Abstract
Colorectal carcinoma screening was begun in 1992, and, in 1998, its financing shifted considerably to being handled under the general-account budget. The so-called triune reform and the great merger of municipalities in the Heisei era led to financial improvement. It was reported that changes were made to the colorectal carcinoma screening after the merger. In our area, five local towns merged into one on October 1, 2004, resulting in the birth of Shima City. As for the cancer detection survey method, it was changed from mass examination only to a combination of mass examination and individual detection survey, and the mass examination was contracted out to an entity chosen through general competitive bidding.
Examination of individual residents was done by clinics belonging to the local medical association. It was found that the then designated organization had difficulty maintaining effective quality control, and the direct responsibility for this duty was given to the new city after the merger. In 2005, 2,088 individuals joined the cancer detection survey and another 1,224 joined the mass screening; the positive rate of the fecal occult blood test for these two groups was 11.7% and 5.15%, respectively. However, in this new city, both the understanding of the survey results obtained from thorough examinations and the management of patients over time were poor. After the merger, in addition to aiming for an increase in colorectal cancer screening rates, it was thought vital to build an effective framework which would make possible the desired level of quality control.
