First study in North Africa: Screening colorectal cancer

Abstract

Introduction: In Algeria in 2015 colorectal cancer represents the 2nd cause of cancer mortality after lung cancer in men and after breast cancer in women. The increasing CRC incidence and mortality can be reduced by screening and treating adenomas and early cancers. A pilot CRC screening programme using immunochemical faecal occult blood testing (iFOBT) and colonoscopy for test-positives were implemented in Béjaia a northeast district of Algeria. This study aims to evaluate the acceptability, feasibility, validity of screening tests, and scaling-up of screening in Algeria. This report describes the implementation, coverage and performance indicators of this pilot project. Methods: This is a pilot study for colorectal cancer screening with an immunological test of an average risk population aged [50-74] over a 20-month period. A target population aged 50-74 years was informed about and invited to undergo CRC screening by community -clinics. faecal sample collection kits were provided through local primary care units for home sample collection. iFOBT-positive persons were referred for colonoscopy at the Béjaia University hospital, and endoscopic polypectomy/biopsies were performed according to the colonoscopies findings. Those with confirmed CRC received appropriate treatment. Results: Of the 10,000-target population, 2562 (26%) were screened using iFOBT between January 2016 and November 2017. The main issue in the program was accessing people living in study areas due to lack of valid registry system. Of those screened, 156 (6.11%) were found positive; positivity was equitably between men and woman, a rate of 39.4% polyps among the pathological colonoscopies, 6 cancers are found which corresponding 3.7% of positive tests and a colorectal cancer detection rate of 2.35%. The high false positive rate in our study would be investigated during the next stage through assessment of several kits in Algeria to compare their validity. Conclusion: The successful implementation of the pilot CRC screening with satisfactory process measures indicate the feasibility of scaling-up organized CRC screening through existing health services In Algeria. More work is needed in assessment of kits to be used in the national program. Also, the process of identification of the population based on their residential access will be evaluated further. An economic evaluation for the program to be conducted before the end of 2018.