Медицина/ 3. Организация здравоохранения

Abdullayev M. Sh., Mansurova A.B.

Director of City Clinical Hospital No. 7 of Almaty city. Phd doctoral student of Asfendiyarov Kazakh National Medical University

Colorectal screening in Kazakhstan and Poland in a comparative perspective

Colorectal screening in Kazakhstan

In the Republic of Kazakhstan in 2011, population colorectal screening was introduced. The scheme of screening consists in the use of an immunochemical blood test to determine the latent blood in the stool and the subsequent total colonoscopy in the case of a positive result when using the i-FOBT test

Screening is held for men and women aged 50 to 70 years with an interval of 1 every 2 years. The exception are men and women who are registered for colorectal cancer and polyposis of the large intestine.

The pre-formed group does not include citizens with severe concomitant diseases that can lead to death in the next 10 years (myocardial infarction with congestive heart failure, cirrhosis, decompensated diabetes mellitus, etc.).

Methods of research:

1. All men and women of the target group receive an immunochemical blood test. To perform it, you need to empty the intestines and, following the instructions, conduct an express test with the subsequent evaluation of the result of the study. For each test, there is a specific wait time after the test.

With a positive version of the study, the patient (the patient) is sent to a total colonoscopy. If the analysis is negative, after two years the patient repeatedly performs the hemocult test.

2. Total colonoscopy is performed in conditions of an oncologic dispensary or clinical diagnostic center. In case of detection of pathology of the large intestine or rectum, the material is sampled for histological examination. In the absence of pathology of the large intestine or rectum, after two years the patient repeatedly conducts the hemocult test.

3. Pathomorphological (histological) research is conducted in the laboratory of pathomorphology. When a cancer of the colon or rectum is detected, the patient goes to the oncologist. When a benign pathology (polyp) of the large intestine or rectum is detected, the patient is sent to the endoscopist to perform the removal of this formation (polypectomy, polyps dissection, etc.) [1].

Colorectal screening is included in the list of Guaranteed volume of free medical care and fully funded by the state.

Population-based colonoscopy screening program (PCSP) of Poland

Colorectal cancer is the second leading cause of death in Poland and in Europe [2, 3]. It is known that CRC develops from polyps (adenomas) for a very long time, which helps to prevent the development of colorectal cancer using screening methods. Although colonoscopy has been approved by various expert committees as a method of choice in colorectal screening, there is not a single randomized trial that proves this fact [4, 5]. To date, three such studies have been launched, but their results will be known not earlier than in 10 years [6, 7]. Given the proven effectiveness of cancer screening in a randomized study (breast cancer in Norway), there is the question of measures of effectiveness after the introduction of cancer screening at the national scale. To conduct such a study, it was suggested to screen CRC using experimental design in order to provide a detailed assessment of its effectiveness when implemented at the national level [8]. This approach was introduced into the screening program in Finland using hemoculttest [10] and in Norway using sigmoidoscopy [9].

In 2000, the Ministry of Health of Poland introduced opportunistic colonoscopy screening [11]. Within the framework of this screening, screening centers were created, which were included in a single network of centers interconnected. A coordinating center was established in each screening center, which functions under the supervision of the leading endoscopist of the center, responsible for coordination and supervision in the field. The screening center employs trained endoscopists, anesthesiologists-resuscitators (if necessary, sedation), middle and junior medical personnel. Colonoscopy in the center is held in the afternoon, due to the employment of endoscopists in hospitals. The number of endoscopists involved in screening increased approximately 10-fold over the past year. This was done thanks to the Polish Endoscopists School, which organized 2-4 week colonoscopy workshops for 250 endoscopists. By 2011, the number of colonoscopies has increased to 140,000 colonoscopies per year, which is three times more than the number of colonoscopies for which the state allocated funds in the non-scratch survey. In 2000, since the beginning of the opportunistic screening, a database of CRC screening was opened, where data on patients screened for screening, video recording of a colonoscopy, results of a biopsy, etc. was received. Every year trained staff of screening centers checks colonoscopy records, fixed on the electronic carrier by an endoscopist, in order to control the quality of the procedure. Screening participants undergo screening screening procedures using a questionnaire, but this information is sent to the head center, bypassing the screening centers. Since 2006, the "screening quality assessment program has included" feedback "with the patient as a quality indicator [12,13].

The coordinating center of the screening center consists of managers who are responsible for planning, conducting and evaluating screening. Colonoscopic screening is under the control of the Ministry of Health of Poland and fully financed by it. One screening center covers an area from 2 to 10 administrative zones, the radius of the center's coverage is 40 km from it.

List of references

1. Order of the acting Minister of Health of the Republic of Kazakhstan №685 of November 10, 2009 "On the Approval of the Rules for Conducting Preventive Medical Examinations of Target Populations"

2. Ferlay J, Parkin DM, Steliarova-Foucher E. Estimates of cancer incidence and mortality in Europe in 2008. Eur J Cancer 2010; 46: 765–781

3. Wojciechowska U, Didkowska J, Zatoński W. Nowotwory złośliwe w Polsce w 2008 roku. Cancer in Poland in 2008. Gdańsk: Centrum Onkologii-Instytut; 2010

4. Force USPST. Screening for colorectal cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2008; 149: 627–637

5. Segnan N, Patnick J, von Karsa L. European guidelines for quality assurance in colorectal cancer screening and diagnosis. Luxembourg: Publications Office of the European Union; 2010

6. Kaminski MF, Bretthauer M, Zauber AG et al. The NordICC Study: rationale and design of a randomized trial on colonoscopy screening for colorectal cancer. Endoscopy 2012; 44: 695–702

7. Quintero E, Castells A, Bujanda L et al. Colonoscopy versus fecal immunochemical testing in colorectal-cancer screening. N Engl J Med 2012; 366: 697–706

8. Kalager M, Zelen M, Langmark F et al. Effect of screening mammography on breast-cancer mortality in Norway. N Engl J Med 2010; 363: 1203–1210

9. Bretthauer M, Hoff G. Comparative effectiveness research in cancer screening programmes. BMJ 2012; 344: e2864

10. Malila N, Oivanen T, Malminiemi O et al. Test, episode, and programme sensitivities of screening for colorectal cancer as a public health policy in Finland: experimental design. BMJ 2008; 337: a2261

11. Regula J, Rupinski M, Kraszewska E et al. Colonoscopy in colorectal-cancer screening for detection of advanced neoplasia. N Engl J Med 2006; 355: 1863–1872

12. Kaminski MF, Kraszewska E, Polkowski M et al. Continous quality improvement of screening colonoscopy: data from a large colorectal cancer screening program. Gastrointest Endosc 2009; 69: AB215

13. Kaminski MF, Regula J, Kraszewska E et al. Quality indicators for colonoscopy and the risk of interval cancer. N Engl J Med 2010; 362: 1795–1803

14. Kaminski Michal F, Ewa Kraszewska, Maciej Rupinski et al. Design of the Polish Colonoscopy Screening Program: a randomized health services study/ Endoscopy 2015; 47: 1144–1150