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Background Colorectal cancer (CRC) screening programmes require high levels of participation in order to reduce mortality. To improve participation rates, it is necessary to identify the health risk factors and social inequalities associated with non-participation. Methods A systematic review was conducted between June and September of 2019 in six databases: CINHAL, Medline, Scopus, Social Sciences Citation Index, Embase and PsycINFO. Studies assessing the relationship between health risk factors, participation in preventive activities and participation in CRC screening were included. Methodological assessment was carried out according to the Quality Assessment Tools of the National Heart, Lung and Blood Institute. Results A total of nine studies that analyze participation in both organized and opportunistic screening programmes using any type of screening method were finally selected. Data were mainly self-reported although in two studies medical records were also studied. We identified several variables: gender, body mass index, consultation with a doctor or a specialist, educational level, employment, health insurance, residence, ethnicity, age, marital status, income, other preventive activities, obesity, physical activity, smoking, family history of CRC and general health status. Conclusion The scarcity of studies linking risk factors, social inequalities and participation in preventive activities for participation in screening in the same study makes it difficult to reach definitive patterns related to non-participation in CRC screening programmes. Nevertheless, being under 60, obese, smoker and sedentary have shown an association with non-participation as well as not visiting a doctor.

Background The Basque Health Service (Spain) approved the Colorectal Cancer (CRC) screening programme in 2008; targeted at residents (50 to 69 years old) by biennial faecal immunochemical test and colonoscopy in positive cases. Total coverage was reached in 2014. Despite our high participation rate (72.3%), some people have never been screened, probably due to several factors (socio-economic factors, lifestyles, comorbidities, health preventive actions, etc.). The identification of these factors could be crucial in order to improve the results and impact of the programme. Methods Cross sectional descriptive study. All invited population in a complete round between 2015 and the first trimester of 2017 were included. Data base was linked to registered health risk factors, preventive activities managed by Primary Care and socioeconomic deprivation index. Univariate and multivariate analyses were performed by SPSS 23.0. Results 515,388 people were invited and 71.9% participated. Non-participation is significantly (p ≤ 0.001) related to: being men (OR = 1.10); younger than 60 (OR = 1.18); smoker (OR = 1.20); hypertensive (OR = 1.14) and diabetic (OR = 1.40), as well as to having a severe comorbidity (OR = 2.09) and very high deprivation (OR = 1.15). Low use of Primary Care services (OR = 2.39) and inappropriate control of risk factors also increase the likelihood of not participating. Conclusions Several factors addressed in Primary Care influence the participation in the CRC Screening Programme. Its results and impact (decreasing incidence and mortality) could be improved if individual and socioeconomic factors are taken into account to increase participation. Primary care and social networks are key in further planned interventions. Key messages Decreasing inequalities in the screening participation is one of the most important objectives in this Public Health strategy. Primary Care plays a key role in all the screening programmes’ implementations.

The steady increase in colorectal cancer (CRC) could be reversed through timely secondary prevention (screening) as a main strategy. The aims of this study were to determine the main features of CRC, survival rate and related factors for different types of identified CRCs in a population-based screening programme using the faecal immunochemical test (FIT).The CRCs in the susceptible population to be screened between 2009 and 2014 were identified and classified into four groups: (a) nonscreening-detected CRC (diagnosed before first screening invitation and nonparticipants), (b) screening-detected CRC, (c) interval cancer (IC) FIT (diagnosed between screening rounds after a negative FIT) and (d) IC colonoscopy (diagnosed before the colonoscopy surveillance, which is recommended after the screening colonoscopy). Patient demographics and epidemiological characteristics, tumour characteristics and survival were compared between the four groups.5909 individuals were diagnosed with a CRC. The median follow-up of survival was 4.6 years (range: 0-9 years). The study highlights a significant difference (P0.0001) in the 5-year survival in the screening-detected CRC group compared with those who had nonscreening-detected CRCs (90.1 vs. 66.7%). Although ICs are not desirable events, the 5-year survival rate is significantly higher with respect to nonparticipants (P0.0001) (76.3 vs. 60.5%), this being the group with the lowest survival rate.The significantly higher 5-year survival rate of 23.4% of the participants in the screening programme suggests that incidence and mortality rates of CRC will decrease in the near future for participants in screening programmes. A high participation rate is essential to achieve health benefits, irrespective of the type of participation.

