Colorectal cancer screening among government servants in Brunei Darussalam.
BACKGROUND
This study concerns uptake and results of colorectal cancer (CRC) screening of government servant as part of the Health Screening Program that was conducted in Brunei Darussalam in 2009.


METHODS
Government servants above the age of 40 or with family history of CRC were screened with a single fecal occult blood test (FIT, immunohistochemistry). Among 11,576 eligible subjects, 7,360 (66.9%) returned their specimen. Subjects with positive family history of CRC (n=329) or polyps (n=135) were advised to attend clinics to arrange screening. All the subjects with positive FIT (n=142, 1.9%) were referred to the endoscopy unit for counselling for screening colonoscopy.


RESULTS
Overall only 17.7% of eligible subjects attended for screening; 54.9% (n=79/142) of positive FIT, 8.8% (n=29/329) of positive family history of CRC and none with history of polyps (n=0/135). Of these, only 54 patients (50.5%) agreed for colonoscopy, 52 (48.6%) declined as they were asymptomatic, and one was not offered (0.9%) due to his very young age. On screening colonoscopy, 12.9% (n=7) had advanced lesions including a sigmoid carcinoma in situ and six advanced polyps. The other findings included non advanced polyps (n=21), diverticular (n=11) and hemorrhoids (n=26). One patient who missed his screening colonoscopy appointment re-presented two years later and was diagnosed with advanced right sided CRC. All the advanced lesions were detected in patients with positive FIT, giving a yield of 20.5% for advanced lesions including cancers in the 5.1% FIT positive subjects.


CONCLUSIONS
Our study showed screening for CRC even with a single FIT was effective. However, the uptake rate was poor with just over half of the patients agreeing to screening colonoscopy. Measures to increase public awareness are important. Since one limitation of our study was the relatively small sample size, larger studies should be conduced in future.
Endoscopy Unit, Department of Medicine, RIPAS Hospital, Brunei Darussalam E-mail : chongvuih@yahoo.co.uk.
Vui Heng
VH
Chong
Suriawati
S
Bakar
Rusanah
R
Sia
James
J
Lee
Norhayati
N
Kassim
Lubna
L
Rajak
Muhd Syafiq
MS
Abdullah
Chee Fui
CF
Chong
D000236:Adenoma / Q000175:diagnosis*; D000328:Adult; D002010:Brunei; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003955:Diagnostic Tests, Routine / Q000379:methods*; D055088:Early Detection of Cancer; D005243:Feces; D005260:Female; D005500:Follow-Up Studies; D006076:Government; D006801:Humans; D007124:Immunoenzyme Techniques; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D011379:Prognosis; D012812:Sigmoidoscopy