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Feasibility study into population screening for bowel cancer : Detection of bowel cancer put into practice

Uitvoeringstoets bevolkingsonderzoek naar darmkanker : Opsporing van darmkanker in praktijk gebracht


The introduction and implementation of nationwide population screening for bowel cancer in the Netherlands is certainly feasible. However, the population screening programme will require effective preparation and a phased introduction if the associated quality requirements are to be guaranteed. The same applies to the need for sufficient capacity to carry out any follow-up tests that may be required. This emerged from a so-called feasibility study into this population screening programme, carried out by the National Institute for Public Health and the Environment (RIVM). The Minister of Health, Welfare and Sport will use this study in reaching a decision on whether to proceed with the introduction of this population screening programme. A population screening programme for bowel cancer is cost effective, and can ultimately prevent 2400 deaths from this disease each year. Once a decision on the introduction has been made, the preparation of this population screening programme will involve at least two years.

The population screening programme is intended for individuals between 55 and 75 years of age (4.4 million people). The screening organisations contact these individuals every two years, and invite them to participate in the population screening programme. Home testing kits (iFOBT) are sent to the home addresses. After use, these kits are sent off for analysis. Those whose tests produce an abnormal result will be referred for further diagnosis (colonoscopy) and, if necessary, treatment.

The feasibility study was set up in cooperation with the relevant professional groups, patient organisations, the screening organisations, and other stakeholders. The introduction of screening enjoys broad support among these stakeholders.

Part of the feasibility study was to determine which preparatory activities should be carried out, and under what conditions. This study describes the guidelines and quality requirements that are needed, and how the quality of the programme can be monitored. Measures are proposed to compensate for the calculated capacity shortfalls, such as a shifting in the allocation of responsibilities and an efficient colonoscopy procedure. Steps must be taken to avoid long waiting lists for colonoscopy and subsequent treatment. If necessary, the phased introduction can be modified to this end. Appropriate consideration should also be given to communication, both in a general sense during the introduction of the population screening programme and, more specifically, with participants (concerning the programme's purpose and usefulness, and the processes involved). In addition, details of the major implementation activities are provided, together with a forecast of costs.

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