COLORECTAL CANCER SCREENING WITH COLONOSCOPY IN THE REPUBLIC OF BELARUS
Objective. To increase the efficiency of detecting early forms of colorectal cancer (CRC) and precancerous diseases (polyps) by developing an algorithm and introducing screening and secondary prevention of CRC. Materials and methods. The objects of the research were men and women aged 45 to 70 years without serious concomitant pathology. The main target group consisted of 50-70 years old patients and an additional group of people aged 45-49 was included in the research. The total colonoscopy was performed in the endoscopy room supplied with the necessary anesthetic equipment. The entire colon was examined. The polyps >0.6 cm large were removed and sent for routine histological examinations. In case of suspected malignancy, biopsy material from the mucous cut-off edge was taken separately. The smaller and suspicious polyps were removed, if cancer was suspected a biopsy was performed and the possibility of endoscopic removal was assessed. In case the tumor could not be radically removed endoscopically or its removal was associated with a high risk of complications a surgeon and an oncologist were involved in the further tactics development. The endoscopic protocols indicated the localization, the length of the colonoscopies, the sizes and the number of polyps up to 0.6 cm and >0.6 cm for the polyps the number being >2. Results. 1933 participants aged 45 to 70 years were subject to screening. As part of the screening program, 602 colonoscopies were conducted at this stage. Screening coverage for 5 years was 31.1% and when performing a colonoscopy once in 10years it was 62.2%. In 332 (55.1%) people out of 602 patients, polyps were revealed. Totally, 630 polyps were detected. In the group of 45-49years old persons, 540 participants had to be screened, 122 of whom underwent colonoscopies. Screening coverage for 5 years was 22.5% and when performing colonoscopies once in 10years, it would be 45.1%. In the group of 50-70years old persons, 1393participants were to be screened, 480 of whom underwent colonoscopies. The coverage by screening for 5years was 34.4% and when performing colonoscopies once in 10 years it would be 68.9%. Due to the detection of adenomatous polyps that could become malignant (more than 0.6 cm large) and their removal the proportion of the prevented cases of colorectal cancer in both groups was 8.8%. When carrying out screening and secondary prevention of CRC according to the developed algorithm in the group of 50-70 years three (0.63%) cases of colorectal cancer, two cases of CRC in stage 0 (TisN0M0) and one case in stage IIa (T3N0M0) (early cancer) were identified. Conclusion. Five years of experience of practicing screening colonoscopy showed no recurrence after polypectomy indicating at the colonoscopy high level.