Resumen Introduccion La colonoscopia es la prueba de confirmacion diagnostica/terapeutica del cancer colorrectal. La monitorizacion de la experiencia de las personas que se han realizado la prueba resulta de interes en la mejora de su calidad. El objetivo fue estudiar los factores relacionados con la experiencia y su relacion con los indicadores de calidad de las guias de practica clinica. Pacientes y metodos Se realizo un estudio transversal observacional, incluyendo indicadores de calidad y experiencia (cuestionario mGHAA9 adaptado e historia clinica) con una muestra de 432 participantes de entre 40-75 anos que se realizaron una colonoscopia en 2015. Analisis univariante y multivariante con regresion logistica multiple. Resultados La satisfaccion se asocio en el analisis multivariante con una valoracion del tiempo de espera para la colonoscopia como corto (OR = 3,80) (1,76-10,90; IC 95%), tener mas de 55 anos de edad (OR = 2,60) (1,19-5,68; IC 95%), una valoracion positiva de la experiencia de la preparacion (OR = 7,34) (3,15-17,09; IC 95%), no referir dolor o molestias durante el procedimiento (OR = 3,71) (1,03-13,40; IC 95%) (p = 0,006) y la realizacion de la exploracion en un hospital terciario (OR = 2,81) (1,17-6,72; IC 95%) (p = 0,020) Discusion El cuestionario mGHAA9 adaptado al castellano es util para estudiar los factores relativos a la experiencia. Hay aspectos de mejora en los tiempos de espera, limpieza colonica, satisfaccion con la preparacion y los problemas poscolonoscopia. Se deben implementar intervenciones que permitan mejorar la experiencia de las personas y la calidad de la colonoscopia.

Background The overall aim of this study was to describe trends in participation rates and detection of lesions in a colorectal cancer (CRC) screening programme, during three rounds, using faecal immunochemical test (FIT). Methods National registers were used to collect data on invitations for CRC screening in the Basque Country (Spain) from 2009 to 2014. Information about participation, age, gender and lesions in each round were collected. Results A total of 961.533 individuals were included in the analysis; respectively, 584.950, 298.143 and 78.440 in the first, second and third rounds. The average participation rate was 68.4% (66.8, 70.4 and 72.3%, respectively by round; P < 0.001) and the positivity rate was 6.3% (7, 5.5 and 5.4%, respectively by round; P < 0.001). The participation rate increased significantly with age and was found to be higher in women versus men. A total of 15.144 advanced adenomas and 2.131 CRCs were diagnosed, leading to a detection rate of 23.9 and 3.4‰, respectively. Regarding gender, men had the highest rates in all periods and rounds. The detection rate of advanced neoplasia was lower in the regular when compared with irregular paricipants. Conclusions In a CRC screening, this organization obtained high FIT participation rates. Older participants and women were associated with a higher participation. The detection rate of lesions was higher in men, independent on age and round.

Screening by means of biennial fecal occult blood test has provided a reduction in overall colorectal cancer mortality. Notwithstanding, we should not underestimate the harms that it can produce.The aim of this article is to identify the independent risk factors of complications after a screening colonoscopy.A six-year, nested case-control study was conducted. Mortality/complications within 30 days after colonoscopy were registered and its predictors identified through logistic regression.After 39,254 colonoscopies, the complication rate was 1.0%. Independent predictors were sex (OR 1.68 for men; CI 95% 1.18-2.39), ASA physical status classification system (OR 1.73 for ASA II-III; CI 95% 1.53-3.69), history of abdominal surgery (OR 2.37; CI 95% 1.72-4.08), diverticulosis (OR 2.89; CI 95% 1.94-4.30), inadequate cleansing (OR 29.35; CI 95% 6.52-132.17), detection of advanced neoplasia (AN) (OR 4.92; CI 95% 3.29-7.36), detection of stage I adenocarcinoma (OR 9.44; CI 95% 4.46-20.0), polyps in right colon OR 2.27 CI 95% 1.38-3.74) and complex polypectomy (OR 2.00; CI 95% 1.25-3.20). The logistic model explained 82% of the complications (CI 95% 0.798-0.854,Colonoscopy, with or without removal of a lesion, is an invasive procedure with a non-deniable risk of major complications. Factors like inadequate cleansing or detection of AN are determinants. Therefore, it is vital to know which aspects predict their appearance to implement countermeasures.

