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List of all projects Targeted screening of colorectal cancer in patients with type 2 diabetes and in individuals at a high cardiovascular risk: multicentre prospective study

Coordinator Coordinator: Májek Ondřej

Duration Duration: 2012–2015

The project objectives were to verify the hypothesis that individuals with a higher cardiovascular risk and diabetic patients are at a higher risk of developing colorectal neoplasia, to identify and to select these individuals for colonoscopy, which should subsequently verify the hypothesis that targeted screening is effective in this group of patients, and finally to verify the feasibility, effectiveness and safety of targeted screening.


Colorectal cancer (CRC) is one of the most common cancers, and its incidence is growing continuously in all developed countries. Unfortunately, the Czech Republic still ranks among countries with the highest colorectal cancer incidence rates worldwide. For many years now, the United European Gastroenterology Federation (UEGF) and the European Commission (EC) have supported the strategy of introducing CRC screening programmes in EU member states. These programmes aimed at early detection and prevention of colorectal cancer identify two groups of people:

  1. individuals with an average risk, aged over 50, who are included in the CRC screening programme,
  2. individuals at a higher risk, who are included in a follow-up programme.

In the Czech Republic, a colorectal cancer screening programme (see http://www.kolorektum.cz) aimed at the A group was introduced in the early 2000s. The programme was revised in 2009 by the Czech Ministry of Health Gazette No. 01/2009 [1]. Asymptomatic individuals aged 50–54 can undergo either guaiac faecal occult blood test (gFOBT) or immunological faecal occult blood test (iFOBT) at one-year intervals, and screening colonoscopy follows if the FOBT result is positive. Those aged over 55 can choose between FOBT at two-year intervals, or the so-called primary screening colonoscopy, which might be repeated after 10 years. The revision led to an increase in CRC screening participation rates; nevertheless, it is still not a population-based programme with a sufficient participation rate of at least 50%.

As for the B group, follow-up by a gastroenterologist and regular monitoring by colonoscopy is recommended. There are some data suggesting that patients with diabetes are at a higher risk of developing colorectal cancer [2–4]. When taking into account the high burden with cardiovascular and cancer-related morbidity/mortality, almost the same risk factors and lifestyle recommendations apply for these patients, including a healthy diet, physical exercise, stress reduction, non-smoking and avoiding too much alcohol. The current knowledge and experience suggest that a higher risk of cardiovascular mortality is accompanied by a higher risk of cancer, particularly gastrointestinal cancers, and CRC as the most common cancer in this group of patients.

The project investigators aimed to identify a group of diabetic patients with a high cardiovascular risk in a low-risk target population for CRC screening, and to apply a targeted one-step screening programme in these patients, based on the primary screening colonoscopy (PSC). With respect to CRC epidemiology in the Czech Republic, there is an urgent need to make CRC screening more effective.

Project objectives:

  • verifying the hypothesis that individuals with a higher cardiovascular risk according to the SCORE >10% (gender, smoking, systolic blood pressure [mmHg], total cholesterol level [mmol/l]) and diabetic patients are at a higher risk of developing colorectal neoplasia,
  • identifying and selecting these individuals for colonoscopy, which should subsequently verify the hypothesis that targeted screening is effective in this group of patients,
  • verifying the feasibility, effectiveness and safety of targeted screening, and determining the age interval,
  • developing recommendations by expert medical societies,
  • publishing the results in a peer-reviewed journal, and presenting the results internationally.

Other important information:

  • Expert guarantors: Prof Miroslav Zavoral, MD, PhD (Czech Society of Gastroenterology); Svatopluk Solar, MD (Czech Diabetes Society); Assoc Prof Bohumil Seifert, MD, PhD (Czech Society of General Practice)
  • Funding: The project has been supported by the Internal Grant Agency of the Ministry of Health of the Czech Republic (IGA) within the programme “ Departmental Programme of Research and Development – MH III from 2010 to 2015”. The project is registered with the identifier NT13673.
  • Partners: general practitioners and diabetologists from across the Czech Republic, selected gastroenterology centres
  • Brief overview of results: you can find more detailed information – in Czech language only – in the VaVaI information system

References

  1. Czech Ministry of Health Gazette No. 01/2009 (pp. 20–23): Standard při poskytování a vykazování výkonů screeningu nádorů kolorekta v České republice. [text in Czech language]
  2. Larsson SC, Orsini N, Wolk A. Diabetes mellitus and risk of colorectal cancer: a meta-analysis. Journal of the National Cancer Institute 2005; 97(22): 1679–1687. doi: 10.1093/jnci/dji375.
  3. Hu FB, Manson JE, Liu S, Hunter D, Colditz GA, Michels KB, Speizer FE, Giovannucci E. Prospective study of adult onset diabetes mellitus (type 2) and risk of colorectal cancer in women. Journal of the National Cancer Institute 1999; 91(6): 542–547. doi: 10.1093/jnci/91.6.542.
  4. Will JC, Galuska DA, Vinicor F, Calle EE. Colorectal cancer: another complication of diabetes mellitus? American Journal of Epidemiology 1998; 147(9): 816–825.


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