Program badań przesiewowych
The New England Journal of Medicine – the world’s most renowned clinical journal – published two articles developed and written by scientists from the Gastroenterology Clinic of the Oncology Center in Warsaw (currently NIO-PIB). These are the only two publications in the history of this journal that were written exclusively by Polish authors.
The first one was published in November 2006. The first author is prof. Jarosław Reguła. This study investigated the risk factors of advanced neoplasia in people presenting for screening, i.e. people without colorectal symptoms  .
The data of people tested in the Screening Program in 2000-2004 were analyzed. At that time, the study was performed in 50,148 people without symptoms of the colon, including 43,042 people between 50 and 66 years of age, and 7,106 people between the age of 40 and 49 who had a positive family history of cancer. Women constituted 64% of the entire group. The complete examination, i.e. with reaching the cecum, was performed in 45,693 (91.1%) people.
Advanced neoplasia, defined as cancer or adenoma at least 10 mm in diameter, with high-grade dysplasia, villous or tubulovillous, was diagnosed in 2,553 (5.9%) people aged 50-66 and 243 ( 3.4%) of people aged 40-49. Adenocarcinoma was diagnosed in 416 people: in 169 stage I, in 91 stage II and 111 stage III.
Gender, age, and family history of colorectal cancer have been shown to be associated with the risk of advanced neoplasia.
The risk of developing advanced neoplasia at screening:
- is twice as high in men as in women (OR = 2.08, p & lt; 0.001),
- increases by about 60% with each subsequent 5 years of life, (50-54 vs 40-49 OR = 1.64, 55-59 vs 40-49 OR = 2.4, 60-66 vs 40-49 OR = 2.95 , p & lt; 0.0001),
- is approximately 2 times higher in people diagnosed with colorectal cancer in 2 1st-degree relatives or in one 1st-degree relative before the age of 60 than in those with no family history of cancer (OR = 2.1 , OR = 1.87, p & lt; 0.0001, respectively).
- is 40% higher in people diagnosed with colorectal cancer of one 1st degree relative over the age of 60 compared to those with no family history of cancer (OR = 1.43, p & lt; 0.0001). li >
By family history of colorectal cancer:
- in 1 in 20 or 1 in 30 men aged 40-49, and
- 1 in 6 or 1 in 10 men aged 60-66 without bowel symptoms
diagnosed with advanced neoplasia.
Depending on the family history of colorectal cancer
- 1 in 32 or 1 in 52 women aged 40-49, and
- 1 in 16 or 1 in 19 women aged 60-66 without bowel symptoms
diagnosed with advanced neoplasia.
The above results may be the basis for the verification of recommendations for screening for colorectal cancer.
If men are recommended to perform the first test at the age of 50, it seems that the age limit for the first test in women can be extended to 55-60 years of age – the number of tests that should be performed to detect one advanced neoplasia in these groups is similar: 13 and 16 in people with a family history of colorectal cancer, and 18 and 19 in people with no family history of colorectal cancer.
The second publication appeared in May 2010, its first author is Dr. Michał F. Kamiński. In this study, the screening quality parameters related to the incidence of interval cancer  were investigated.
The data of people tested in the Screening Program in 2000-2004, who had sufficient bowel cleansing before the examination, had all found polyps removed, and no cancer diagnosed as a result of the screening, were analyzed.
Data from people examined by endoscopists who performed less than 30 tests as part of the screening program were excluded from the analysis.
The analysis included 45,026 people, mean age 55.1 years, of whom 35.7% were male. The full examination, i.e. the examination reaching the cecum, was performed in 41,552 (92.3%) subjects.
Interval cancer was defined as an adenocarcinoma of the colon that appeared between screening and the recommended time of follow-up, but no later than 5 years, in the part of the intestine that was viewed at the time of screening. The following were considered as study quality parameters defined for individual endoscopists:
- frequency of adenoma detection, which is the number of tests in which at least 1 adenoma was detected divided by the number of tests performed,
- frequency of tests to reach the contra-angle.
The analyzed group of people was examined by 186 endoscopists, including 149 (80.1%) men who performed 30 to 1,848 endoscopies. Half of the respondents performed more than 145 tests under the screening program. Half of the endoscopists detected adenomas more often than in 12.2% of the examined people. Half of the endoscopists achieved the contra-angle more often than in 94% of their examinations.
The total observation time of the study group was 188,788 person-years. At that time, 42 interval cancers were diagnosed, which is 22.3 events per 100,000 person-years of follow-up. 35 (83.3%) of interval cancers were reported in people with no family history of colorectal cancer and 39 (92.9%) in people who had no adenoma detected at screening.
It has been shown that the factors related to the occurrence of interval cancer are the age of the examined person and the frequency of adenomas detection by an endoscopist.