Using the algorithm of the World Endoscopy Organisation (WEO), we have studied retrospectively all colorectal cancers, both detected and non-detected by the Basque Country screening programme from 2009 to 2017. In the screening programme 61,335 colonoscopies were performed following a positive Faecal Immunochemical test (FIT) (≥20 µg Hb/g faeces) and the 128 cases of post-colonoscopy colorectal cancer (PCCRC) detected were analysed. Among them, 50 interval type PCCRCs were diagnosed (before the recommended surveillance), 0.8 cases per 1000 colonoscopies performed, and 78 non-interval type PCCRCs (in the surveillance carried out at the recommended time or delayed), 1.3 per 1000 colonoscopies. Among the non-interval type PCCRCs, 61 cases were detected in the surveillance carried out at the recommended time (type A) and 17 when the surveillance was delayed (type B), 1 case per 1000 colonoscopies performed and 0.28 cases per 1000 colonoscopies performed, respectively. Interval type PCCRC is less frequent than non-interval type PCCRC. In interval type PCCRCs, CRCs detected in advanced stages (stages III–IV) were significantly more frequent than those detected in early stages, compared to those of non-interval type PCCRCs (OR = 3.057, 95% CI, 1.410–6.625, p &lt, 0.005). Non-interval type B PCCRCs are less frequent than non-interval type A PCCRCs, but the frequency of advanced stages is higher in interval type B PCCRCs.

AIM To assess proportions, related conditions and survival of interval cancer (IC). METHODS The programme has a linkage with different clinical databases and cancer registers to allow suitable evaluation. This evaluation involves the detection of ICs after a negative faecal inmunochemical test (FIT), interval cancer FIT (IC-FIT) prior to a subsequent invitation, and the detection of ICs after a positive FIT and confirmatory diagnosis without colorectal cancer (CRC) detected and before the following recommended colonoscopy, IC-colonoscopy. We conducted a retrospective observational study analyzing from January 2009 to December 2015 1193602 invited people onto the Programme (participation rate of 68.6%). RESULTS Two thousand five hundred and eighteen cancers were diagnosed through the programme, 18 cases of IC-colonoscopy were found before the recommended follow-up (43542 colonoscopies performed) and 186 IC-FIT were identified before the following invitation of the 769200 negative FITs. There was no statistically significant relation between the predictor variables of ICs with sex, age and deprivation index, but there was relation between location and stage. Additionally, it was observed that there was less risk when the location was distal rather than proximal (OR = 0.28, 95%CI: 0.20-0.40, P < 0.0001), with no statistical significance when the location was in the rectum as opposed to proximal. When comparing the screen-detected cancers (SCs) with ICs, significant differences in survival were found (P < 0.001); being the 5-years survival for SCs 91.6% and IC-FIT 77.8%. CONCLUSION These findings in a Population Based CRC Screening Programme indicate the need of population-based studies that continue analyzing related factors to improve their detection and reducing harm.

espanolObjetivo: analizar la efectividad de una intervencion enfermera en Atencion Primaria (AP) para la mejora de la preparacion colonica de las personas que se realizan una colonoscopia de cribado. Metodo: estudio de evaluacion antes (invitacion 2015 del Programa de Cribado de Cancer Colorrectal –PCCR-) despues (invitacion 2018 del PCCR) en una Unidad de Atencion Primaria del Pais Vasco, sobre 154 personas que se hicieron la colonoscopia de confirmacion tras tener resultado positivo en el PCCR. La intervencion llevada a cabo por profesionales de Enfermeria de AP consto de la realizacion de una consulta especifica para instruir a los pacientes sobre la preparacion colonica a traves de una lista de comprobacion disponible en la historia clinica digital, y una llamada recordatorio 24 horas antes de la colonoscopia. La variable principal fue la calidad de la preparacion colonica (escala de Boston). Se utilizo Chi-cuadrado o el test exacto de Fisher en los analisis bivariantes. Resultados: 135 personas aceptaron participar en el estudio. El 54,1% visualizo los videos sobre la preparacion. El 94,8% recibio la llamada telefonica. La variable de resultado “calidad de la preparacion de la colonoscopia” mostro diferencias estadisticamente significativas entre los dos anos comparados, pudiendose observar una preparacion adecuada en mas casos en el ano 2018 que en el ano 2015 (97,8% vs. 88,7%; p= 0,003). Conclusiones: la realizacion de la intervencion enfermera orientada a una mejor preparacion colonica siguiendo la lista de comprobacion estandarizado y disponible en la historia clinica, ademas de la llamada telefonica 24 horas antes de la colonoscopia, resulto efectiva en la mejora de la calidad de la limpieza colonica. Tambien, ha supuesto la creacion de un registro del proceso de atencion de Enfermeria. EnglishObjective: to analyze the efficacy of a Primary Care (PC) nursing intervention for the colonic preparation of patients undergoing colonoscopy screening. Method: a before (2015 invitation by the Colorectal Cancer Screening Program – CCSP) and after (2018 invitation by the CCSP) evaluation study at a Primary Care Unit in the Basque Country, including 154 persons who underwent confirmation colonoscopy after obtaining a positive result in the CCSP. The intervention was conducted by PC Nursing professionals, and consisted of a specific training consultation for patients about colonic preparation, through a check-list available at the electronic clinical record, and a reminder call 24 hours prior to the colonoscopy. The primary variable was the quality of the colonic preparation (Boston Scale). Chi-square or Fisher’s exact test were used at bivariate analyses. Results: in total, 135 persons accepted to participate in the study; 54.1% of them viewed the videos on preparation, and 94.8% of them received the phone call. The “quality of the colonoscopy preparation” outcome variable showed statistically significant differences between both years compared: an adequate preparation could be observed in more cases in 2018 than in 2015 (97.8% vs. 88.7%; p= 0.003). Conclusions: conducting the nursing intervention, targeted to a better colonic preparation, and following the standard check-list available in the clinical record, as well as the phone call 24 hours prior to the colonoscopy, proved to be effective for the improvement of colonic cleansing. Moreover, it has led to the creation of a Nursing care process record.

