An adapted program of colorectal cancer screening--7 years experience and cost-benefit analysis.

The Czech program of colorectal cancer screening differs from most foreign programs in a number of points. The age interval of screened population was limited to 45 to 60 years. Screening was multicentric, with one reference center. More than 95% of the subjects screened were asymptomatic employees of various factories, boards and institutions. Total colonoscopy was the primary procedure in all Haemoccult-positive subjects. Some 109,213 subjects received 3 Haemoccult slides. Compliance was 83.1%, and Haemoccult was positive in 2.92% of the subjects. The diagnostic program revealed 347 (13.1%) cancers, 763 adenomas in 592 (22.2%) subjects, and other bleeding conditions in 1043 (39.2%) persons. Dukes A or B colorectal cancer was found in two-thirds of the screened subjects and in only one-third of non-screened symptomatic patients. Average diagnostic and therapeutic costs were almost the same in both groups. Gross national product savings realized by one asymptomatic subject were 315,540 Czechoslovak Crowns (approximately 18,560 US-dollars at the 1989 exchange rates). The adapted program was found to be effective, and its use in a population with a high incidence of colorectal neoplasia deserves consideration.

[High ileus with a prolonged course]. / Vysoký ileus s protrahovaným prubehem.

The authors describe the atypical development of a so-called high ileus caused by a bulky phytobezoar made up of tropical fruit. it is of interest that the organism managed to cope for two months relatively well with a condition described in surgical practice as acute abdomen where urgent or at least acute intervention is essential. The authors draw attention to pitfalls of out-patient care which may involve risk of delay due to incomplete evaluation by the specialists involved. This risk is particularly great during the present period of restructuring of the health services "hunting for a"high point score".

[Incidence of cholecystolithiasis in a population 20-59 years of age]. / Výskyt cholecystolitiázy v populacní skupine 20-59 let veku.

In 1989-1990 sonographic examination of the gallbladder of 1186 people aged 20-59 years revealed in 262 cholecystolithiasis (22.1%). The group comprised 477 men (40.2%) and 709 women (59.8%). The general prevalence which is 22.1% comprises prevalence of sonographically revealed lithiasis--213 patients (18%) and lithiasis treated by cholecystectomy before sonographic examination--49 patients (4.1%). Among men cholecystolithiasis was revealed in 60 (12.6%) and among women in 202 (28.5%). The author discusses the relationship of cholecystolithiasis and body weight and the incidence of the disease in the family.

[The prevalence of idiopathic proctocolitis]. / K otázce prevalence idiopatické proktokolitidy.

During screening of colorectal cancer by the Haemoccult test (Röhm Pharma Co.) the authors investigated the incidence of idiopathic proctocolitis in the population of the Bruntál district. The group of tested subjects comprises 16.642 of the population aged 45 to 86 years. After examination of 380 positive subjects (2.28%) twelve cases of idiopathic proctocolitis were detected. Of these twelve seven were identified previously and a new diagnosis was made in five subjects. At twelve cases were identified from a population of 16.642, the assumed prevalence in 1989 in the given age group is 72/100.000. This suggests considerable underestimation of the prevalence of idiopathic proctocolitis in current epidemiological surveys.

[Costs and benefits of screening for colorectal tumors using the Hemoccult test in asymptomatic individuals 45-60 years of age]. / Náklady a uzitek depistáze kolorektálních nádoru Haemoccult testem u asymptomatických jedincu ve veku 45-60 let.

Screening of colorectal tumours by the Haemoccult test (HT) in asymptomatic subjects aged 45-60 years makes it possible to assess the diagnosis of colorectal carcinoma (CR-CA) in two-thirds of the affected subjects in Dukes stage A and B, as compared with one third of symptomatic patients of the same age group. The mean diagnostic and therapeutic costs related to the relative incidence of individual stages of Dukes staging of CR-CA in screened asymptomatic individuals and symptomatic patients are approximately equal. The analysis is not concerned with costs of care after surgical and supplementary treatment which are considerable in subjects with the advanced form of the disease. Its incidence is significantly higher in symptomatic patients. The mean expected productive age under 60 years is in symptomatic patients 2.604 years and in asymptomatic individuals 4.357 years. The mean national product assembled during this period is 468.720 Kcs and 784.260 Kcs resp. The difference in favour of one asymptomatic subject in the analyzed group is 38,495.880 Kcs. These facts fully justify further extension of screening programmes of CR-CA in our population.

