MEDICINSKI GLASNIK - Aktuelno Ljekarska komora ZE - DO kantona

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Medicinski Glasnik, Volumen 8, Number 1, February 2011
INTRODUCTION
Colorectal cancer is currently on the second position
by both incidence and mortality rate among
malignant tumours in EU countries (1). It is one
of the fastest growing types of cancer in western
countries, which is supposed to be a consequence
of modern lifestyle such as unhealthy diet, rich in
saturated fat and poor in vegetables and fruits, as
well as lack of body exercises (2).
On the other hand, it has an excellent possibilities
to be cut if recognized and cured at an early
stage. Theoretically, all colon and rectal cancers
can be either prevented or cured by removal of
adenomas and cancers in their early stages (2,3).
Past experience in using conventional screening
method for early detection of the colorectal cancer,
Fecal Occult Blood Test (FOBT), applied
in asymptomatic population at average risk, has
shown that 3-5% persons with positive tests could
be expected (4,18). They are candidates for
further evaluation by colonoscopy (4,18). Following
up this protocol, it is possible to decline
the mortality rates for 18-33% (4).
In Croatia, both the colorectal cancer incidence
and the mortality rates are on a steady increase
(14). It is ranking second in prevalence for both
sexes, following lung cancer in men and breast
cancer in women (5). A need for urgent implementation
of systematically performed screening
on colorectal cancer on a national scale is
illustrated by the fact that high mortality rates
(varying between 2000 and 2006 from 37,5 to
40,5/100,000) have been recorded (5). It can partially
be a consequence of the fact that it is detected
too late (6).
In the Osijek-Baranja County, the increasing
trend of the mortality rates for colorectal cancer
even exceeds the average for Croatia. One of the
reasons of such unfavourable statistics may be the
war in 1991/92, the Osijek-Baranja County was
faced with, and the long post-war period leaving
the negative consequences on the local economy
and health of the citizens (7,8).
After several years of preparations and following
the international recommendations, the National
Program for Early Detection of Colorectal Cancer
was implemented in November 2007. This
program is a part of a more ambitious project for
early detection of four main cancer sites proved
to be preventable, including also breast, prostate
and cervix uteri (9-12).
Taking into account the unfavourable colorectal
cancer statistics and using their own experiences
in performing systematic screening on colorectal
cancer, the leaders of the Department of Family
Medicine of the Osijek University School of Medicine
and the Health Center Osijek introduced
at the same time the project ‘’A Model of Early
Cancer Detection Integrated in Practice of Family
Physicians’’ (13). An idea promoted by the
project is that screening and early diagnosis of
cancer is more efficient if integrated in practice
of family physicians, compared to the National
Program, centrally directed and supplied by the
public services.
This paper presents preliminary results of the colorectal
cancer early detection program obtained
by the project. Possible advantages of this model
are emphasized as compared to the alternative
model proposed by the National Program.
RESEARCH SAMPLE AND METHODS
Croatian National Program of Prevention and
Early Detection of Colorectal Cancer
The main objectives of the project was to achieve
the screening coverage of at least 60%, to reverse
the low proportion of diagnosed pre-clinical
and localised cancers, to reduce mortality by
15% during the period of five years after the program
started. Specific goals are directed towards
improvements in diagnostics and treatment and
standardization of protocols (10-12).
The target population was defined according to
international recommendations and include males
and females aged 50-74 at average risk (10-
12).
The screening protocol was based on two-year
checkups with the FOBT. Persons with positive
tests are referred to colonoscopy in the nearest endoscopic
unit (10-12). Based on widely obtained
data, 10-15% of them are expected to be diagnosed
colorectal cancer and 30-40% adenomas (3).
Special protocols including the beginning of the
screening much earlier in the life and more frequent
colonoscopic examination are planned for population
groups at higher than average risk, such
as patients with inflammatory bowl diseases, or