ANALISI DELL¿ATTIVITÀ DI SCREENING DEL COLON RETTO NELL'ASL MILANO 1 (2006-12)

Objective Colorectal cancer is one of the main challenges in public health: it is cancer with higher incidence in Western society, and is available for its early diagnosis a screening test which can be followed a treatment effective. In particular, Europe countries in the last decade have developed screening programs. A program was developed in Asl Milano 1 (Lombardia – Italy) from 2006 to nowadays. The objective of the study is to analyze the overall performance of colon rectal screening in ASL Milano 1 in the period 2006-12 Methods Every two years, 50–69 year olds receive a letter from Asl Milano 1 that invite them to go in a pharmacy and take a FOBT-kit (fecal occult blood test). People complete the test in the privacy of their own home. Kit must be reported in a pharmacy that sent it to the laboratory for analysis. Negative people is informed about test result by mail. Positive people is usually informed by a telephone call by a nurse of his health territorial unit that recommend a colonoscopy and book one in an hospital. Participation in the program is voluntary and there is no cost involved in completing the test or colonoscopy. Quality-assurance requirements were established to ensure safe procedures and practice in every clinical aspect of a screening-program Results From 2006 to 2012 a total of 722.605 individuals were invited to screening , 274.167 returned with a correctly placed stool specimen on FOBT cards, 565 and 3344 High risk adenoma were identified . Some indicator were calculated(reported only last year- 2011): subjects invited 91%, crude compliance 45%; adjusted adherence 46%; delay between FOBT screening and negative result 99% within 21 days; Positivity rate 5,4%; participation to colonoscopy 90%; complete colonoscopy rate 93%; Delay between the call for colonoscopy and the colonoscopy procedure ; 61% within 60 calendar days ; positive predictive value of FOBT at colonoscopy 3,1% for cancer and 21,9 %for high risk adenoma; 1/3 of cancers screen-detected are T1; sensibility 86% (IC 95% 83-89) specificity 97%. Conclusion The screening program has provided the public with a service that meets the needs and sustainable over the years. Limit in the organizational process is the waiting time for the provision of colonoscopy: impact significantly on the ability to increase screening performaces. iFOBT-based screening programmes showed a high performance in terms of sensitivity as estimated through the interval cancers rates.