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Background The results of a pilot colorectal cancer screening programme by biennial immunochemical faecal occult blood test (FOBT) are reported. Methods All residents aged between 50 and 69 years in the Italian province of Lecco were invited to have a FOBT. Those with a positive result were offered colonoscopy. FOBT uptake and compliance with colonoscopy were assessed. Detection rate and positive predictive value (PPV) for cancer and adenoma were calculated. Tumour stages were compared between screen-detected cancers and other colorectal cancers diagnosed within the target age group. Results Some 38 693 (49·6 per cent) of 78 083 individuals had a FOBT and 2392 (6·2 per cent) had a positive result. Colorectal cancer was diagnosed in 4·6 per cent and advanced adenoma in 32·7 per cent. PPVs were 4·0 per cent for cancer, 28·1 per cent for advanced adenoma and 36·6 per cent for any adenoma. There was a significant difference in incidence of stage III/IV disease between screened and non-screened cohorts. Compliance for colonoscopy was 92·0 per cent. Major determinants of compliance were age less than 59 years, female sex, high education level and non-manual work. Conclusion These results justify extension of colorectal cancer screening to other regions of Italy.

Since 2005, the Italian National Health System (NHS) has implemented a screening program for colorectal cancer for all citizens over 50. Screening tests are free for the target population (so-called Minimal Care Level guaranteed for all Italian citizens). Invitees are asked to take an immunological test for Faecal Occult Blood (FOBT) every two years. Individuals with a positive FOBT test are invited to undergo a total colonoscopy in an SSN-accredited Endoscopy Department. Each Italian Region has a centre for the coordination of the screening programme, which employs a dedicated software that can trace the progress of each citizen within the programme: FOBT invitation (first round) compliance/non-compliance (reminder); FOBT positive cases: total colonoscopy, endoscopic or surgical treatment of screen-detected lesions plus follow-up; FOBT negative cases: FOBT invitation after two years (second round). The ‘Screening Centre’ has a database that can provide a detailed, real-time status of the programme: it is therefore possible to compare the characteristics of screen-detected and non-screen-detected cancers. The target population for the screening programme includes all citizens aged 50–70, except ‘high-risk’ subjects (family history; serious, persistent IBD; previous colorectal surgery; recent non-screen-related FOBT and/or colonoscopy; apparent digestive-tract symptoms (proctorrhagia, abdominal pain, bowel irregularities, etc)).

Severe oral mucositis is a major cause of morbidity following allogeneic hematopoietic stem cell transplantation (AHSCT). Cryotherapy, that is, the application of ice chips on the mucosa of the oral cavity during the administration of antineoplastic agents, may reduce the incidence and severity of chemotherapy-related oral mucositis. In this multicenter randomized study, we addressed whether cryotherapy during MTX administration is effective in the prevention of severe oral mucositis in patients undergoing myeloablative AHSCT. One hundred and thirty patients undergoing myeloablative AHSCT and MTX-containing GVHD prophylaxis were enrolled and randomized to receive or not receive cryotherapy during MTX administration. The incidence of severe (grade 3-4) oral mucositis, the primary end point of the study, was comparable in patients receiving or not cryotherapy. Moreover, no difference was observed in the incidence of oral mucositis grade 2-4 and the duration of oral mucositis grade 3-4 or 2-4, or in the kinetics of mucositis over time. In univariate and multivariate analysis, severe oral mucositis correlated with TBI in the conditioning regimen and lack of folinic acid rescue following MTX administration. Thus, cryotherapy during MTX administration does not reduce severe oral mucositis in patients undergoing myeloablative allogeneic HSCT. Future studies will assess cryotherapy before allogeneic HSCT.