[Are there common risk factors for the development of ischemic heart disease and colorectal carcinoma?]. / Jsou rizikové faktory pro vznik a rozvoj ischemické choroby srdecní a kolorektálního karcinomu spolecné?

The author evaluates accepted risks for the genesis and development of ischaemic heart disease in relation to their incidence in patients with confirmed colorectal adenoma. These risks were investigated in 194 patients with adenoma of the large intestine and their presence was compared with a group of 200 subjects not suffering from this disease. In the investigated group with colorectal adenoma an elevated blood pressure was recorded in 98 patients (50.5%), hypercholesterolaemia in 127 (65.5%), obesity in 113 (58.3%) and smoking in 104 patients (53.6%). In the control group of 200 subjects a high blood pressure was recorded in 54 patients (27%), hypercholesterolaemia in 72 (36%), obesity in 70 patients (35%) and smoking in 101 cases (50.5%). The results are discussed with regard to possible aimed secondary prevention, as the contemporary screening of colorectal cancer by means of occult haemorrhage tests is done only up to the age of 45 years. The risk of obesity, hypercholesterolaemia and high blood pressure is found in the group with colorectal adenoma significantly more frequently, as compared with the control group not suffering from oncological disease.

[Classification of colorectal adenomas based on the histological picture in patients without symptoms]. / Trídení kolorektálních adenomu podle histologického obrazu u nemocných bez príznaku.

During screening of colorectal carcinoma by the test of occult haemorrhage in 1985 to 1989 in the Bruntál district during coloscopic examination of positive subjects a total of 277 adenomatous polyps of the large intestine were revealed. Adenomatous polyps were detected in 227 patients where by in 180 solitary polyps were involved and in 47 cases synchronous polyps. 222 adenomatous polyps were in the rectum and left half of the colon (80.1%). Histological examination revealed: tubular adenoma 153 cases (55.23%), tubovillous adenoma 92 cases (33.21%), villous adenoma 13 cases (4.69%), adenoma with intramucous carcinoma 12 cases (4.43%) and adenoma with invasive carcinoma 7 cases (2.53%).

[Problems in the early diagnosis and treatment of colorectal carcinoma and adenoma in the aged]. / Problematika vcasné diagnózy a lécby kolorektálního karcinomu a adenomu ve stárí.

In 1985-1989 in the Bruntál district by means of the test for occult haemorrhage (Haemoccult, Röhm Pharma Co.) a total of 1084 subjects aged 65-86 years were examined. The test was positive in 74 subjects (6.83%). A subsequent coloscopic examination was made in 60 subjects, 81% of those with a positive test. Coloscopic examination revealed 8 patients with carcinoma of the large intestine and 45 patients with an adenomatous polyp. The oncological positivity is thus 4.89% of the tested subjects and 88.33% of those subjected to coloscopy. The carcinoma was evaluated in two cases in the stage Dukes A, in four instances in stage Dukes B, in one case in stage Dukes C and in one case in stage Dukes D. In two patients with carcinoma another adenomatous polyp was found in the large intestine. In 14 patients of 45 with an adenomatous polyp another synchronous adenomatous polyp was detected (31.1%). 43 patients were treated by coloscopic polypectomy. Contemporary possibilities of early diagnosis of colorectal carcinoma in conjunction with effective therapeutic endoscopy are perspective in particular in patients of advanced age.

Results of screening for colorectal carcinoma in the District of Bruntál using the Haemoccult Test in 1985-1988.

In 1985-1988, 11,046 working people of the district of Bruntál, aged 45-69, were examined for occult bleeding into the stools, using the Haemoccult test. The return rate of the tests was 92.05%. Screening detected 241 patients (2.18%) with positive stools test results who were referred to further examination. 129 patients (1.17%) were found to have one or more adenomatous polyps or adenocarcinoma in the large intestine. Adenocarcinoma was detected in 15 cases (0.13%): eight in stage Dukes A, two in stage Dukes B, three in Dukes C, and two in Dukes D stages. Endoscopic polypectomy or surgical operation were used for treatment. The programme of screening for colorectal carcinoma as elaborated for the low-risk group of asymptomatic subjects over 45 years of age helps to detect less advanced stages of this oncological affection.

