Colorectal cancer (CRC) is the third most common neoplasm and the fourth cause of cancer death worldwide. During 2020, 1.93 million new cases were diagnosed and 935,000 deaths from CRC were estimated.(1) Argentina is among the countries with the highest incidence and mortality rates for CRC in South America (it is only surpassed by Uruguay). Approximately each year more than 16,000 cases are diagnosed and 8,700 people die, which corresponds to an incidence and mortality rate of 25 and 12.6 per 100,000 inhabitants. In this way, it constitutes the second cause of specific mortality in Argentina after lung cancer. Most cases are sporadic (75%) and affect those over 50 years of age (90%).(1)
The long latency of CRC transformation turns it into a preventable tumour, to the extent that its precursor lesion, the adenomatous polyp, is a slow growing lesion. Only 5% of these lesions will progress to invasive carcinoma after a mean time of 10 years, which makes it possible to interfere and modify their natural history.(2) The transition from the polyp to carcinoma is 90% related to age (over 50 years) in both sexes, which represents a primary factor in analysing disease control strategies in the coming years. This provides some time for the screening to take place.
The Immunochemical Faecal Occult Blood Test (iFOBT) is a test that examines the possible presence of blood in the stool, which can be a sign of cancer or polyps.(2)
The performance of the test annually in people between 50 and 75 years of age has shown to reduce mortality from CRC and to be a cost-effective screening strategy in Argentina.(3)
In Argentina, the National Cancer Institute (INC) has started the implementation of a National Program for the prevention and early detection of CRC with iFOBT annually in people of both sexes, between 50 and 75 years old, without a personal or family history of colorectal disease. For a screening program to be effective, coverage of at least 70% of the population is required. The fourth edition of the National Survey of Risk Factors(4) conducted in 2018 enquired about the CRC screening in the interviewed population. A total of 29,224 people was interviewed, of which 10,102 were between 50 and 75 years of age, representing 34.5% of the total survey participants. Of those, 57.1% were women (n = 5,766), with the mean age for both sexes being 61 years. The response rate for this section of the survey was only 28.5% (n = 2,883). Of these, 12% (n = 347) had undergone IFOBT in the last year, while 57.4% (n = 1,653) had a colonoscopy done in the last five years.
The adherence rate of the general population to screening is low. Multiple factors explain this, with low public knowledge being one of the main reasons.
The workplace setting has great potential to improve adherence to preventive interventions, becoming increasingly recognised for disseminating information and implementing health promotion activities, including those aimed at the prevention and early detection of cancer.(5–8) It represents a convenient environment for behavioural changes and prevention, particularly due to the fact that many neoplasms are closely related to lifestyle. In addition, it allows targeting a captive population, thus reaching even those who do not regularly visit the doctor, or request a periodic health examination. The benefits of implementing programs in the workplace include improving the health of employees but also increasing their levels of productivity.
Several methodologies have been implemented. Employee-facing strategies as electronic invitation and reminders seem to positively influence the percentage of participation and early detection in CRC in a given setting.(9, 10) Telephone calls, intranet messages and videos, flyers, the use of social networks, e-mail or the mobile messaging system of mobile phones, letters of invitation, sending of educational material, provision of a kit to carry out the test at home, or combinations of these have been shown to be more effective than non-intervention in increasing the percentage of adherence. A better uptake of screening may lead to future high health benefits and cost reductions both for the employer and the health system.
As a pilot project based on the guide developed for the implementation of programs for the prevention and early detection of CRC from the INC(11), it has the potential to be scalable to the entire province of Buenos Aires, or to other provincial or national government and non-government institutions.
The objective of this study was design and evaluate the feasibility, acceptability, and effectiveness of a strategy implemented in the workplace to improve the rate of adherence to the IFOBT screening in workers of the Internal Revenue Agency of the Province of Buenos Aires (ARBA from its acronym in Spanish ‘Agencia de Recaudación de Buenos Aires’), a public institution. Secondary objectives were to identify those factors hindering or facilitating adherence to the screening program.