Keywords: colorectal cancer, screening, participation, incidence, mortality

Background:

In Slovakia, colorectal cancer (CRC) is the most frequently diagnosed malignancy, with about 4,000 new cases annually; by world age standardised rates, CRC ranks third for both incidence (35.7/100,000) and mortality (17.2/100,000). A national CRC screening programme using faecal occult blood testing (FOBT) for people aged ≥50 years was launched in 2002, with the expectation that at least 50% of the target population would participate and that incidence and mortality would decline.

Research questions:

This study aimed to assess the current status and outcomes of CRC screening delivered by GPs in Slovakia.

Method:

A retrospective quantitative study was conducted using data from the National Cancer Registry and data reported by health insurance companies to the National Health Information Centre. The target population was invited by GPs or health insurance companies to undergo FOBT. Descriptive statistics were used to analyse time trends in CRC incidence, mortality, clinical stage at diagnosis, and survival.

Results:

Participation in CRC screening remained suboptimal for most of the study period, but in 2023–2024 approximately 50% of individuals aged 50–75 years completed FOBT. Since 2008, the absolute number of new CRC cases has stabilised, and age standardised incidence has declined since 2016. From 2020, the absolute number of CRC related deaths has decreased, with age standardised mortality decreasing since 2013. Five year survival has improved modestly since 2019, from 0.49 to 0.51. Earlier national analyses had already suggested that CRC screening is economically highly effective in Slovakia and internationally, regardless of the screening method used.

Conclusions:

GPs in Slovakia actively participate in CRC screening, and the programme has recently achieved the target participation rate of 50% in the 50–75 year age group. Stable or declining incidence and mortality and modestly improving survival suggest favourable population level impact but maintaining high participation and documenting stage shifts at diagnosis remain priorities.

Points for discussion:

How can participation in CRC screening be sustained above 50% in General Practice?

How can General Practitioners most effectively motivate and engage patients who initially refuse participation in colorectal cancer screening programme?