Colorectal cancer fecal screening test completion after age 74, sources and outcomes in French program

Abstract

Background: Elderly patients aged at least 75 years old (Elderly_75), represent 45% of colorectal cancer (CRC) incidence. As others, the French Colorectal Cancer Screening Program (CRCSP) does not include Elderly_75. To date, there is little evidence to justify stopping screening at 74 years of age.

Aim: To describe CRC fecal screening test completion after age 74, source (CRCSP/Provider ordered) and outcomes of these tests.

Methods: The study concerned 18704 Elderly_75 residing in eleven French districts (Ain, Doubs, Essonne, Haute-Saone, Hauts-de-Seine, Jura, Seine-Saint-Denis, Territoire-de-Belfort, Val-de-Marne, Val-d'Oise, Yonne), having performed a CRC screening test between January 2008 and December 2017. The tests performed in a circumstance of delayed response to a solicitation (DRS) from the local cancer screening managing center (Managing-Center) were distinguished from the tests non-solicited by the Managing-Center, performed after a recommendation by a General Practitioner (GP) or other provider ordered (RGP). DRS was any test realized by an Elderly_75 following an initial invitation from the Managing-Center with a maximum 24 mo after this invitation. Any Non-DRS test was considered RGP. The outcomes of these tests were described according to the circumstances of test completion.

Results: Of 18995 screening-tests were performed at ages: 75 (83.5%), 76-80 (13.4%) and > 80 (3.1%) years old. Elderly_75 performed the screening test in a circumstance of DRS (71.9%) or RGP (28.1%). The proportion of the tests that could not be analyzed and not restarted was 13.2%. For these unanalyzed tests, the reason was age-related in 78.0% of cases, related to the laboratory's refusal to analyze the test of people aged ≥ 77. Reported colonoscopy completion rate was 81.3%. For those 575 people with reported colonoscopy, no complication was listed. 18.0% of the 366 Elderly_75 with lesions had no anteriority in the CRCSP. The neoplasia (124 Low-risk-polyps, 159 High-risk-polyps, 13 Unspecified-polyps and 70 CRCs) detection rate was 19.3/1000 Elderly_75 screened and the CRC detection rate was 3.7/1000 Elderly_75 screened.

Conclusion: The high rate of colonoscopy completion after a positive test and the high proportion of screened lesions observed suggest that the lengthening of the screening period could allow significant detection of CRC and polyps that occur in Elderly_75 excluded from CRCSP.

Keywords: Colonoscopy completion rate; Colorectal cancer; Elderly; Fecal screening test; Participation rate.

Figure 1

Frequency of participation in previous campaigns, by circumstances and by screening year. DRS: Delayed response after solicitation; RGP: Recommendation of a General Practitioner/Provider ordered; CI: Confidence interval.