A single-centre survey on the adherence to colorectal cancer screening (CRCS) in Apulia: Impact of the Organized Region Screening Strategy (ORSS)

ABSTRACT

Background: A great disparity in CRCS adherence exists between the various Regions of Italy, ranging from 98% (North) to 44% (South). The AIRTUM report in 2019 counted almost 2900 new CRC diagnosis for the Apulian Region, while CRCS adherence was inferior to 5%. To counterbalance this trend, an ORSS has been started since September 2019, consisting in an invitation to faecal occult blood tests for people aged 50-70 years. The effects of this strategy have not yet been quantified, while SARS-COV2 pandemic interference is unknown. The aim of our study was to evaluate the percentage of patients with recent CRC diagnosis by screening in a period across the start of the ORSS and unravel the reasons for patient refusal. Material and methods: Patients aged >50 years and residing in Apulia with CRC diagnosis made at the Division of Medical Oncology in “A.O.U. Consorziale Policlinico di Bari” between May 2018 and April 2021 were interviewed by phone. Hereditary or IBD related CRC were both considered exclusion criteria. We collected data about the cause of diagnosis, knowledge of CRCS, how the subjects were informed about screening and reasons for non-adhesion. Close relatives were also asked if had joined or intended to take part in CRCS since they were considered a very sensitized population. Results: We enrolled 130 patients, including 60 diagnosed before and 70 after September 2019. Overall, 10% of patients had received a diagnosis of CRC by screening. Of these, 1% was diagnosed before the start of the ORSS and 9% after. Only 23% of participants were sufficiently learned of CRCS across the study period, while invitation was received from ORSS in 14% and from general practitioners (GP) in 6%. The major reasons for CRCS denial were “diffidence” (65%) and “futility” (35%). Among close relatives of people with recent CRC history, a 24% of CRCS adherence was observed, while another 50% of them said that intended to take the test. Conclusions: We found an inadequate adherence to CRCS mainly due to poor consciousness of CRC disease and prevention, while it significantly increased in sensitized people. Moreover, the higher percentage of CRC diagnoses made by CRCS since 2019 may represent a direct effect of the ORSS, although the number of persons invited is still not enough. These data confirm the gap of the Apulia from other Italian Regions regarding the reluctance to carry out CRCS and suggest greater investments in awareness campaigns for the population and GP.