Report in English with a Dutch summary (KCE reports 45A)

KCE reports vol.45 Screening for Colorectal Cancer 1
Table of contents
ABBREVIATIONS...................................................................................................................... 5
GLOSSARY ................................................................................................................................. 8
1 GENERAL INTRODUCTION TO CANCER SCREENING...................................... 16
1.1 DEFINITION OF SCREENING ...............................................................................................................16
1.2 PRINCIPLES OF SCREENING .................................................................................................................16
1.3 PITFALLS AND POSSIBLE HARMS........................................................................................................17
1.3.1 Biases ................................................................................................................................................17
1.3.2 End points in RCTs on cancer screening ..................................................................................18
1.3.3 Adverse effects ...............................................................................................................................19
1.3.4 Target population and appropriateness of screening .............................................................19
1.4 SCREENING VERSUS SURVEILLANCE ................................................................................................20
1.5 IMPLICATIONS FOR COLORECTAL CANCER SCREENING ......................................................20
2 EPIDEMIOLOGY OF COLORECTAL CANCER ....................................................... 22
2.1 INTERNATIONAL CLASSIFICATION..................................................................................................22
2.2 INCIDENCE.................................................................................................................................................22
2.3 PRIMARY TUMOR LOCALISATIONS..................................................................................................25
2.4 STAGING.....................................................................................................................................................26
2.5 MORTALITY AND SURVIVAL................................................................................................................28
3 RISK STRATIFICATION FOR COLORECTAL CANCER........................................ 34
3.1 INTRODUCTION......................................................................................................................................34
3.2 PERSONAL AND FAMILIAL HISTORY ELEMENTS INDICATING INCREASED CRC RISK..34
3.2.1 Personal history of adenomatous polyps ..................................................................................34
3.2.2 Personal history of colorectal cancer ........................................................................................36
3.2.3 Personal history of endometrial or ovarian cancer ................................................................36
3.2.4 Personal history of long standing active inflammatory bowel disease involving the colon
36
3.2.5 Acromegaly......................................................................................................................................36
3.2.6 Ureterosigmoidostomy patients .................................................................................................36
3.2.7 Family history of colorectal cancer ............................................................................................37
3.2.8 Hereditary high risk.......................................................................................................................37
3.3 ESTIMATIONS OF RELATIVE (RR) AND ABSOLUTE RISK (AR) .................................................37
3.3.1 The Fuchs study, 1994 ..................................................................................................................37
3.3.2 Focused search for articles on risk estimations in familial CRC..........................................38
3.3.3 Primary studies ...............................................................................................................................38
3.3.4 Systematic reviews with meta-analysis ......................................................................................41
3.3.5 Economic evaluations ....................................................................................................................43
3.3.6 Conclusion.......................................................................................................................................44
3.4 RISK STRATIFICATION ...........................................................................................................................44
3.5 PREVALENCE OF A FAMILY HISTORY OF COLORECTAL CANCER IN THE GENERAL
POPULATION ............................................................................................................................................45
4 GUIDELINES ON COLORECTAL CANCER SCREENING AND SURVEILLANCE
.......................................................................................................................................... 48
4.1 INTRODUCTION......................................................................................................................................48