Colon to Rectum
Gut. 2023;72(7):1319–25
Impact of delayed screening invitations on screen-detected and interval cancers in the Dutch colorectal cancer screening program: Individual-level data analysis
Objective: To assess the impact of delayed invitation on screen-detected and interval colorectal cancers (CRCs) within a fecal immunochemical test (FIT)-based CRC screening program.
Design: All individuals that participated in 2017 and 2018 with a negative FIT and were eligible for CRC screening in 2019 and 2020 were included using individual-level data. Multivariable logistic regression analyses were used to assess the association between either the different time periods (i.e., ’before’, ’during’ and ’after’ the first COVID-19 wave) or the invitation interval on screen-detected and interval CRCs.
Results: Positive predictive value for advanced neoplasia (AN) was slightly lower during (odds ratio [OR] = 0.91) and after (OR = 0.95) the first COVID-19 wave, but no significant difference was observed for the different invitation intervals. Out of all individuals that previously tested negative, 84 (0.004%) had an interval CRC beyond the 24 months since their last invitation. The time period of invitation as well as the extended invitation interval was not associated with detection rates for AN and interval CRC rate.
Conclusion: The impact of the first COVID-19 wave on screening yield was modest. A very small proportion of the fecal immunochemical test negatives had an interval colorectal cancer (CRC) possibly due to an extended interval, which potentially could have been prevented if they had received the invitation earlier. Nonetheless, no increase in interval CRC rate was observed, indicating that an extended invitation interval up to 30 months had no negative impact on the performance of the CRC screening program and a modest extension of the invitation interval seems an appropriate intervention.