1. a guaiac- based faecal occult blood colorectal cancer screening program involving general practitioners is feasible and cost-effective for mass population screening Bernard DENIS, Philippe PERRIN, Isabelle GENDRE, Marcel RUETSCH, Patrick STRENTZ, Jean Yves VOGEL Association pour le dépistage du cancer colorectal dans le Haut-Rhin (ADECA 68) Colmar, France

2. B. Denis - UEGW 2006 - Berlin background l randomised and controlled trials have demonstrated the efficacy of colorectal cancer (CRC) screening with FOBT: reduction of 15 to 18% in deaths from CRC l how about feasibility and effectiveness in the real world ? Hardcastle JD 1996, Kronborg O 1996, Faivre J 2004

3. B. Denis - UEGW 2006 - Berlin background l start in 2003 l 23 pilot areas l assessment of feasibility and effectiveness of a population based CRC screening program based on FOBT

4. B. Denis - UEGW 2006 - Berlin aim to report the short term outcomes and cost of the 1st round of a pilot CRC screening program in the Haut-Rhin

5. B. Denis - UEGW 2006 - Berlin methods l Haut-Rhin: 0.71 million inhabitants l all average risk residents aged 50-74 y (188 438 p.) l biennial non rehydrated guaiac FOBT (Hemoccult II®) without dietary restriction

6. B. Denis - UEGW 2006 - Berlin invitations – methods and results exclusions participation

7. B. Denis - UEGW 2006 - Berlin results completed FOBTs / prescribers

8. B. Denis - UEGW 2006 - Berlin results - GPs’ involvement l 618 (98.6%) GPs participated l mean 135 FOBTs provided / GP l 81.6% of FOBTs provided / GPs completed l 86.9% of + FOBTs followed / colonoscopy

9. B. Denis - UEGW 2006 - Berlin results - exclusions 10.0%total exclusions 0.4%concurrent severe disease 3.2%high CRC risk 6.2% recent screening 19 037 exclusions

10. B. Denis - UEGW 2006 - Berlin results - participation 93 841 FOBTs completed adjusted participation = completed FOBTs target population - exclusions = 54.3%

11. B. Denis - UEGW 2006 - Berlin Wintzenheim Thann Dannemarie Masevaux Altkirch Hirsingue Cernay Guebwiller Saint-Amarin Munster Rouffach Soultz Lapoutroie Sainte-Marie-aux-Mines Wittenheim Mulhouse Ferrette Sierentz Huningue Illzach Habsheim Ensisheim Kaysersberg Ribeauville Neuf-Brisach Colmar Andolsheim results - participation / district Mulhouse Haut-Rhin Ensisheim 46 – 50 % 50 – 54 % 54 – 58 % 58 – 62 %

12. B. Denis - UEGW 2006 - Berlin results - diagnostic yield 11.5% non adv. adenomas 10.3% cancers 21.0% advanced adenomas FOBT positivity rate3.3% PPV neoplasia (adenoma + cancer) 2689 colonoscopies recorded 42.8%

13. B. Denis - UEGW 2006 - Berlin results - colonoscopies’ yield 48.8% normal 6% cancers 45.2% polyps - Non adenomatous 18.4% - Adenomatous 81.6%

14. B. Denis - UEGW 2006 - Berlin results – cancers’ stages stage 0 (Tis)73 (32.3%) stage I (T1T2N0)74 (32.7%) stage II (T3T4N0)38 (16.8%) stage III (TxN1)29 (12.8%) stage IV (M1)12 (5.3%) 82% localized stages 35.4% removed at colonoscopy

15. B. Denis - UEGW 2006 - Berlin comparison – European randomised and controlled trials (1st rounds) Haut-RhinR&C trials participation (%) 54.353 - 67 + FOBT (%) 3.31.0 – 2.1 PPV neoplasia (%) 42.837 - 49 CRC detection rate (‰ p. screened) 3.11.7 – 2.1 Hardcastle JD 1996, Kronborg O 1996, Faivre J 2004

16. B. Denis - UEGW 2006 - Berlin colorectal cancer incidence - Europe men women

17. B. Denis - UEGW 2006 - Berlin results - cost l budget = 1 million € / year l individual cost s4.3 € / eligible person / year s26 € /screened person s9 500 € to find 1 CRC

18. B. Denis - UEGW 2006 - Berlin conclusion l Participation and diagnostic yield of controlled trials of guaiac-based FOBT screening are reproducible in the real world at an acceptable cost through an organized population-based program involving GPs