follow-up of people with a positive FIT test over the period 2018-2020

As part of its mission to assess the national organized screening program for colorectal cancer, Public Health France publishes on its website the monitoring data for positive screenings carried out during the 2018-2019 period based on data sources from Regional Cancer Screening Coordination Centres. These new data confirm the efficacy of the immunological test but underline the persistence of longer delays in recourse to colonoscopy following a positive test. Given the impact of COVID-19 on access to care, the Agency also analyzed the first data received for 2020 in advance. Remember that detected early, this cancer can be cured in 90% of cases. case.

Colorectal cancer: better chances of recovery if detected at an early stage

Colorectal cancer develops from cells that line the inside lining of the colon or rectum. Most often, these malignant tumors arise from a benign tumor that grows slowly and eventually becomes cancerous.

Colorectal cancer can be discovered at an early stage through screening for fecal occult blood. An organized screening program is offered in France to all people aged 50 to 74. People screened positive are invited to perform a colonoscopy to detect the possible presence of precancerous lesions or cancer. Public Health France is in charge of evaluating the performance of the screening program and publishes the participation indicators at national, regional and departmental level each year, and every two years the follow-up data for people screened positive.

Colorectal cancer: a more efficient screening test but the time to use colonoscopy needs to be improved

Regarding the tests: the immunological screening test confirms its good performance

For the 2018-2019 period, the performance of the immunological test (implemented in 2015) remains much higher than that of the guaiac test (2013-2014 period), with:

• a detection rate of advanced adenomas almost 3 times higher (9.3‰ vs 3.3‰);
• a cancer detection rate nearly twice as high (2.1‰ vs. 1.2‰);
• a higher positive predictive value (i.e. the probability of having the disease if the screening test is positive) for the detection of advanced adenomas (28.4% vs 17.0%);
• a higher positive predictive value for the detection of cancers (6.6% vs 6.3%);
• a higher percentage of invasive cancers detected at an early stage (stage I): 43.9% vs 37.7%.

However, the median time to perform a colonoscopy following a positive test continues to increase: from 62 days in 2013-2014 to 80 days in 2018-2019. In 2020, the median time to perform a colonoscopy following a positive test is 87 days (result which needs to be consolidated because obtained from partial data*, marked by the start of the COVID-19 pandemic).

Regarding the follow-up of people screened: a possible drop in the number of colonoscopies performed since the start of the COVID-19 pandemic

At the national level, the monitoring indicators for people tested positive remain in 2018-2019, in accordance with the european landmarks in terms of organized screening for colorectal cancer:

• percentage of colonoscopies performed after a positive test = 86.4%European benchmark: acceptable: ≥85% – desirable: ≥90%
• percentage of complete colonoscopies = 93.4% European benchmark: acceptable: ≥90% – desirable: ≥95%

However, the analysis of the first data for 2020, monitoring people screened positive indicates a percentage of colonoscopies carried out following a positive test of 76.5% (result which needs to be consolidated because obtained from partial data*, marked by the start of the COVID-19 pandemic).

*Information is currently only available for approximately 80% of the positive tests carried out.

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