ABSTRACT
BACKGROUND: Since its complete roll-out in 2009, the French colorectal cancer screening program (CRCSP) experienced 3 major constraints [use of a less efficient Guaiac-test (gFOBT), stopping the supply of Fecal-Immunochemical-Test kits (FIT), and suspension of the program due to the coronavirus disease 2019 (COVID-19)] affecting its effectiveness. AIM: To describe the impact of the constraints in terms of changes in the quality of screening-colonoscopy (Quali-Colo). METHODS: This retrospective cohort study included screening-colonoscopies performed by gastroenterologists between Jan-2010 and Dec-2020 in people aged 50-74 living in Ile-de-France (France). The changes in Quali-colo (Proportion of colonoscopies performed beyond 7 mo (Colo_7 mo), Frequency of serious adverse events (SAE) and Colonoscopy detection rate) were described in a cohort of Gastroenterologists who performed at least one colonoscopy over each of the four periods defined according to the chronology of the constraints [gFOBT: Normal progress of the CRCSP using gFOBT (2010-2014); FIT: Normal progress of the CRCSP using FIT (2015-2018); STOP-FIT: Year (2019) during which the CRCSP experienced the cessation of the supply of test kits; COVID: Program suspension due to the COVID-19 health crisis (2020)]. The link between each dependent variable (Colo_7 mo; SAE occurrence, neoplasm detection rate) and the predictive factors was analyzed in a two-level multivariate hierarchical model. RESULTS: The 533 gastroenterologists (cohort) achieved 21509 screening colonoscopies over gFOBT period, 38352 over FIT, 7342 over STOP-FIT and 7995 over COVID period. The frequency of SAE did not change between periods (gFOBT: 0.3%; FIT: 0.3%; STOP-FIT: 0.3%; and COVID: 0.2%; P = 0.10). The risk of Colo_7 mo doubled between FIT [adjusted odds ratio (aOR): 1.2 (1.1; 1.2)] and STOP-FIT [aOR: 2.4 (2.1; 2.6)]; then, decreased by 40% between STOP-FIT and COVID [aOR: 2.0 (1.8; 2.2)]. Regardless of the period, this Colo_7 mo's risk was twice as high for screening colonoscopy performed in a public hospital [aOR: 2.1 (1.3; 3.6)] compared to screening-colonoscopy performed in a private clinic. The neoplasm detection, which increased by 60% between gFOBT and FIT [aOR: 1.6 (1.5; 1.7)], decreased by 40% between FIT and COVID [aOR: 1.1 (1.0; 1.3)]. CONCLUSION: The constraints likely affected the time-to-colonoscopy as well as the colonoscopy detection rate without impacting the SAE's occurrence, highlighting the need for a respectable reference time-to-colonoscopy in CRCSP.
Subject(s)
COVID-19 , Colorectal Neoplasms , Gastroenterologists , Humans , Guaiac , Early Detection of Cancer , Retrospective Studies , COVID-19/diagnosis , COVID-19/epidemiology , Colorectal Neoplasms/diagnosis , Colorectal Neoplasms/epidemiology , Mass Screening , Colonoscopy , Occult Blood , RadiopharmaceuticalsABSTRACT
Résumé Face à l’épidémie de coronavirus disease 2019 (covid-19), la France a décidé un confinement total le 16 mars 2020 et une levée de celui-ci le 11 mai 2020. Cela a été associé à des directives d’arrêt des dépistages du cancer du sein puis de reprise de l’activité mammographique selon des modalités précises hiérarchisant les priorités. L’objectif principal de ce travail, réalisé dans deux régions françaises, l’Île-de-France et les Hauts-de-France, était de mesurer l’impact de la crise sanitaire sur la participation au dépistage organisé du cancer du sein. Il s’agissait par ailleurs de disposer d’une vision globale des dépistages en recueillant les données du dépistage individuel. En tout, sur l’ensemble de l’année 2020, l’activité de dépistage organisé a représenté 92% de l’activité de 2019 en Île-de-France et 93% dans les Hauts-de-France, alors que pendant deux mois l’activité était tombée à moins de 10% de l’activité habituelle et que pendant deux autres mois l’activité était en-deçà de l’activité normale. Le bilan en fin d’année témoigne donc d’un fort rattrapage lors du second semestre 2020. Après la prise en compte de l’activité de dépistage individuel, une réduction globale mais modérée de 6 à 7% du dépistage du cancer du sein a été observée dans les deux régions en 2020. Il conviendra dans les suites de ce travail d’analyser les conséquences de ces observations sur le stade évolutif des cancers détectés, ainsi que sur les délais de prises en charge. Summary In response to the coronavirus disease 2019 (covid-19) epidemic, France declared a full lockdown from the 16th March 2020 to the 11th May 2020. This was coupled with directives to stop breast cancer screening. Mammographic activities were then resumed according to precise modalities establishing a hierarchy of priorities. The main objective of this study, carried out in two French regions, Île-de-France and Hauts-de-France, was to measure the impact of the health crisis on participation in organised breast cancer screening. The aim was also to obtain a global overview of screening by collecting data on individual screening. Altogether, over the whole of 2020, organized breast cancer screening activity was equivalent to 92% of 2019 activity in Île-de-France and 93% in Hauts-de-France. Activity was below the normal level for a total of 4 months, including two months where activity had fallen to less than 10% of the usual mammographic activity. The annual review therefore indicates a significant recovery of the mammographic activity in the second half of the year 2020. After taking into account individual screening activity, an overall but moderate reduction of 6 to 7% in breast cancer screening was observed in the two regions in 2020. As the follow-up of this work, it will be necessary to examine the consequences of these observations on the stage of the cancers detected, as well as on the time taken to start a treatment.