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Background: Both colorectal cancer incidence and mortality rates, in Croatia, are on the increase. Currently, it is ranking second in both men (after lungs) and women (after breast) with the total incidence rate of 64.0/100.000 (2005). High mortality- rates have been recorded (40.6/100.000, 2006), probably due to a low percent (less than 10%) of newly diagnosed cases with localized lesions. In the Osijek-Baranya County (Eastern Region), more rapid increase in mortality rates, compared to the whole of Croatia, can be observed. The Osijek-Baranya County has a long-lasting experience in performing activities on primary prevention and early detection of colorectal cancer. However, people in this region have been faced with the devastating effects of the war and the overwhelming poverty in the post-war period. Based on unfavourable statistics, The Croatian Government has passed the Conclusion on The National Program of the Prevention and Early Detection of Colorectal Cancer (the Program) which has started on 1st November 2008. Objectives are to present organizational preparations for the implementation of the Program and early screening results in Croatia and, especially, in the Osijek-Baranya County. Methods: Conventional screening method for the early detection of colorectal cancer Fecal Occult Blood Test (FOBT) by 2 yearly examination protocol is being applied in asymptomatic population at average risk, aged 50-74 years. Target population accounts approximately 1.200.000 persons ; 600.000 persons are expected to be tested a year. Implementation of the Program is carried out by laboratory workers and physicians employed at regional Public Health Institutes and specialists colonoscopists. Family physicians and non-governmental organizations are also included, participating in education and motivation activities. The Croatian Public Health Institute in collaboration with the county institutes is responsible for the coordination and the monitoring of the action, invitation organization, collecting and evaluation of data. Invitation letters have been sending by mail. In an envelope, there are three testing-cards together with instructions for their use, questionnaire about risk factors and educational brochure to ensure invited persons be informed on the screening. Invited persons have been asked to mail applied testing-cards back, together with filled questionnaire. Persons testing positive have been invited for colonoscopy, organized in the nearest endoscopic unit. Results: A total of 93 000 invitation letters have been sent until now, mostly to persons of advanced age (74 and 70 years old). According to preliminary results, responding rates are very low (25% maximum) ; in the Osijek- Baranya County 19%. Estimations are based on the total number of envelopes mailed back. When inaccurately applied or nonapplied tests are excluded, the results will be even worse. The percent of FOBT positive tests varies from 3.6% to 24.3 % ; in the Osijek-Baranya County 10.9%. Conclusions: Analysis of the early screening results may help to overcome possible obstacles in achieving the main goals of the Program, such as: the screening coverage of at least 60%, the reversal of the low proportion of diagnosed pre-clinical and localised cancers and the reduction in mortaity by 15%, following the 5-year implementation of the Program. |
