Program badań przesiewowych

Screening Program for the Early Detection of Colorectal Cancer
The Screening Program for the Early Detection of Colorectal Cancer (PBP) is the responsibility of the National Cancer Control Program. As part of PBP, free prophylactic colonoscopies have been performed since 2000. Since 2012, PBP has been sending personal, one-time invitations to colonoscopy to people aged 55-64.
The goal of PBP is to reduce the incidence and deaths of colorectal cancer.
Colorectal cancer is the second most common malignant neoplasm in Poland. Each year, more than 18,000 new cases are diagnosed. Colorectal cancer develops from benign lesions – polyps. Such a transformation usually takes several years. Therefore, by getting tested early and removing the polyps can prevent the development of cancer. Early cancer is also almost always curable .
Neither polyps nor early-stage cancer usually cause symptoms. The essence of prophylactic colonoscopy is to find these asymptomatic changes and remove them. Doing so reduces the risk of developing colorectal cancer by up to 60-90% .
Prophylactic examination should be performed between 55 and 64 years of age
The prevalence of polyps and the risk of developing them malignant increases with age. The vast majority of new cases occur in people over 55 years of age. The aim of the program for men and women between 55 and 64 years of age is to detect curable changes . At this age, 25-30% of people have polyps, and 5% have changes that threaten to develop cancer in the near future.
People who have received an invitation can participate in the study
Anyone who has received an invitation to colonoscopy screening is a candidate to participate in PBP. Contraindication to screening colonoscopy is myocardial infarction within the last 3 months, acute heart or respiratory failure, and active inflammatory bowel disease. In the case of severe chronic diseases, as well as any doubts, it is worth consulting with the attending physician. The diseases we ask about in the form are not a contraindication to colonoscopy. Information about them allows you to plan a safe and comfortable examination.
The invitation is personal and cannot be transferred to another person. The invitation contains a proposed date for the study. You can change the date. You can resign from the study at any time.
I have not received an invitation but would like to undergo a preventive examination
People who have not yet received an invitation will most likely receive it in the coming years. In addition, in the next four years, the possibility of undergoing the examination without invitation (under the so-called „opportunistic program”), provided that the qualifying conditions for the Program are met:

• all people aged 50-65 without symptoms such as gastrointestinal bleeding, diarrhea or constipation in the last few months for which the cause is unknown, and weight loss or anemia for no known reason.
• people aged 40-49 without symptoms of colorectal cancer who have had at least one first-degree relative (parents, siblings, children) in family (parents, siblings, children) with cancer of the colon.
• people aged 25-49 from a family with Lynch syndrome. In this group of people, it is necessary to confirm the diagnosis of belonging to a family with Lynch syndrome from a genetic clinic based on the fulfillment of the so-called the Amsterdam criteria and possible genetic testing. Only the first test can be performed under the Screening Program.
• people aged 20-49 from a family with familial adenomatous polyposis syndrome – FAP. In this case, a referral (confirmation) from the Genetic Clinic is necessary. Only the first test can be performed under the Screening Program.

People who have had a colonoscopy within the last 10 years are not eligible for the study.

You can sign up for a preventive colonoscopy by phone at 22 825 62 99 or in person at PFG endotherapy facilities at ul. Waryńskiego 10a and Aleja Niepodległości 18 in Warsaw, after filling in the questionnaire (which is also a referral). The questionnaire can be filled in by a physician of any specialty and can be downloaded here: . When signing up for the test, you will receive the necessary information on how to prepare for the test and its course (also available on the website www.przychodniapfg.pl / preparation-for-research / )

Research
Colonoscopy is an endoscopic examination of the large intestine. It is the best examination of the large intestine available, allowing for the direct and most accurate assessment of the large intestine, removal of polyps and sampling for histopathology. The examination is performed using a colonoscope, i.e. a flexible probe 130-160 cm long, equipped with a vision track. During the examination, the image of the inside of the intestine is displayed on the monitor and assessed by the doctor. During the examination, it is also possible to take a biopsy and take therapeutic measures, eg polypectomy, bleeding control, coagulation of vascular lesions, tattooing … Colonoscopy requires preparation (cleaning) of the large intestine before the examination (see Preparation).

Preparation

A thorough examination of the intestine from the inside requires its perfect cleaning of food debris. This is achieved by using the appropriate drug prepared and applied according to the instructions. The correct reaction to the preparation will be frequent bowel movements, at the end with transparent or yellow colored liquid, clear contents. Preparation should be divided into two stages – on the eve and on the day of the study. This method of preparation gives the best possible effect and is much better tolerated by patients than preparation in the evening, the day before the examination. There are several intestinal cleansing preparations available in Poland. In the Screening Program, we routinely use the best known and long-used polyethylene glycol preparation (Fortrans), but it is possible to use other preparations (Clensia, Citrafleet, Moviprep, Eziclen)

• download – Instructions for preparation for colonoscopy with FORTRANS

Below we also present preparation diagrams with the use of four other preparations. These diagrams are based on scientific guidelines from European societies and / or publications and may differ from the method proposed in the leaflet.

