title: Appropriateness of endoscopic surveillance recommendations in organised colorectal cancer screening programmes based on the faecal immunochemical test.
abstract: To assess the appropriateness of recommendations for endoscopic surveillance in organised colorectal cancer (CRC) screening programmes based on the faecal immunochemical test (FIT).
  
  
  
  74 Italian CRC screening programmes provided aggregated data on the recommendations given after FIT-positive colonoscopies in 2011 and 2013. Index colonoscopies were divided into negative/no adenoma and low- risk, intermediate-risk and high-risk adenomas. Postcolonoscopy recommendations included a return to screening (FIT after 2 years or 5 years), an endoscopic surveillance after 6 months or after 1 year, 3 years or 5 years, surgery or other. We assessed the deviation from the postcolonoscopy recommendations of the European Guidelines in 2011 and 2013 and the correlation between overuse of endoscopic surveillance in 2011 and the process indicators associated with the endoscopic workload in 2013.
  
  
  
  49 704 postcolonoscopy recommendations were analysed. High-risk, intermediate-risk and low-risk adenomas, and no adenomas were reported in 5.9%, 19.3%, 15.3% and 51.5% of the cases, respectively. Endoscopic surveillance was inappropriately recommended in 67.4% and 7%, respectively, of cases with low-risk and no adenoma. Overall, 37% of all endoscopic surveillance recommendations were inappropriate (6696/17 860). Overuse of endoscopic surveillance was positively correlated with the extension of invitations (correlation coefficient (cc) 0.29; p value 0.03) and with compliance with post-FIT+ colonoscopy (cc 0.25; p value 0.05), while it was negatively correlated with total colonoscopy waiting times longer than 60 days (cc -0.26; p value 0.05).
  
  
  
  In organised screening programmes, a high rate of inappropriate recommendations for patients with low risk or no adenomas occurs, affecting the demand for endoscopic surveillance by a third.
authors: Registro Tumori del Veneto, Regione Veneto, Padova, Italy.
authors: Manuel
authors: M
authors: Zorzi
authors: AOU Città della Salute e della Scienza, CPO Piemonte, Torino, Italy.
authors: Carlo
authors: C
authors: Senore
authors: Settore promozione e sviluppo igiene e sanità pubblica, Regione Veneto, Venezia, Italy.
authors: Anna
authors: A
authors: Turrin
authors: Istituto per lo Studio e la Prevenzione Oncologica, Firenze, Italy.
authors: Paola
authors: P
authors: Mantellini
authors: Istituto per lo Studio e la Prevenzione Oncologica, Firenze, Italy.
authors: Carmen Beatriz
authors: CB
authors: Visioli
authors: Assessorato alle politiche per la salute, Regione Emilia-Romagna, Bologna, Italy.
authors: Carlo
authors: C
authors: Naldoni
authors: Assessorato alle politiche per la salute, Regione Emilia-Romagna, Bologna, Italy.
authors: Priscilla
authors: P
authors: Sassoli De' Bianchi
authors: Settore promozione e sviluppo igiene e sanità pubblica, Regione Veneto, Venezia, Italy.
authors: Chiara
authors: C
authors: Fedato
authors: Servizio Medicina Preventiva nelle Comunità-AUSL Mantova, Mantova, Italy.
authors: Emanuela
authors: E
authors: Anghinoni
authors: Istituto per lo Studio e la Prevenzione Oncologica, Firenze, Italy.
authors: Marco
authors: M
authors: Zappa
authors: Unità di Gastroenterologia, Ospedale Nuovo Regina Margherita, Roma, Italy.
authors: Cesare
authors: C
authors: Hassan
mesh_terms: D000236:Adenoma / Q000175:diagnosis / Q000473:pathology; D003113:Colonoscopy / Q000379:methods / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology; D055088:Early Detection of Cancer / Q000379:methods / Q000706:statistics & numerical data; D005243:Feces; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007120:Immunochemistry; D007558:Italy / Q000453:epidemiology; D008297:Male; D000069342:Medical Overuse / Q000517:prevention & control / Q000706:statistics & numerical data; D008875:Middle Aged; D020380:Needs Assessment; D011379:Prognosis; D018570:Risk Assessment; D014850:Waiting Lists
keywords: COLONOSCOPY; COLORECTAL CANCER SCREENING