Supply and quality of colonoscopy according to the characteristics of gastroenterologists in the French population-based colorectalcancer screening program

BACKGROUND Since its complete roll-out in 2009,the French colorectal cancer screening program(CRCSP)experienced 3 major constraints[use of a less efficient Guaiac-test(gFOBT),stopping the supply of Fecal-Immunochemical-Test kits(FIT),and suspension of the program due to the coronavirus disease 2019(COVID-19)]affecting its effectiveness.AIM To describe the impact of the constraints in terms of changes in the quality of screeningcolonoscopy(Quali-Colo).METHODS This retrospective cohort study included screening-colonoscopies performed by gastroenterologists between Jan-2010 and Dec-2020 in people aged 50-74 living in Ile-de-France(France).The changes in Quali-colo(Proportion of colonoscopies performed beyond 7 mo(Colo_7 mo),Frequency of serious adverse events(SAE)and Colonoscopy detection rate)were described in a cohort of Gastroenterologists who performed at least one colonoscopy over each of the four periods defined according to the chronology of the constraints[gFOBT:Normal progress of the CRCSP using gFOBT(2010-2014);FIT:Normal progress of the CRCSP using FIT(2015-2018);STOP-FIT:Year(2019)during which the CRCSP experienced the cessation of the supply of test kits;COVID:Program suspension due to the COVID-19 health crisis(2020)].The link between each dependent variable(Colo_7 mo;SAE occurrence,neoplasm detection rate)and the predictive factors was analyzed in a two-level multivariate hierarchical model.RESULTS The 533 gastroenterologists(cohort)achieved 21509 screening colonoscopies over gFOBT period,38352 over FIT,7342 over STOP-FIT and 7995 over COVID period.The frequency of SAE did not change between periods(gFOBT:0.3%;FIT:0.3%;STOP-FIT:0.3%;and COVID:0.2%;P=0.10).The risk of Colo_7 mo doubled between FIT[adjusted odds ratio(aOR):1.2(1.1;1.2)]and STOPFIT[aOR:2.4(2.1;2.6)];then,decreased by 40%between STOP-FIT and COVID[aOR:2.0(1.8;2.2)].Regardless of the period,this Colo_7 mo’s risk was twice as high for screening colonoscopy performed in a public hospital[aOR:2.1(1.3;3.6)]compared to screening-colonoscopy performed in a private clinic.The neoplasm detection,which increased by 60%between gFOBT and FIT[aOR:1.6(1.5;1.7)],decreased by 40%between FIT and COVID[aOR:1.1(1.0;1.3)].CONCLUSION The constraints likely affected the time-to-colonoscopy as well as the colonoscopy detection rate without impacting the SAE’s occurrence,highlighting the need for a respectable reference time-tocolonoscopy in CRCSP.

Colorectal cancer fecal screening test completion after age 74,sources and outcomes in French program

BACKGROUND Elderly patients aged at least 75 years old(Elderly_75),represent 45%of colorectal cancer(CRC)incidence.As others,the French Colorectal Cancer Screening Program(CRCSP)does not include Elderly_75.To date,there is little evidence to justify stopping screening at 74 years of age.AIM To describe CRC fecal screening test completion after age 74,source(CRCSP/Provider ordered)and outcomes of these tests.METHODS The study concerned 18704 Elderly_75 residing in eleven French districts(Ain,Doubs,Essonne,Haute-Saone,Hauts-de-Seine,Jura,Seine-Saint-Denis,Territoire-de-Belfort,Val-de-Marne,Val-d'Oise,Yonne),having performed a CRC screening test between January 2008 and December 2017.The tests performed in a circumstance of delayed response to a solicitation(DRS)from the local cancer screening managing center(Managing-Center)were distinguished from the tests non-solicited by the Managing-Center,performed after a recommendation by a General Practitioner(GP)or other provider ordered(RGP).DRS was any test realized by an Elderly_75 following an initial invitation from the ManagingCenter with a maximum 24 mo after this invitation.Any Non-DRS test was considered RGP.The outcomes of these tests were described according to the circumstances of test completion.RESULTS Of 18995 screening-tests were performed at ages:75(83.5%),76-80(13.4%)and>80(3.1%)years old.Elderly_75 performed the screening test in a circumstance of DRS(71.9%)or RGP(28.1%).The proportion of the tests that could not be analyzed and not restarted was 13.2%.For these unanalyzed tests,the reason was age-related in 78.0%of cases,related to the laboratory's refusal to analyze the test of people aged≥77.Reported colonoscopy completion rate was 81.3%.For those575 people with reported colonoscopy,no complication was listed.18.0%of the366 Elderly_75 with lesions had no anteriority in the CRCSP.The neoplasia(124 Low-risk-polyps,159 High-risk-polyps,13 Unspecified-polyps and 70 CRCs)detection rate was 19.3/1000 Elderly_75 screened and the CRC detection rate was3.7/1000 Elderly_75 screened.CONCLUSION The high rate of colonoscopy completion after a positive test and the high proportion of screened lesions observed suggest that the lengthening of the screening period could allow significant detection of CRC and polyps that occur in Elderly_75 excluded from CRCSP.