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Participation in the First Four Rounds of the Colorectal Cancer ScreeningProgram With Guaiac Fecal Occult Blood Test Conducted in the Haut-Rhin(Alsace, France)Bernard Denis, Isabelle Gendre, Philippe Perrin

Organized screening programs depend on high participation rates to be effective and efficient.Whether uptake rates obtained in randomized controlled trials on colorectal cancer (CRC)screening with guaiac fecal occult blood test (gFOBT) are transposable in the real world isquestionable. gFOBT has several drawbacks, one is the requirement for frequent testing,which may limit compliance. Aim: To assess participation in the first 4 rounds of anorganized CRC screening program using gFOBT. Methods: Comparison of the determinantsof participation in the first 4 rounds (R1 to R4) of the CRC screening program with HemoccultII implemented since 2003 in the Haut-Rhin, a French administrative area. We performeda population-based open cohort study of all average risk residents aged 50 - 74 years. Theywere invited to participate every other year. A first letter invited them to visit their generalpractitioner (GP) for CRC screening. Three recall letters were mailed to all those who hadnot complied, the second with a gFOBT kit. Results: Main results are presented in the table.The decrease in uptake was similar in men and women and was observed in all age groupsexcept the 70 - 74 year age group. Overall, after 4 rounds, 242,292 persons had been invitedand 34545 (14.3%) had completed 4 tests, 26675 (11.0%) 3 tests, 37193 (15.4%) 2 testsand 50070 (20.7%) 1 test. Overall, 148,483 (61.3%) persons had been screened at leastonce. Of 86,694 people who were eligible in all rounds, 34,545 (39.8%) had completed allthe 4 tests, 8679 (10.0%) 3 tests, 8099 (9.3%) 2 tests, 6552 (7.6%) 1 test, and 28,819(33.2%) 0 test. The uptake following the 2nd, 3rd and 4th invitation in people whonever complied before was 17.0%, 8.8% and 5.5%, respectively. 16% of people who hadparticipated in Rn did not participate in Rn+1. The proportion of people screened by GPsincreased significantly from 76.9% in the 1st round to 84.0% in the 4th (p<0.01) whilethat of people screened by direct mailing of the gFOBT kit decreased significantly from15.6% to 12.1% (p<0.01). The proportion of uptake following the first 2 invitation lettersincreased from R1 to R4 from 78.4% to 86.9%, while that following the mailing of thegFOBT kit decreased from 15.3% to 7.8%. The uptake decreased between years 2008 -2009 and 2011 - 2012 from 34.3% to 31.7% in France and from 51.3% to 47.1% in ourregion. The latter uptake was among the highest achieved in France, where it varied from7.1% to 51.4% depending on regions. Conclusion: The uptake and adherence to repeattesting are modest and deteriorate with time in the French organized population-basedgFOBT CRC screening program, so that the reduction in CRC mortality will be significantlylower than in the trials. Effort is needed to enhance uptake and to reduce inequalities inparticipation related to sex, age, place of residence and deprivation.

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The Association Between the APC I1307K Allele and Colorectal and Non-Colorectal Cancer RiskAri Leshno, Eliezer Liberman, Shiran Shapira, Sarah Kraus, Nadir Arber, MenachemMoshkowitz

Background: The APC I1307K missense mutation has been detected in 6-7% of the generalAshkenazi Jewish (AJ) population and in 10%-28% of AJ with either a personal or familyhistory of colorectal cancer (CRC) or adenomatous polyps. Aim of study: To confirm theassociation of I1307K in CRC and evaluate its role in non CR neoplasia Subjects and Methods:Clinical data and blood samples were prospectively collected from healthy individualsundergoing annual screening at the Integrated Cancer Prevention Center at Tel-Aviv SouraskyMedical Center between 1.1.2010-30.11.13. The genotyping of APC I1307K was routinelyperformed in all subjects from DNA extracted from peripheral blood leukocytes using real-time PCR The prevalence of personal history of CRC, CR adenomatous polyps and non-CRC among I1307K carriers and non-carriers was determined. Results: Overall, the APCI1307K variant was detected in 455/5937 (7.7%) individuals undergoing testing (10.7%Ashkenazi, 1.5% Sephardic). The prevalence of personal history of CRC, colorectal adenoma-tous polyps and non-colorectal cancers is described in the table below. No significantassociation was found between a personal history of other types of cancers (esophagus,stomach, prostate, gynecological, kidney and urinary tract, hematological, brain, endocrineand liver) and I1307K carrier state. Conclusion: 1. I1307K carriers posses a double risk forCR neoplasia. 2. I1307K carriers are at increased risk for pancreas, breast, lung and melanoma.3. Analyzing I1307K can help in the evaluation of an individual cancer risk

