MEDICINSKI GLASNIK - Aktuelno Ljekarska komora ZE - DO kantona

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Medicinski Glasnik, Volumen 8, Number 1, February 2011
Based on these long-term experiences in performing
cancer-related programs in the local
community, local health authorities assume that
cancer early detection measures have to be focused
on the Primary Health Care services, with
the central role of family physicians (16). A simulated
model of early detection of colorectal
cancer was performed in order to estimate time
and costs required. In general, the model showed
that no more than 2 or 3 patients should be added
per day, consuming as much as 20-50 minutes
of an extra time of a family medicine team, depending
on whether it is the first examination or
a follow-up of cases with positive results. This
was an argument that it is possible to integrate
the colorectal cancer early detection program
into the official health care system, without the
need for substantial organizational changes and
additional finance. The project is based on active
and systematic approach of a family doctor.
That means that the doctor actively performs
preventive measures, recognizing medical needs
of the patients and following the guidelines. This
approach is different from that whereby the doctor
generally responds to patient’s requests (15).
Family physicians possess excellent possibilities
to perform preventive activities, because of their
specific position in the health care system, in the
front line contact with the population (24). Their
attitudes are that the prevention and early detection
of cancer is necessary and still insufficiently
implemented in practice. Moreover, preventive
activities should become a centre of their occupation.
In order to implement these programs within
routine practice, they suggest certain organizational
prerequisites. The emphasis is placed
on the decrease of the number of patients on their
lists and a more precise definition of the working
frame of family medicine as a specific medical
profession. Family physicians included in the
project were additionally educated on cancer early
detection methods.
When data concerning positive tests are analysed,
some important observations can be made.
In general, it seems that older part of the conventionally
defined target group included in the
National Program and already covered by screening
(aged 70-74), are preferentially disposed
to colorectal occult bleeding and even for the
development of cancer (11,88% positive results
for the Osijek-Baranja County). This could be in
accordance with the statistics showing that colorectal
cancer incidence in Croatia, in the groups
aged 60 years and more, largely exceeds the younger
groups (78,3% compared to 7,9% in the
groups up to 50 years of age) (5). High rates of
positive tests obtained by the National Program
can partially be a consequence of a long period of
absence of systematically performed screening.
Data obtained by the project indicate that in the
middle age population groups (45-49) a very low
rate of positive tests on systematically and non
selectively performed screening can be expected
(1% positive tests). This indicates that, for younger
population groups, information on family history
of colorectal cancer and other colon related
diseases, as well as colon related symptoms and
signs, should be obtained first in order to select
persons at higher than average risk for the development
of colon cancer.
Nevertheless, based on the results of this study
screening of colorectal cancer using hemoccult
test proved to be an economically justified procedure
(17). There is a growing awareness worldwide
that only global action can make a dramatic
stride in taking the control over the spreading of
malignant disease (25-27). The main objective set
by international bodies is to increase the number
of countries that have the national cancer control
program, covering cancer prevention, early detection,
treatment, palliative care and support to
cancer patients (28-31). This is equally important
for the developing and the developed countries,
as it is estimated that more than 70% of all cancer
deaths occur in low income countries. Bearing in
mind the differences in socioeconomic, cultural
and resource settings among countries, the world
health authorities have stated that all countries
should adopt evidence-based guidelines and quality-assured
national programs for early detection
and treatment of cancer, but based on their own
infrastructure (26). World experiences gained so
far in the implementation of national programs
on colorectal cancer early detection show that
the best results are achieved when programs are
performed in a centralized and standardized fashion
(2). This includes a central agency with an
established call/recall system to ensure equality
in access to screening for all people from the
target population, evaluation of tests in a central