between the stages at diagnosis according to the time for colonoscopy within the first 6 months. CONCLUSIONS: CRC and AA detection rates increased significantly between the two campaigns. Longer follow-up will be required to show a potential decrease in the incidence of invasive CRCs.

The mean number of adenomas per procedure should become the gold standard to measure the neoplasia yield of colonoscopy: a population-based cohort study.

BACKGROUND: Measuring adenoma detection is a priority in the quality improvement process for colonoscopy. Our aim was (1) to determine the most appropriate quality indicators to assess the neoplasia yield of colonoscopy and (2) to establish benchmark rates for the French colorectal cancer screening programme. METHODS: Retrospective study of all colonoscopies performed in average-risk asymptomatic people aged 50-74 years after a positive guaiac faecal occult blood test in eight administrative areas of the French population-based programme. RESULTS: We analysed 42,817 colonoscopies performed by 316 gastroenterologists. Endoscopists who had an adenoma detection rate around the benchmark of 35% had a mean number of adenomas per colonoscopy varying between 0.36 and 0.98. 13.9% of endoscopists had a mean number of adenomas above the benchmark of 0.6 and an adenoma detection rate below the benchmark of 35%, or inversely. Correlation was excellent between mean numbers of adenomas and polyps per colonoscopy (Pearson coefficient r=0.90, p<0.0001), better than correlation between mean number of adenomas and adenoma detection rate (r=0.84, p=0.01). CONCLUSION: The mean number of adenomas per procedure should become the gold standard to measure the neoplasia yield of colonoscopy. Benchmark could be established at 0.6 in the French programme.