S-407 AGA Abstracts

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Incidence of Colorectal Neoplasms Among Male PilotsMenachem Moshkowitz, Ohad Toledano, Lior Galazan, Erwin Santo, Aharon Hallak,Nadir Arber

Background: Military and commercial airline pilots are exposed to cosmic radiation andother specific occupational risk factors. Several epidemiological studies on a possible elevatedcancer risk, including colorectal cancer among flight personnel have yielded contradictoryresults. Aims: To assess the prevalence of colorectal neoplasms (adenomas, advanced adeno-mas and colorectal cancers) in a cohort of military and commercial airline pilots in IsraelSubjects and Methods: Initial screening colonoscopy was performed on average-risk (nosymptoms and no family history) airline pilots at the Integrated Cancer Prevention Center(ICPC) in the Tel-Aviv Medical Center. Visualized polyps were excised and sent for pathologi-cal examination. Advanced adenoma was defined as > 10 mm in diameter, high-gradedysplasia, villous histology or more than 3 adenomas. The results were compared with thoseof an age- and gender-matched random sample of healthy adults undergoing routine screeningcolonoscopy at the ICPC. Results: There were 270 pilots (mean age 55.2±7.4 y) and 1150controls (mean age 55.7±7.8 y). The prevalence of colorectal neoplasms was 15.9% amongthe pilots and 20.6% among the controls (P =0.097, χ2 test). There were significantly morehyperplastic polyps among pilots (15.5% vs. 9.4% p=0.004), and a trend, although notstatistically significant, for less adenomas (14.8% vs. 20.3% p=0.06). The prevalence ofadvanced lesions among pilots and the control group was identical 5.9% and 4.7% (P =0.49) respectively. The prevalence of cancer was 0.7% and 0.69% (P = 0.93). Conclusions:The prevalence of colorectal neoplasia tends to be lower among pilots as compared to thegeneral population. Healthier status of pilots and periodic checkups might be the reason.There are more hyperplastic polyps among pilots.

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Prevalence of Colorectal Neoplasia in Asymptomatic Average-Risk IndividualsAged 40-49 Years Undergoing Screening ColonoscopyAri Leshno, Menachem Moshkowitz, Aharon Hallak, Roman Grinshpoon, Erwin Santo,Nadir Arber

Background: Colorectal cancer (CRC) screening is recommended for average-risk personsbeginning at age 50. The role of screening at a younger age is not recommended. Aim ofstudy: To assess prospectively the prevalence of colorectal neoplasia in a large consecutivelyscreened asymptomatic average-risk population, aged 40-49 and 50-59 years old in a tertiaryreferral center in Israel. Patients and Methods: Included were 1675 consecutive asymptomatic,average-risk individuals aged 40-59 years, who underwent screening colonoscopy. The studypopulation was stratified according to age and gender, and compared to 7 large internationalstudies. Results: Prevalence of overall adenomas was 71/506 (14%) in the 40-49 years agegroup, and 199/1169 (17%) in the 50-59 years age group (p=0.13). Advanced adenomawas found in 7/506 (1.4%) of the 40-49 years age group, and18/116 9 (1.5%) in the 50-59 years age group (p=0.64). Five patients had CRC and one patient had high grade dysplasia(HGD) (0.4% of population). One (0.2%) and 5 (0.4%) in the 40-49 and 50-59 years oldage groups (p=NS). Overall, male gender was found to be a risk factor for adenoma (oddsratio [OR] = 1.66, 95% confidence interval [CI]: 1.27-2.16, p<0.000only in the 50-59 yearage group (OR = 1.72, 95% CI: 1.26-2.34), p<0.001) but not in the 40-49 year age group.No mortality or major complications were noted. Conclusions: 1. Prevalence of adenomain subjects aged 40-49 years did not differ significantly from that of subjects aged 50-59years. 2. Male sex was found to be a risk factor for adenoma only in the 50-59 years agegroup. 3. Rate of advanced adenoma was lower than expected as compared to the worldliterature. It might be due to true average risk (no family history) subjects in the currentstudy, lower prevalence rate in Israel or missed cases. 4. Guidelines for screening colonoscopyin asymptomatic, average-risk individuals should be re-evaluated.

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