Implementation of colorectal cancer screening in Finland: experiences from the first three years of a public health programme.
OBJECTIVE
Colorectal cancer mortality can be reduced by repeated screening, using faecal occult blood testing. This report describes the implementation of service screening in Finland and performance indicators from the first three years.


METHODS
The programme is based on gradual expansion over six years of implementation. It involves individual-level randomisation into screening or control arms among a target population of men and women aged 60-69 years. The effects will be evaluated comparing incidence of and mortality from colorectal cancer in the invited arm with the controls. The screening test is a biannual guaiac-based faecal occult blood test with three test cards for consecutive samples and colonoscopies offered to those with any blood observed.


RESULTS
Between September 2004 and December 2006, 52,994 test kits (to 26,247 men and 26,747 women) were sent out in 160 municipalities out of 444. Attendance to screening was 71% overall, 63% in men and 78% in women. People from the youngest age-group (born in 1946) were less compliant than those from the oldest one (born in 1940). Among the screened, 2.1% were found with blood in the stools, 3% of men and 1.5% of women. Cancers and adenomas were detected according to expectations, in 8.6 and 43.2%, respectively, among those who underwent colonoscopy.


CONCLUSIONS
The implementation measured with attendance and performance of the test of colorectal cancer screening in Finland has been successful. The programme meets the criteria both for a randomised trial and for a public health programme allowing unbiased data to be collected during the implementation period.
Malila
N
N
Finnish Cancer Registry, Mass Screening Registry, Helsinki, Finland. nea.malila@cancer.fi
Oivanen
T
T
Hakama
M
M
D000236:Adenoma / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality; D000367:Age Factors; D000368:Aged; D003111:Colonic Polyps / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality; D005387:Finland; D006284:Health Plan Implementation / Q000458:organization & administration*; D006801:Humans; D008403:Mass Screening / Q000458:organization & administration*; D008875:Middle Aged; D009780:Occult Blood; D010349:Patient Compliance / Q000706:statistics & numerical data; D016032:Randomized Controlled Trials as Topic; D012737:Sex Factors; D016019:Survival Analysis