title: Impact of a population-based colorectal cancer screening program on local health services demand in Italy: a 7-year survey in a northern province.
abstract: OBJECTIVE
  In 2005, the National Health Service recommended a population-based colorectal cancer (CRC) screening program using biennial fecal occult blood testing (FOBT), followed by total colonoscopy in positive patients. So far, no studies have been performed to evaluate the impact of a mass-screening CRC campaign on the health system services at the community level in Italy. We have therefore assessed the workload generated by the first two biennial rounds of screening program on the activity of hospital services involved in CRC diagnosis in the Lecco province.
  
  
  METHODS
  Routine data from all hospital services of our province were collected on activity levels related to CRC diagnosis from January 2003 to December 2009. This time span covered the 2 years prior to, as well as the two biennial rounds of the CRC screening program. In particular, we focused on the volume of outpatient FOBTs and colonoscopies (both diagnostic and interventional) performed among subjects outside the screening program. Joinpoint models were used to test whether an apparent change in trend of examination over time was statistically significant in different age cohorts of the population (<50 years, 50-69 years, and ≥70 years).
  
  
  RESULTS
  The volume of "extra-screening" per-patient/FOBTs and colonoscopies increased significantly over the evaluated periods in all ages, until year 2008, when a steady trend was beginning; the AAPCs (average of the annual percent changes) values were 5.7, 3.1, and 8.4 for FOBT and 14.6, 13.4, and 16.7 for colonoscopy in the three age cohorts, respectively. However, the increase in both FOBT and colonoscopy demand was maximal in the cohort ≥70 years, where three statistically significant annual percent changes (APCs) were identified (in 2003-2005, 2005-2006, and 2006-2007 APCs were 12.3, 14.9, and 15.9 for FOBT, and 18.7, 36.8, and 25.4 for colonoscopy, respectively).
  
  
  CONCLUSIONS
  After the implementation of a FOBT-based mass-screening program for CRC, careful consideration must be given to the significant increase in the workload of hospital services involved in CRC diagnosis, outside the screening campaign. The extra-work mainly involves gastroenterologists performing colonoscopy, whose activity increased over the 5-year period by 118%, as well as laboratory services, where the demand of FOBTs rose by 40%. This phenomenon, mainly attributable to a profound change in the attitude toward CRC screening by those age cohorts outside the program, covers a time span of two full rounds of screening, whereupon a steady trend for colonoscopy is apparent.
authors.affiliation: Gastroenterology Unit, Alessandro Manzoni Hospital, Lecco, Italy. f.parente@ospedale.lecco.it
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Parente
authors.forename: Barbara
authors.initials: B
authors.lastname: Marino
authors.forename: Antonio
authors.initials: A
authors.lastname: Ardizzoia
authors.forename: Giovanni
authors.initials: G
authors.lastname: Ucci
authors.forename: Antonina
authors.initials: A
authors.lastname: Ilardo
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Limonta
authors.forename: Patrizia
authors.initials: P
authors.lastname: Villani
authors.forename: Roberto
authors.initials: R
authors.lastname: Moretti
authors.forename: Alberto
authors.initials: A
authors.lastname: Zucchi
authors.forename: Marco
authors.initials: M
authors.lastname: Cremaschini
authors.forename: Maria Elena
authors.initials: ME
authors.lastname: Pirola
mesh_terms: D000367:Age Factors; D000368:Aged; D003113:Colonoscopy / Q000706:statistics & numerical data* / Q000639:trends; D015179:Colorectal Neoplasms / Q000517:prevention & control*; D055088:Early Detection of Cancer / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D007558:Italy; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data* / Q000639:trends; D008875:Middle Aged; D009780:Occult Blood; D016526:Workload / Q000706:statistics & numerical data*