Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 21, 2021; 27(39): 6689-6700
Published online Oct 21, 2021. doi: 10.3748/wjg.v27.i39.6689
Impact of a colorectal cancer screening program implantation on delays and prognosis of non-screening detected colorectal cancer
Joaquin Cubiella, María Lorenzo, Franco Baiocchi, Coral Tejido, Alejandro Conde, María Sande-Meijide, Margarita Castro
Joaquin Cubiella, Coral Tejido, Department of Gastroenterology, Complexo Hospitalario Universitario de Ourense, Ourense 32005, Orense, Spain
María Lorenzo, Alejandro Conde, María Sande-Meijide, Department of Preventive Medicine, Complexo Hospitalario Universitario de Ourense, Ourense 32003, Orense, Spain
Franco Baiocchi, Department of Gastroenterology, Hospital del Bierzo, Ponferrada 24404, Leon, Spain
Margarita Castro, Dirección Xeral de Saúde Pública, Conselleria de Sanidade, Santiago de Compostela 15703, Spain
Author contributions: Cubiella J, Sande-Meijide M and Castro M contributed to the conception and design of the article; Cubiella J, Sande-Meijide M, Castro M and Lorenzo M contributed to obtaining funding; Lorenzo M, Baiocchi F, Tejido C and Conde A contributed to acquisition of data; Cubiella J contributed to analysis, interpretation of data and drafting the article; all authors made critical revisions related to the manuscript’s important intellectual content and gave final approval of the version of the article to be published.
Supported by the Spain’s Carlos III Health Care Institute by means of project PI17/00837 (Co-funded by European Regional Development Fund/European Social Fund "A way to make Europe"/"Investing in your future").
Institutional review board statement: The study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the Ethics Committee of Galicia, Spain (code 2016/274). As long as the study was based on database use, no informed consent was required. The information was accessed according to prevailing European and Spanish legislation.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: We will share the data base on demand and according to European legislation.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Joaquin Cubiella, MD, PhD, Doctor, Staff Physician, Statistician, Department of Gastroenterology, Complexo Hospitalario Universitario de Ourense, Rúa Ramón Puga 52-54, Ourense 32005, Orense, Spain. joaquin.cubiella.fernandez@sergas.es
Received: April 14, 2021
Peer-review started: April 14, 2021
First decision: July 14, 2021
Revised: July 15, 2021
Accepted: September 8, 2021
Article in press: September 8, 2021
Published online: October 21, 2021
Processing time: 188 Days and 23.3 Hours
ARTICLE HIGHLIGHTS
Research background

In spite of the implementation of colorectal cancer (CRC) screening programmes, most CRC are detected among symptomatic patients outside the scope of CRC screening. However, they may increase the CRC awareness of patients and primary care physicians (PCP).

Research motivation

The implementation of a mass CRC screening programme could raise awareness of patients and PCPs, we decided to design a retrospective intervention study to determine whether implementation of a CRC screening programme could reduce health system delays and, secondarily, improve CRC staging at diagnosis and long term survival.

Research objectives

To determine the effect of implementation of a CRC screening programme on diagnostic delays and prognosis of CRC detected outside the scope of a screening programme.

Research methods

We designed a retrospective intervention study with a pre-post design without a control group. We compared diagnostic delays, CRC stage and two year survival of a yearly CRC diagnosed before the implementation of a CRC screening programa with a CRC cohort diagnosed the year after the first round.

Research results

There was a significant increase in direct referral to colonoscopy from primary healthcare (25.5%, 35.8%; P = 0.04) in the post-implantation cohort. Diagnostic delay was reduced by 24 d (106.64 ± 148.84 d, 82.84 ± 109.31 d; P = 0.02) due to the reduction in secondary healthcare delay (46.01 ± 111.65 d; 29.20 ± 60.83 d; P = 0.02). However, we did not find any differences in CRC stage at diagnosis or in two-year survival (70.3%; P = 0.9).

Research conclusions

Although implementation of a CRC screening programme can reduce diagnostic delays for CRC detected in symptomatic patients, this has no effect on CRC stage or survival.

Research perspectives

We need more research on the motivations and perspectives of patients seeking help in primary healthcare.