The risk of developing interval cancer in long-term follow-up is:
- many times greater in people aged 60-66 compared to those aged 40-49 (OR = 13.3, p = 0.01)
- more than 10 times higher in people examined by endoscopists, whose adenoma detection frequency does not exceed 20%, (15% -20% vs> 20% OR = 10.9, 11% -15% vs> 20% OR = 10.7, & lt; 11% vs & gt; 20% OR = 12.5%, p = 0.02)
The obtained results confirm the importance of the quality parameter, which is the frequency of adenomas detection by the endoscopist performing the examination. It is a factor significantly related to the occurrence of interval cancer in further observation. The prognostic significance of the frequency of examinations reaching the cecum has not been confirmed.
- 1 . Regula J, Rupinski M, Kraszewska E, Polkowski M, Pachlewski J, Orlowska J, Nowacki MP, Butruk E, Colonoscopy in colorectal-cancer screening for detection of advanced neoplasia. N Engl J Med 2006; 355: 1863-72
2 . Kaminski MF, Regula J, Kraszewska E, Polkowski M, Wojciechowska U, Didkowska J, Zwierko M, Rupinski M, Nowacki MP, Butruk E. Quality indicators for colonoscopy and the risk of interval cancer. N Engl J Med. 2010; 362: 1795-803
Publications of work on colorectal cancer and screening tests, the authors or co-authors of which are the coordinators of the Colon Cancer Screening Program in Poland and the PBP team
European recommendations and initiatives to work on changes
- Quality indicators for endoscopy laboratories: an initiative to improve the quality of the European Society for Gastrointestinal Endoscopy (ESGE).
Valori, R., Cortas, G., de Lange, T., Salem Balfaqih, O., de Pater, M., Eisendrath, P., Falt, P., Koruk, I., Ono, A., Rustemovic, N., Schoon, E., Veitch, A., Senore, C., Bellisario, C., Minozzi, S., Bennett, C., Bretthauer, M., Dinis-Ribeiro, M., Domagk, D., Hassan, C., Kaminski, MF, Rees, CJ, Spada, C., Bisschops, R. and Rutter, M. Performance measures for endoscopy services: A European Society of Gastrointestinal Endoscopy (ESGE) quality improvement initiative. United European Gastroenterol J 2019; 7: 21-44.
- Polypectomy and endoscopic mucosal resection (EMR) of the colon: clinical guidelines of the European Society of Gastrointestinal Endoscopy.
Ferlitsch, M., Moss, A., Hassan, C., Bhandari, P., Dumonceau, JM, Paspatis, G., Jover, R., Langner, C., Bronzwaer, M., Nalankilli, K., Fockens , P., Hazzan, R., Gralnek, IM, Gschwantler, M., Waldmann, E., Jeschek, P., Penz, D., Heresbach, D., Moons, L., Lemmers, A., Paraskeva, K., Pohl, J., Ponchon, T., Regula, J., Repici, A., Rutter, MD, Burgess, NG and Bourke, MJ Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2017; 49: 270-297.
- Lower gastrointestinal endoscopy quality indicators: an initiative to improve the quality of the European Society for Gastrointestinal Endoscopy (ESGE).
Kaminski, MF, Thomas-Gibson, S., Bugajski, M., Bretthauer, M., Rees, C. .J, Dekker, E, Hoff, G., Jover, R., Suchanek, S. and Ferlitsch, M . Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) quality improvement initiative . Endoscopy 2017; 49: 378-397.
- Gastrointestinal Endoscopy Reporting Systems: Requirements and Standards to Facilitate Quality Improvement: Statement by the European Society for Gastrointestinal Endoscopy.
Bretthauer, M., Aabakken, L., Dekker, E., Kaminski, MF, Rosch, T., Hultcrantz, R., Suchanek, S., Jover, R., Kuipers, EJ, Bisschops, R., Spada, C., Valori, R., Domagk, D., Rees, C. and Rutter, MD Reporting systems in gastrointestinal endoscopy: Requirements and standards facilitating quality improvement: European Society of Gastrointestinal Endoscopy position statement. United European Gastroenterol J 2016; 4: 172-6.
- European Code Against Cancer – 4th edition – screening tests.
Armaroli, P., Villain, P., Suonio, E., Almonte, M., Anttila, A., Atkin, WS, Dean, PB, de Koning, HJ, Dillner, L., Herrero, R., Kuipers, EJ, Lansdorp-Vogelaar, I., Minozzi, S., Paci, E., Regula, J., Tornberg, S. and Segnan, N. European Code against Cancer, 4th Edition: Cancer screening. Cancer Epidemiol 2015; 39 Suppl 1: S139-52.
- Effect of low volume versus large bowel preparation volume on reportingability for screening colonoscopy: a randomized public health study.
