Background

In Chile and the Region of the Americas and the Caribbean (LAC), cancer is the second cause of death after cardiovascular diseases. In Chile this is changing and in seven of the thirteen geographical regions, cancer is the first cause of death. This pilot screening programme was developed on one of the territories with highest cancer mortality rate, 28% higher than the national average.
In Chile Colorectal cancer  (CRC)  is the second most frequent cancer and the third cause of cancer-related death. Particularities of CRC make it specially susceptible to prevention and early detection through screening programs  using the fecal occult blood test (FIT)  with impact on the decrease of the incidence and mortality, as shown by a robust body of evidence since over 25 years. Most of developed countries have implemented organized population-based CRC screening programs. In LAC region, there are very few countries with organized screening programs at national level, and not many documented local experiences.
In this context, the East Metropolitan Health Authority (SSMO) of the Ministry of Health together with the Municipality of Peñalolen aimed at developing a screening programme for CRC in the territory.
 
Objective
The guiding objective was to improve our capacity as a system, to detect early and prevent timely CRC on our population, starting by implementing a pilot screening programme using the existing public healthcare network, through an integrated model  based on primary health care and through the different levels of care according to need.
 
Method
This opportunistic screening programe targeted population aged 50 to 74 in primary care centers, evaluated during general morbidity consultation or preventive health assessment consultation. Risk was evaluated over standard scores defined by the coloproctologist team, based on symptoms and signs associated with CRC, the physical exam, and  personal and family history.
Individuals at risk were indicated the FIT test, at the point of care.The subsequent approach for each individual depended on the test result, endoscopic findings, and histopathological outcome.
 
Results
Between March and December 2024, 1397 FIT exams were indicated, 894 performed correctly (64%) of which 71% were women. 121 test (13.5%) were positive and 87 (72%) had Indication for colonoscopy. To the cut for the study, 43 colonoscopies were performed, with 27 requiered biopsies. As a result, 16 cases of adenomas were identified with 4 being high degree and 4 cases of carcinomas were identified and succesfully resolved.
 
Conclusion
This pilot is the first experience in the country in a real-life setting within the public health network and showed to be feasible. Though the numbers are still small, the fact that four people could be treated on time for their carcinomas, four people were caught timely before a declared cancer, and secondary prevention was performed, seems promising
 Screening programmes to decrease the incidence and mortality for colorectal cancer are advancing in Chile, yet we believe a strong impulse on the early detection and prevention of CRC in the LAC Region is still a challenge, as imperative as possible .