Nordic colorectal cancer screening programmes: A comparison of organization, operation, and quality indicators

Abstract

Introduction: While comparison studies are common in the Nordic countries, important differences need to be illuminated to understand the comparability of future studies within colorectal cancer (CRC) screening research. Therefore, a systematic overview of similarities and differences in the CRC screening programmes in Denmark, Finland, Iceland, Norway, and Sweden was conducted METHODS: Information from each country was gathered through the Nordic CRC screening network, which includes experts in CRC screening from the participating countries. A timeline describing preceding pilot studies and national roll-outs in all countries was established. Furthermore, the screening flow in each country and the quality indicator monitoring including performance standards were presented.

Results: During 2014-2024, all five Nordic countries implemented CRC screening using faecal immunochemical testing (FIT) but with different implementation strategies and cut-off values. Taking colonoscopy resources into account, gradual implementation strategies were used in all countries, but with different paces. Quality monitoring follows the European recommendations with some variation; however key performance indicators such as adenoma detection rates (ADR), colonoscopy complication rates, serrated polyp detection, post-colonoscopy CRC (PCCRC) rates, and interval cancer rates, are monitored by all countries.

Conclusion: This paper may serve as a key reference for future research and comparison studies across the Nordic countries. The variation found in countries with similar health care systems might serve as natural experiments in future studies. Furthermore, this overview shows that there might be room for improvements in the monitoring of certain quality indicators to facilitate quality improvement efforts in all Nordic countries.

Keywords: Colonic Polyps; Colonoscopy; Colorectal neoplasms; Health plan implementation; Healthcare; Mass screening; Quality assurance; Quality indicators; Scandinavian and Nordic countries.