[Results of colonoscopic examination 2 years after polypectomy of an intestinal adenoma]. / Výsledky koloskopického vysetrení za dva roky po polypektomii adenomu streva.

The authors examined 204 patients after a two-year interval following endoscopic and surgical polypectomy resp. of an adenoma of the large intestine. The group comprised 67 patients (32.8%) with a metachronous adenomatous polyp. In none of these patients carcinoma was diagnosed. In patients where originally a solitary adenoma was diagnosed a metachronous adenoma developed in 14%. In the group with originally synchronous polyps a metachronous polyp developed in 85.2%. The male:female ratio during the original examination and after two years in relation to an adenoma of the large intestine did not change significantly. The test for occult blood in the faeces made by the Haemoccult test gave in 3% falsely positive results and in 27% falsely negative results. According to the results of the examination the two-year interval is sufficient for repeated coloscopy within the framework of dispensarization of patients after polypectomy. In exceptional cases the interval of the check-up must be adjusted to the patient's condition with regard to the follow up by and collaboration with the general practitioner.

[Results of screening for colorectal carcinoma in the Bruntál District using the Haemoccult Test 1985-1986]. / Výsledky depistáze kolorektálního karcinomu v okrese Bruntál Haemoccult testem v letech 1985-1986.

In the Bruntál district in 1985-1986 in 11,046 working people aged 45-69 years an examination for occult haemorrhage into faeces was made, using the Haemoccult test. The return rate of the tests was 92.05%. Screening detected 241 patients (2.18%) with positive tests in faeces, who were subjected to further examinations. In 129 patients (1.17%) one or more adenomatous polyps or adenocarcinoma of the large intestine was proved. Adenocarcinoma was detected in 15 (0.13%), eight times in stage Dukes A, twice Dukes B, three times Dukes C and twice Dukes 2. Treatment involved endoscopic polypectomy or surgical operation. Tre elaborated screening programme of colorectal carcinoma for a low risk group of asymptomatic subjects above 45 years of age helps to detect less advanced stages of this oncological affection.

[Repeat screening for colorectal carcinoma in a population of asymptomatic individuals after 2 years]. / Opakovaná depistáz kolorektálního karcinomu v populaci asymptomatických jedincu po dvou letech.

The first stage of the screening of colorectal carcinoma took place in the Bruntál district in 1985-1986. In 1987-1988 this population group of asymptomatic workers was examined repeatedly. After two years an examination of 4512 subjects from a total of 4909 issued tests was made. During the repeated screening programme the return rate of tests was 91.9%. The number of patients with positive occult haemorrhage into faeces was 65 (1.44%). The number of patients with positive oncological disease in the sense of an adenomatous polyp or carcinoma was 18 (0.40%). None of these 18 patients was in the group of patients with positive occult haemorrhage in the first stage of the screening in 1985-1986. Adenocarcinoma was revealed in two instances, once in stage Dukes A and once in stage Dukes B. Another cause of positivity of occult haemorrhage in faeces was diagnosed in 47 cases (1.04%). The frequency of oncologically conditioned positivity of occult haemorrhage in faces declined during screening after two years from the original 0.92% to 0.40%. Both detected carcinomas of the large intestine were revealed at a time which, if further radical treatment is provided, gives hope of satisfactory therapeutic results.

[Experience with screening for colorectal carcinoma using the Haemoccult Test]. / Zkusenosti s depistází kolorektálního karcinomu Haemoccult testem.

The authors submit their experience with the screening of colorectal cancer in 1985-1987 in the Bruntál district. Within the programme 9772 workers from industry and agriculture aged 45 years and more, regardless of sex, were examined. The return rate of tests was 93% and a total of 189 patients with a positive test of occult haemorrhage (1.93%) was detected. Adenomatous polyps or colorectal carcinoma were diagnosed in 91 patients (0.93%). The authors discuss demands which must be respected to make the screening successful. Attention is focused not only on the activity of health workers in this preventive programme but also to help leading workers in enterprises and the lay public. Only by coordination of the activities of all these bodies a favourable effects can be achieved.