A pilot of systematic colorectal cancer screening using FIT in primary care: a single-centered study in the Nepalese population

Abstract

Abstract:

Introduction: Colorectal cancer (CRC) is the third most common cancer worldwide and the fourth most common cancer in Nepal. The global burden of CRC is increasing in Low- and Middle-income Countries (LMIC), creating a significant public health concern. Therefore, it is high time to implement screening programs that help reduce the rising incidence of CRC. Since there is no published research on systematic CRC Screening (CRCS) programs in Nepal, Gurkha Welfare Trust Nepal (GWTN) aimed to collect and analyze data from a newly introduced screening service and share these with other healthcare professionals in Nepal and globally.

Objectives: The primary goal of this study is to document the uptake of CRCS, measure positive FIT test results, record the outcomes of the positive findings, and evaluate the subjective experiences of medical staff and patient participants.

Methodology: This is a prospective mixed-method study conducted at the GWTN from October 2024 to December 2024. The study included patients aged 45 to 85 years. The screening method used was a stool sample tested for occult blood via a Fecal Immunochemical Test (FIT). All FIT-positive patients were referred to a tertiary center for colonoscopy, with guidance to follow up within one week of receiving the colonoscopy report. A structured set of questionnaires was administered to 70 randomly selected patients to inquire about their prior knowledge of CRCS, participation, awareness, and overall experience. A different set of structured questionnaires was distributed to the staff to evaluate their subjective experience. All data were initially recorded in Microsoft Excel and later analyzed using the Statistical Package for Social Science (SPSS).

Result: A total of 1,166 patients were counseled for CRCS, of which 1,029 (88.23%) provided a sample. Among these, 105 (10.2%) had FIT-positive results. Of the FIT-positive patients, 90 (85.7%) underwent colonoscopy. 36 (40%). Patients had a normal colonoscopy. Hemorrhoids were observed in 29 (32.2%) patients and terminal ileitis in 2 (2.2%) patients. Notably, 24 (26.6%) had colonic polyps and 5 (5.5%) had rectal polyps, findings of clinical significance. Of the 24 colonic polyps, 12 (50%) were tubular adenomas (2 high grade, 10 low grade), 3 (12.5%)