Involvement of Gynaecologists in Colorectal Cancer Screening

Abstract

Background and study aims: Primary care physicians play a principal role in colorectal cancer (CRC) screening in many countries that are using a two-step program; faecal occult blood test (FOBT)+colonoscopy. In order to improve the screening uptake in the Czech Republic ambulatory gynaecologists in addition to GPs were involved in FOB testing in 2009. Our objective was to describe the contribution of gynaecologists to the provision of CRC screening. Methods: Data reported to health insurance companies and aggregated by the Czech National Reference Centre were used to monitor the screening process. We focused on the coverage by FOBT examination and positive FOBT rate. We describe time trends in the number and proportion of people tested, describe regional variations and show differences according to sex and age. Results: The target population for CRC screening above age 50 in the Czech Republic was 3,955,968 (37.7% of total population) in 2014. The number of all FOBT performed in primary care (by GPs and gynaecologists) increased from 357,893 in 2008 (417,364 - 2009) to 744,015 in 2014. In 2012, the total coverage of the target population was 25.5%; 23% of men and 27.5% of all women and in 2014 30.8%, 28.5% of men and 32.8% of women. In the years 2009, 2012, 2014 the total contribution of gynaecologists was 3.6%, 8% and 6.4% respectively, of all FOBT performed. Overall in the female target population it was 6.2% in 2009 (out of 236987) 13.6% in 2012 (out of 325,631 FOBT) and 11.2% in 2014 (out of 423660), while in the 50-54 age group 24.4% women were screened by gynaecologists in 2012 and 18.9% in 2014. The data showed significant variations between the 14 regions of the country. The overall positivity rate of FOBT has increased from 4.6% in 2009 to 7.2% in the year 2014. Conclusions: The participation of gynaecologists has contributed significantly to the higher participation of women in the real life Czech CRC screening program, particularly in the 50-54 years old age group, nevertheless the key responsibility stays with GPs. This measure is likely to be applicable in health care systems with a network of ambulatory gynaecologists, as is the case in the Czech Republic and in most Central and Eastern European countries.