engleski

Early results on implementation of the national program for screening of breast and colorectal cancer in Croatiia

Background: Both cancer incidence and mortality rates, in Croatia, are on a steady increase. Considering global experience and recommendations, The Croatian Government has, therefore, passed the decision on the National Program for prevention and early detection of cancer. Early detection is focused on common cancer sites for which effective screening tests are available, including: breast, cervical, colorectal and prostate cancer. Objectives: are to present organizational preparations and preliminary results of breast and colorectal cancer screening surveys, which have started firstly. Methods: Citizens of the target populations are invited by mail. High quality mammography, double reading, for women aged 50-69, by 2 yearly examination protocol, is applied as a method for screening on breast cancer. BI-RADS classification (stages 0-5) is used for reading of mammograms. For the early detection of colorectal cancer, conventional screening method Fecal Occult Blood Test (FOBT) by 2 yearly checking up is applied in asymptomatic population at average risk, aged 50-74. Persons with positive tests are refered for follow up by colonoscopy. The Croatian Public Health Institute in collaboration with the county institutes is responsible for the Program implementation. Results: The National Program for early detection of breast cancer has started in October 2006. Until end of February 2008, a total number of invited women amounted 351.358, exceeding the number of 280.000 women, expected to be invited a year. An average responding rate is 53, 6%, based on data obtained for the women born in 1937, 1954 and 1955, who have initially been covered. Responding rates for the women of a younger age are better, compared to the women of an older age. In some counties, achieved responding rates exceed the planned responding rate of 70% (maximum 82, 6%), but there are counties with low responding rates (minimum 42%). Until now, the number of cases suspected on cancer (BI-RADS 4 and 5) have reached 1.578, while the number of newly diagnosed cancer amounts 577 and is further increasing. The screening programme on colorectal cancer has started in November 2007. It is planned that 600.000 of persons be tested a year, with the coverage of 60%. A total of 93.000 invitation letters have been sent until now, mostly to persons aged 74 and 70. Preliminary results indicate very low responding rates (25% maximum). Estimations are based on the number of tests mailed back. When inaccurately applied tests are excluded, the results will be even worse. The percent of FOBT positive tests widely varies across the counties (from 3.7% to 24.2 %). Conclusions: Following the implementation of the National Program for early detection of breast and colorectal cancer, the higher proportion of diagnosed localised cancer, an increase of incidence rates, but a decrease of mortality rates and better survival rates are expected.

early resultson; nationalni program; screening; breast cancer; colorectal cancer

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