Original ResearchFull Report: Clinical—Alimentary TractReal-Time Monitoring of Results During First Year of Dutch Colorectal Cancer Screening Program and Optimization by Altering Fecal Immunochemical Test Cut-Off Levels
Section snippets
The Dutch CRC Screening Program
The Dutch CRC screening program was implemented gradually by age group from 2014 onward, with a projected roll-out period of 5 years, allowing for timely increase of the colonoscopy capacity to ultimately accommodate the target population of 2.2 million invitees annually (Appendix 1). The target population for 2014 consisted of all individuals reaching the age of 63, 65, 67, or 75 years in 2014. The oldest age group was included in 2014 because it was their only opportunity to be invited. The
Invitation and Participation
The target population for 2014 consisted of 865,048 persons. By the end of the year, 703,626 (81.3%) of those had been invited for screening. Weekly monitoring showed that in some screening regions the entire target population of 2014 had been invited before the end of the year. In these regions, an additional 38,288 persons aged 60 years were invited for screening, resulting in 741,914 invitees in total. Figure 2 shows the flow of individuals through the screening process. A total of 529,056
Discussion
These data show the additional value of real-time monitoring to successfully implement a national screening program. A few months into the program, real-time monitoring showed a higher positivity rate and a lower PPV than expected. This resulted in a higher number of false-positive test results, leading to unnecessary diagnostic colonoscopies with associated risks. In July 2014 the program was adjusted, resulting in a lower positivity rate and fewer false-positive results, which was more in
Acknowledgments
The authors thank the other members of the Dutch national colorectal cancer screening working group: D. L. Schipper, A. A. M. Masclee, T. J. Wiersma, J. A. Otte, A. van der Beek, F. J. van Kemenade, J. Stoker, G. J. den Heeten, E. J. R. de Graaf, W. M. U. van Grevenstein, Y. C. M. Kluiters, and M. A. Blankenstein for their role (on behalf of their professional association) in the realization and implementation of the current screening program and their critical review of the manuscript. The
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Conflicts of interest The authors disclose no conflicts.
Funding This study was funded by the Dutch National Institute for Public Health and the Environment.
Author names in bold designate shared co-first authorship.