Pisera, M., Franczyk, R., Wieszczy, P., Polkowski, M., Rupinski, M., Chaber-Ciopinska, A., Kotowski, B., Kula, Z., Kielek, S., Buszkiewicz, M ., Rupinska, M., Kobiela, J., Kaminski, MF and Regula, J. The impact of low- versus standard-volume bowel preparation on participation in primary screening colonoscopy: a randomized health services study. Endoscopy 2019; 51: 227-236.
- Modifiable factors related to patient-reported pain during and after screening colonoscopy.
Bugajski, M., Wieszczy, P., Hoff, G., Rupinski, M., Regula, J. and Kaminski, MF Modifiable factors associated with patient-reported pain during and after screening colonoscopy. Gut 2018; 67: 1958-1964.
- Relationship between obesity and findings during screening colonoscopy in a large population study. 2017
Kobiela J, Wieszczy P, Regula J, and Kaminski MF Association of obesity with colonic findings in screening colonoscopy in a large population-based study. United European Gastroenterol J 2018; 6: 1538-1546.
- Increasing the detection rate of colorectal adenomas reduces the risk of developing and dying from colorectal cancer.
Kaminski, MF, Wieszczy, P., Rupinski, M., Wojciechowska, U., Didkowska, J., Kraszewska, E., Kobiela, J., Franczyk, R., Rupinska, M., Kocot, B., Chaber -Ciopinska, A., Pachlewski, J., Polkowski, M. and Regula, J. Increased Rate of Adenoma Detection Associates With Reduced Risk of Colorectal Cancer and Death. Gastroenterology 2017; 153: 98-105.
- Detection frequency of serrated polyps and serrated polyposis syndrome in colorectal cancer screening cohorts: a European review.
JEG, I. Jspeert, Bevan, R., Senore, C., Kaminski, MF, Kuipers, EJ, Mroz, A., Bessa, X., Cassoni, P., Hassan, C., Repici, A., Balaguer , F., Rees, CJ and Dekker, E. Detection rate of serrated polyps and serrated polyposis syndrome in colorectal cancer screening cohorts: a European overview. Gut 2017; 66: 1225-1232.
- Colon cancer screening by colonoscopy: a randomized clinical trial.
Bretthauer, M., Kaminski, MF, Loberg, M., Zauber, AG, Regula, J., Kuipers, EJ, Hernan, MA, McFadden, E., Sunde, A., Kalager, M., Dekker, E. , Lansdorp-Vogelaar, I., Garborg, K., Rupinski, M., Spaander, MC, Bugajski, M., Hoie, O., Stefansson, T., Hoff, G. and Adami, HO Population-Based Colonoscopy Screening for Colorectal Cancer: A Randomized Clinical Trial. JAMA Intern Med 2016; 176: 894-902.
- Re-invitation to screening colonoscopy – randomized follow-up study of the effect of a reminder letter and educational meeting on the enrollment of people who did not respond to the original invitation to screening colonoscopy.
Pisera, M., Kaminski, MF, Kraszewska, E., Rupinski, M. and Regula, J. Reinvitation to screening colonoscopy: a randomized-controlled trial of reminding letter and invitation to educational meeting on attendance in nonresponders to initial invitation to screening colonoscopy (REINVITE). Eur J Gastroenterol Hepatol 2016; 28: 538-42.
- Training of endoscopy lab leaders to improve adenoma detection rate during screening colonoscopy – randomized trial.
Kaminski, MF, Anderson, J., Valori, R., Kraszewska, E., Rupinski, M., Pachlewski, J., Wronska, E., Bretthauer, M., Thomas-Gibson, S., Kuipers, EJ and Regula, J. Leadership training to improve adenoma detection rate in screening colonoscopy: a randomized trial. Gut 2016; 65: 616-24.
- Project of the Polish Colon Cancer Screening Program: a randomized public health study.
Kaminski, MF, Kraszewska, E., Rupinski, M., Laskowska, M., Wieszczy, P. and Regula, J. Design of the Polish Colonoscopy Screening Program: a randomized health services study. Endoscopy 2015; 47: 1144-50.
- How to ensure that patients are enrolled in the colon cancer screening program and supervised in your practice.
Hassan C., Kaminski MF, Repici A. How to Ensure Patient Adherence to Colorectal Cancer Screening and Surveillance in Your Practice. Gastroenterology 2018; 155: 252-257.
- The detectability of adenomas and the risk of colorectal cancer.
Wieszczy P., Regula J., Kaminski M.F. Adenoma detection rate and risk of colorectal cancer. Best Pract Res Clin Gastroenterol 2017; 31: 441-446.
- Surveillance of colorectal cancer in gastroenterological practice.
Kaminski M.F., Bretthauer M. Cancer surveillance in gastroenterology practice. Best Pract Res Clin Gastroenterol 2016; 30: 853-854.