Results of the Pilot Project for Colorectal Cancer Screening in the Orenburg Region as a Basis for Developing Target Quality Indicators

Introduction: Incidence rates of colorectal cancer in the Orenburg Region exceed the national averages, thus highlighting the importance of early diagnosis. In 2022, a pilot screening project was implemented in the region, and its results served as the basis for expanding the coverage throughout the region.

Objective: To determine the list of indicators for the high-quality implementation of colorectal cancer screening and their target levels based on the results of the pilot project.

Materials and Methods: The colorectal cancer screening pilot project lasted six months and involved 3,278 participants aged 40 and above, all working at large enterprises of the Orenburg Region. The screening process included a fecal occult blood test (FOBT) at stage 1 and, if needed, colonoscopy at stage 2. During the pilot project, indicators were evaluated according to a predefined list (the proportion of positive FOB test results, endoscopy coverage, the proportion of colonoscopies with debridement/total polypectomy (in outpatient settings), and the proportion of colonoscopies with biopsy). Target levels and the final list were established based on the distribution of the findings.

Results: At the laboratory stage, 10.3 % of all participants had a positive FOBT result and 81.3 % of them underwent endoscopic examination. Of 273 colonoscopies performed, 42 % resulted in complete debridement and 11 % were performed with biopsy; intestinal pathology was detected in 61.9 % of them, including polyps and six cancer cases, with the adenoma and cancer detection rates of 26 % and 0.18 %, respectively. These metrics, including the percentage of positive test results, endoscopy coverage, and the level of outpatient polypectomies, will facilitate the evaluation of screening quality and effectiveness and decision making for the long-term reduction in colorectal cancer incidence and mortality rates.

Conclusions: The pilot project implemented in the Orenburg Region confirmed the effectiveness of a two-stage screening strategy based on the fecal occult blood test and colonoscopy, with the identification of key indicators that will ensure the control and monitoring of the program at the regional level.

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