In Italy, the endoscopic screening of colorectal cancer offered to patients is of good quality but ‘patchy’ or with considerable differences between the centers in the various regions. This is what emerges from a study conducted by the Italian Society of Gastroenterology and Digestive Endoscopy (Sige) on a sample of 64 hospitals in 17 regions, published online in the journal ‘Digestive and Liver Disease’, which assessed the quality for the first time. endoscopic screening of colorectal cancer in Italy. While the survey provided positive results on the whole, at the same time it highlighted numerous shortcomings and discrepancies between the various centers of the Peninsula. Hence the appeal of the scientific society for institutions to pay greater attention to subsidizing and monitoring second-level screening activities, such as colonoscopy and all factors that determine its quality. Colorectal cancer – Sige recalls in a note – is a serious health problem all over the world. Suffice it to say that it represents the third cancer by incidence and the second by mortality: there are almost 50 thousand new cases in one year in Italy, about 500 thousand in Europe and almost 2 million in the world. What makes the difference in the clinical history of patients is screening, which allows for early diagnosis and a reduction in mortality. “In Italy, the screening used is the fecal occult blood test, performed every 2 years in people between 50 and 69 years old, with the exception of the Piedmont region where rectosigmoidoscopy is performed”, explains Marcello Maida, medical director of the Operational Unit. Gastroenterology complex of the Sant Elia-Raimondi hospitals in Caltanissetta and member of the national board of SIGE. “If the first level test is positive – explains Maida – the screening program involves the execution of a colonoscopy as a second examination level. The quality of this examination is therefore crucial in guaranteeing the effectiveness of the entire prevention program “. The goal is in fact to remove any pre-cancerous lesions, such as polyps, in an early and asymptomatic phase. In this way, we intervene in a less aggressive way and increase the chances of effective treatments, less impacting for the patient and with a greater probability of recovery. The survey analyzed data from 64 hospitals in 17 Italian regions: about 50% from the North, almost 20% (18.75%) from the Center and just over 30% (31.25%) from Southern Italy. . Each center has an average of about 5 endoscopists involved in the screening and of these about 3 out of 4 (71.4%) are gastroenterologists. If most of the centers (93.8%) plan a colonoscopy quickly and in any case within 3 months, what is striking is the discrepant data in the various Italian regions. In fact, a significantly higher number of screening colonoscopies (6,500) performed in the North compared to the central-southern centers (4,000 and 3,000 respectively) are recorded on average in one year. The same dyscrasia is found in the number of endoscopists, who are on average 6.5% in the North and 5% and 3.5% in the Center and South. “As Sige we decided to perform an ad hoc study to assess the quality of the colonoscopy of screening in Italy, of the technologies with which it is performed and what is the adherence to international guidelines in clinical practice. If on the one hand we can be satisfied with the quality offered to patients in Italy – continues Maida – on the other we cannot fail to register great heterogeneity among all the participating centers, with a considerable difference in behavior in the execution of endoscopic screening for colorectal cancer. These aspects should be adapted and standardized at national level through constant monitoring of the activity of the screening centers “. Colon cancer screening has a great impact on the natural history of this cancer and helps reduce its mortality, “recalls Maida. “Therefore, institutions should pay more attention to implementing these activities. First of all – says the gastroenterologist – with a national guideline in order to ensure greater uniformity of behavior among all centers but also through greater investment to ensure sufficient staff. and adequate and constantly updated technological instrumentation. From this perspective – he concludes – the national scientific societies will be able to play an important role in supporting the process of uniformity and the growth of individual centers throughout the national territory “.
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