The Impact of a Six-Year Existing Screening Programme Using the Faecal Immunochemical Test in Flanders (Belgium) on Colorectal Cancer Incidence, Mortality and Survival: A Population-Based Study

Thuy Ngan Tran; Sarah Hoeck; Harlinde De Schutter; Sharon Janssens; Marc Peeters; Guido Van Hal

doi:10.3390/ijerph20021654

The Impact of a Six-Year Existing Screening Programme Using the Faecal Immunochemical Test in Flanders (Belgium) on Colorectal Cancer Incidence, Mortality and Survival: A Population-Based Study

Int J Environ Res Public Health. 2023 Jan 16;20(2):1654. doi: 10.3390/ijerph20021654.

Authors

Thuy Ngan Tran^{1

2}, Sarah Hoeck^{1

2}, Harlinde De Schutter³, Sharon Janssens³, Marc Peeters^{4

5}, Guido Van Hal^{1

2}

Affiliations

¹ Centre for Cancer Detection, 8000 Bruges, Belgium.
² Family Medicine and Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium.
³ Research Department, Belgian Cancer Registry, 1210 Brussels, Belgium.
⁴ Department of Oncology, Antwerp University Hospital, 2650 Edegem, Belgium.
⁵ Integrated Personalized & Precision Oncology Network (IPPON), University of Antwerp, 2610 Antwerp, Belgium.

Abstract

The faecal immunochemical test (FIT) has been increasingly used for organised colorectal cancer (CRC) screening. We assessed the impact of a six-year existing FIT screening programme in Flanders (Belgium) on CRC incidence, mortality and survival. The Flemish CRC screening programme started in 2013, targeting individuals aged 50-74 years. Joinpoint regression was used to investigate trends of age-standardised CRC incidence and mortality among individuals aged 50-79 years (2004-2019). Their 5-year relative survival was calculated using the Ederer II method. We found that FIT screening significantly reduced CRC incidence, especially that of advanced-stage CRCs (69.8/100,000 in 2012 vs. 51.1/100,000 in 2019), with a greater impact in men. Mortality started to decline in men two years after organised screening implementation (annual reduction of 9.3% after 2015 vs. 2.2% before 2015). The 5-year relative survival was significantly higher in screen-detected (93.8%) and lower in FIT non-participant CRCs (61.9%) vs. FIT interval cancers and CRCs in never-invited cases (67.6% and 66.7%, respectively). Organised FIT screening in Flanders clearly reduced CRC incidence (especially advanced-stage) and mortality (in men, but not yet in women). Survival is significantly better in screen-detected cases vs. CRCs in unscreened people. Our findings support the implementation of FIT organised screening and the continued effort to increase uptake.

Keywords: cancer screening; colorectal cancer; impact; incidence; interval cancer; mortality; screen-detected cancer; survival.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Belgium / epidemiology
Colonoscopy
Colorectal Neoplasms* / diagnosis
Colorectal Neoplasms* / epidemiology
Early Detection of Cancer* / methods
Female
Humans
Incidence
Male
Mass Screening / methods
Occult Blood

Grants and funding

The Flemish colorectal cancer screening programme is funded exclusively by the Agency for Care and Health, part of the Flemish Ministry of Welfare, Public Health and Family (https://www.vlaanderen.be/en) (accessed on 12 January 2023). The Flemish Ministry was not involved in any phase of this study (design, data collection, analysis, interpretation or writing the manuscript). For its core business of collecting data regarding new cancer diagnoses in Belgium and disseminating associated epidemiological parameters, the Belgian Cancer Registry is financed by the different regional and federal authorities in a structural way. No additional funding was provided for this specific study.