Colorectal Cancer Screening State of the art in Eastern Europe. Mārcis Leja Prague, September 27, 2017

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1 Colorectal Cancer Screening State of the art in Eastern Europe Mārcis Leja Prague, September 27, 2017

2 The borders of Eastern Europe? EU Urals Bering Sea 2

3 3

4 4

5 CRC screening programs in EU in 2016 Cancer Screening in the EU. 2nd survey

6 Central-East EU countries without populationbased invitations for screening Latvia Lithuania Estonia (until 2016) Czech Republic (until 2014) Slovakia Hungary Bulgaria Romania Cancer Screening in the EU. 2nd survey

7 Examination coverage Cancer Screening in the EU. 2nd survey

8 Tests used gfobt Croatia Latvia Czech Republic FIT Slovenia Hungary Lithuania Czech Republic Cancer Screening in the EU. 2nd survey

9 Tests used Cancer Screening in the EU. 2nd survey

10 Poland: colonoscopy screening Opportunistic program implemented in 2000 Once-in-a-lifetime screening colonoscopy Quality assurance program since 2006 Invitation coverage 4.9% in women & 5.3% in men* Participation rate until so far 16.7%* 2011 decision on radual implementation of an organized program Kaminski et al. Endoscopy *- Cancer Screening in the EU. 2nd survey

11 Poland: randomised implementation design Kaminski et al. Endoscopy

12 Cancer Control in Europe WP 7. Cancer Screening

13 The model involving the GPs Screening data base Laboratory Endoscopy Oncologists Cancer reistry 13

14 Countries with active involvement of GPs Czech Republic Estonia Hungary Latvia Lithuania 14

15 Estonia Nation-wide program launched in 2017 Test delivery via GPs, collection by mail FIT Centarlized lab. Established quality requirements in endoscopy 15

16 Lithuania Gradual implementation based on regional pilots FIT POC / Laboratory based Tests delivered, collected and read by GPs No special quality requirements for colonoscopies Uniform endoscopy / pathology data capture system not available 16

17 Hungary Nation-wide program with personal invitations to be launched in 2018 Regional pilot-studies conducted Test delivery via GPs FIT (3 laboratories) Centarlized lab. Endoscopy and pathology data capture systems available Courtesy from Herszényi László 17

18 Slovenia: Implementation Tepes et al. J Clin Gastroenterol

19 Slovenia: Colonoscopy findings Tepes et al. J Clin Gastroenterol

20 Participation rate Country Test type Participation rate Croatia gfobt 15.3% Czech Republic FIT 21%/26% Hungary FIT 36.7% Latvia gfobt 11.1% Lithuania FIT 58%/47% Slovenia FIT 50.5% Cancer Screening in the EU. 2nd survey

21 Colonoscopy attendance of FOBT positive cases Country Colonoscopy attendance rate Croatia 82% Czech Republic 53% Hungary 64% Latvia NA Lithuania 66% Slovenia 92% Cancer Screening in the EU. 2nd survey

22 Pilot in Latvia Repeated mail-delivered invitations Colonoscopy attendance rate 55.5% Eur J Gastroenterol Hepatol

23 Quality assurance of colonoscopy Completeness of colonoscopy registered Czech Republic Slovenia Poland ADR registered Croatia Czech Republic Slovenia Poland Cancer Screening in the EU. 2nd survey

24 28-EU vs. 19-non-EU countries Various data quality of the registries, only 30% of the non-eu countries rank high in data quality

25 Other countries in Europe Serbia an ongoing program Bosnia and Heregovina an ongoing program Republika Srpska opportunistic, population-wide Montenegro - pilot Georgia regional (Tbilisi) Belarus pilots (FIT, POC) Russia: pilot in St.Petersburg Pilot in Kazan, Tatarstan Ukraine - pilots (FIT & colonoscopy) Altobelli et al. WJG Personal communication 25

26 GP invitations (incl. by phone) 99, 592 invitees (19% of the target population) ifob 62.5% participation Primary health centre labs 26

27 Kazakhstan gfobt / POC FIT program Colonoscopy attendance 66.8% 27

28 Conclusions 1. Population-based CRC screening is not available in all countries in East-Europe 2. In a proportion of countries the set-up is not corresponding the principles of organized screening 3. Governence principles are stricly followed only in a proportion of countries 4. In addition to the EU guidelines, CanCon Policy recommendations on governance, organisation and evaluation of cancer screening is going to provide a valuable tool for addressing decision-makers 28

29 Acknowledgements Belarus: Sergej Pimanov Croatia: Nataša Antoljak, Mario Šekerija Estonia: Heidi-Ingrid Maaros Hungary: Herszényi László Lithuania: Juozas Kupcinskas Ukraine: Andrej Dorofeev, Marina Scherbinina 29

30 Thank you! 30

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