Costa Rica, an example of the Americas in the implementation of an innovative organized colorectal screening program during 2017–2022

Costa Rica is an upper-middle-income country, with health policies that have allowed high standards to be emphasized; Cancer is our second leading cause of death, efforts are directed to strengthen screening programs. According to PAHO, Costa Rica estimates an incidence and mortality of colorectal cancer of 16.4 and 7.8 per 100,000 inhabitants respectively, currently does not have a country-level program for the detection of this pathology. In the province of Cartago, the Center for Early Cancer Detection (CDTC) emerged as a collaboration with the Japanese government to promote gastric cancer screening in a region of the country with a high incidence of it,this region has an incidence that oscillates between 15 and 25 cases of colorectal cancer per 100,000 inhabitants. Since 2017, it began with a colorectal cancer screening program based on the use of qualitative Fecal Immunochemical Test (FIT) to prioritize colonoscopies for the detection of early lesions and adequate care for these patients. The CDTC serves the inhabitants of 9 cantons, the target population is between 50 and 74 years old, which corresponds to 140,000 inhabitants.

CDTC information was collected between 2017 and 2022 from people with a colonoscopy according to the criteria of the colorectal cancer program, identifying the population that was invited by a positive FIT result or by having relatives with a history of this cancer, basic sociodemographic data and the result of the colonoscopy were taken, classifying for study purposes all adenomas with low-grade dysplasia as premalignant lesions; adenomas with high dysplasia grade and stages T1a and T1b as early cancer and T2 lesions or higher as advanced cancer.

A total of 97697 FIT were performed, with 5611 (5.74%) positive to which together with 1432 patients with hereditary family history who underwent a diagnostic colonoscopy, for a total of 7043 colonoscopies. The median age was 61.84 years. A total of 1388 (19.70% of all colonoscopies) of premalignant lesions was detected, We detect a 2.30% of colonospies with a cancer report, 50.31% of early cancer and 49.69% of advanced cancer were identified. An association was found between a positive FIT and an altered colonoscopy (OR=1.49 CI95% 1.28-1.75), this association maintained significance between positive FIT and premalignant lesions (OR= 1.70 CI95 1.44-1.99) as well as in early cancer results (OR=3.53 CI95 1.53-8.13), but not with advanced cancer (OR=0.97 CI95 0.57-1.65); statistically significant results was determined between male sex and an altered premalignant result (OR=1.39 CI95% 1.24-1.57), early cancer (OR=2.47 CI95 1.58-3.86) and advanced cancer (OR=1.70 CI 1.09-2.64).

Costa Rica is the only country in the region that has an organized program for colorectal cancer sponsored by the government, focused on only one of its provinces. The optimization of resources in a country and implementation of new strategies in the invitation process have allowed us to obtain the results showed and implement the bases to establish the screening program organized at the national level where more than 50% of the cancers diagnosed are early together with the adequate treatment of premalignant lesions.

The authors.

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All authors have declared no conflicts of interest.