Current results of colorectal cancer screening and potential value of colon capsule endoscopy in the Czech Republic
Abstract
Backgrounds: In an international comparison, the Czech Republic has the highest incidence and mortality from colorectal cancer. A screening program is an essential part of prevention policy in the CR.
Continuous monitoring of the screening process is essential to improve the quality of detection. The aim of the paper is to evaluate the performance of screening with respect to the potential value of colon capsule endoscopy.
Material and Methods: Data on preventive colonoscopies and data from health insurance companies to 2018 were used to evaluate key performance indicators with respect to colon capsule endoscopy, such as fecal ocult blood test (FOBT) positivity, positive predictive value of FOBT, and waiting time for colonoscopy after a positive test. Results: Since 2014, the number of preventive colonoscopies has increased.
The low positive predictive value of FOBT (about 40%) may be associated with high FOBT positivity (about 6-7%) and possibly unnecessary colonoscopies. These facts were associated with a significant increase in waiting times for follow-up colonoscopy after a positive test.
Conclusion: The evaluation of the performance indicators of FOBT and follow-up colonoscopies confirmed the relatively low positive predictive value of FOBT. Many colonoscopies have been therefore performed unnecessarily.
Colon capsule endoscopy, which could be used as a "filter" test in individuals with a positive FOBT, may have the potential to reduce the number of colonoscopies required.