• download – EZICLEN

preparation guide

• download – MOVIPREP

preparation instructions

• download – Preparation of the intestine with CLENSIA
• download – Preparation with Citrafleet

Important information:

1. People who regularly take medications, e.g. for hypertension, heart disease, epilepsy, asthma and others on the day of the examination should take their morning dose of the drug with a little water – EVEN IF THE TEST IS DONE UNDER ANESTHESIA
2. People suffering from diabetes should inform their registration about diabetes in advance, and also consult the attending physician or an anaesthesiologist at our center on how to prepare for the examination. Oral diabetes medications should NOT be taken unless food is being consumed at the same time. / or: Oral antidiabetic drugs should be discontinued on the day of the examination, and in the case of colonoscopy, the evening dose of the previous day should also be omitted /
3. People taking medications that reduce blood clotting
   – do not discontinue acetylsalicylic acid preparations (e.g. Acard, Polocard, Acesan)
   – drugs from the group of new oral anticoagulants (Pradaxa, Xarelto, Eliquis, Lixiana) – should be discontinued on the day before and skip the morning dose on the day of the test.

– drugs from the group of oral anticoagulants (Acenocoumarol, Warfarin) – INR should be determined in the week preceding the test: if the result is in the range of 2-3, do not modify the doses of drugs, if higher, consult your doctor.
In the case of people with a high risk of thromboembolism, after heart attacks or strokes, the optimal procedure is to consult a doctor or an anesthesiologist at our center. It is advisable to switch to CLEXANE in doses of 40, 60 or 80 mg, depending on the body weight, 5 days before and 2 days after the procedure /.
If there is a need to perform a larger endoscopic procedure, e.g. removal of polyps, it may be necessary to repeat the procedure after modifying anticoagulant treatment (e.g. in people using Acenocoumarol, Warfarin, switching to low molecular weight heparin treatment, in case of doubt, OPTIMUM PROCEDURE) CONSULATION WITH A DOCTOR / anesthesiologist of our Center /.

4. Please bring it and show it to the doctor before examining your documentation
   medical, e.g. discharge cards from hospital treatment, descriptions of previously performed endoscopic examinations, ultrasound of the abdominal cavity, ECG, echocardiography, spirometry and others.
   For tests under anesthesia, current test results are required (they must not be older than 3 months) such as: morphology, electrolytes – sodium / potassium, total bilirubin, creatinine, glucose, APTT and INR (if the patient is taking anticoagulants), TSH (if The patient takes thyroid hormones – Euthyrox, Letrox), EKG. Patients should know the names and doses of the medications taken or have a list of them. It is advisable to take these medications with you.
   You should come for the examination under anesthesia with an adult accompanying person.
5. After the examination performed under anesthesia, the patient remains in the observation room. The time of observation depends on the type of surgery and the patient’s condition. After this time, under the supervision of an accompanying person, he can go home. There is a 12-hour absolute ban on driving vehicles, mechanical machines and drinking alcohol. In very rare cases, longer observation may be necessary. Please include this in your plans.
6. If you require reading glasses, please bring them with you.
7. The designated estimated time to start the examination may be delayed because the duration of endoscopic examinations is difficult to predict.

Contraindications
Colonoscopy is safe, but there are some general contraindications for performing it. The most important are:

• Large aortic aneurysm
• Recent heart attack
• Severe heart failure
• Respiratory failure
• Pulmonary embolism
• Severe enteritis
• Suspicion of bowel perforation
• Mechanical bowel obstruction
• Pregnancy (2nd and 3rd trimester)

Before the examination, you will fill in a questionnaire regarding your current health condition in which you will be able to mark this type of information. They will be taken into account when qualifying for the study. Also, the doctor conducting the examination will – if necessary and in doubt, ask questions about past illnesses, so that the examination is safe for you.
Complications
During the examination, air is administered to the intestine, so after the examination you may feel bloating, discomfort, a feeling of distension, excessive gas discharge – this is not a complication, but only a result of the presence of gas in the intestine. During the examination, the doctor injects air or carbon dioxide into the intestine, which allows for a good visualization of the entire surface of the mucosa. There are toilets in each screening center that you can freely use. Gassing away usually brings relief after the test.
Colonoscopy is a safe examination, although its success and complete safety cannot be guaranteed by any physician. Complications are extremely rare. The most serious of them, i.e. perforation (perforation of the intestinal wall) or bleeding, may require immediate or urgent surgery. In the Polish screening program, perforation occurred only in 5 out of 50,000 tests (0.01%). If any symptom resulting from the performed colnoscopy worries the Patient or the physician performing the colonoscopy, the Patient remains under the care of the examining physician, and if necessary, he / she is obliged to provide further treatment.

• Survey for the screening program
• Survey for the screening program

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