Background & Aims Most fulfillment and benchmarking information for colonoscopy quality indicators has been obtained from studies of primary screening colonoscopies. We analyzed differences in the fulfillment of colonoscopy quality indicators based on the indication for endoscopy. Methods We performed an observational, multicenter, cross-sectional study of 14,867 patients who underwent endoscopy procedures for gastrointestinal symptoms (40.3%), a positive result from a fecal immunochemical test (36.0%), postpolypectomy surveillance (15.3%), or primary screening (8.4%), from February 2016 through December 2017 at 14 centers in Spain. We evaluated rates of adequate colon cleansing, cecal intubation, adenoma detection, and colorectal cancer detection, among others. We used findings from primary screening colonoscopies as the reference standard. Results Fewer than 90% of patients had adequate bowel preparation; 83.1% of patients with gastrointestinal symptoms had adequate bowel preparation (odds ratio [OR] compared with patients with primary screening colonoscopies, 0.62; 95% CI, 0.49–0.78) and 85.3% of patients receiving postpolypectomy surveillance had adequate bowel preparation (OR, 0.71; 95% CI, 0.55–0.91). The cecal intubation rate was also lower in patients with gastrointestinal symptoms (93.1%) (OR, 0.34; 95% CI, 0.22–0.52). The adenoma detection rate was higher in patients with a positive result from a fecal immunochemical test (46.4%) (OR, 2.01; 95% CI, 1.71–2.35) and in patients undergoing postpolypectomy surveillance (48.2%) (OR, 1.41; 95% CI, 1.20–1.67). The highest proportion of patients with colorectal cancer was in the gastrointestinal symptom group (5.1%) (OR, 5.24; 95% CI, 2.30–11.93) and the lowest was in patients undergoing surveillance (0.8%) (OR, 0.83; 95% CI, 0.32–2.14). Conclusions Fulfillment of colonoscopy performance measures varies substantially by indication. Policies addressing performance measures beyond colonoscopy screening procedures should be developed. Benchmarking recommendations could be adjusted according to colonoscopy indication.

Euskadiko Baheketa Programa 50 eta 69 urte bitarteko biztanleei zuzenduta dago. Gorozkietan ezkutuan dagoen odola detektatzeko testaren (FIT) bidez egiten da, bi urtean behin, eta kasu positiboetan kolonoskopia egiten da sedazioarekin. Metodoa: analisi-kita etxera bidalita gonbidatzen dira indibidualki ikerketako adin-taldeko biztanle oro. Osakidetzako Historia Elektroniko, Minbizi Erregistro eta Heriotza Erregistroko datuak erabiltzen dira informazio-iturri. 2009-2016 bitartean egindako gonbidapen guztien azterketa sexuaren eta adinaren arabera eta biziraupenaren azterketa 2014. urteraino. 2011ko Europako Kalitate Gidan azaltzen diren irizpide eta adierazleak erabiliaz. R eta SPSS aplikazioak erabili dira deskribapen estatistikoa eta biziraute kurbak (Kaplan-Meyer) lortzeko. Emaitzak: 1.426.846 baliozko gonbidapen, parte-hartzeak joera positiboa (p