The Tunisian National Authority for Evaluation and Accreditation in Health (INEAS) has collaborated with the Ministry of Health to publish a national guide for colorectal cancer screening. The guide recommends screening for adults aged 50-74 with an average risk of developing the disease. This initiative aims to address the growing concern of colorectal cancer in Tunisia, which is the second most common cancer in the country.
Colorectal cancer incidence in Tunisia has been increasing at a rate of 5.8% per year between 2000 and 2018. Nearly 30% of cases are diagnosed at a metastatic stage. Projections indicate that by 2040, the standardized incidence rates will be 79.5 cases per 100,000 men and 61.3 cases per 100,000 women. The new program seeks to change this trend by promoting early detection and treatment.
The national guide, developed by a multidisciplinary Tunisian panel, adapts Canadian recommendations to the local context. It suggests using the automated quantitative fecal immunochemical test (FIT) for screening, which is deemed more accurate than qualitative tests. A negative test result requires a repeat every two years, while a positive result necessitates a confirmatory colonoscopy.
The program's strategy is expected to yield significant economic benefits, with estimated savings of 195.85 million dinars compared to curative care costs for cancer. This projection is based on an average FIT positivity rate of 5% and accounts for the benefits of early detection of precancerous lesions and reduced advanced-stage diagnoses.
To implement the program effectively, the guide recommends establishing regional coordination centers, dedicated endoscopy units, and a centralized appointment scheduling system. A secure national digital platform will be developed to manage invitations, centralize laboratory results, and track screened individuals.
The program will be rolled out in phases, starting with a one-year pilot in several governorates, including Tunis and Sfax, as well as rural areas. This pilot phase will assess the program's functionality and determine the optimal FIT positivity threshold before gradually expanding it nationwide over five years.
The program aims to achieve a participation rate of 45-50% among the target population to significantly impact colorectal cancer mortality. The National Health Insurance Fund (CNAM) and private healthcare providers will be involved to facilitate access to colonoscopies and ensure continuity of care.
Key points
- The program recommends screening adults aged 50-74 with an average risk of developing colorectal cancer.
- The program is expected to generate 195.85 million dinars in savings compared to curative care costs for cancer.
- A participation rate of 45-50% among the target population is necessary to significantly impact colorectal cancer mortality.
