Report in English with a Dutch summary (KCE reports 45A)
Report in English with a Dutch summary (KCE reports 45A) Report in English with a Dutch summary (KCE reports 45A)
2 Screening for Colorectal Cancer KCE reports vol.45 4.2 GENERAL PRINCIPLES.............................................................................................................................48 4.3 POSITION PAPER ON CANCER SCREENING IN THE EUROPEAN UNION .........................52 4.4 RATING SCHEMES FOR THE STRENGTH OF EVIDENCE AND RECOMMENDATIONS ...52 4.5 AVERAGE RISK SCREENING (N = 14) ................................................................................................52 4.5.1 Review of retrieved guidelines ....................................................................................................52 4.5.2 Conclusions.....................................................................................................................................53 4.6 TARGETED SCREENING IN CASE OF A POSITIVE FAMILY HISTORY (N = 10)....................54 4.7 SURVEILLANCE IN CASE OF HIGH PERSONAL RISK (N = 11) ..................................................54 5 CLINICAL EFFECTIVENESS OF MASS SCREENING FOR COLORECTAL CANCER ......................................................................................................................... 56 5.1 INTRODUCTION......................................................................................................................................56 5.2 INCREMENTAL SEARCH ON CLINICAL EFFECTIVENESS OF COLORECTAL SCREENING ........................................................................................................................................................................56 5.2.1 Results ..............................................................................................................................................57 5.3 RATIONALE OF COLORECTAL CANCER SCREENING ..............................................................58 5.3.1 First criterion ..................................................................................................................................59 5.3.2 Second criterion.............................................................................................................................59 5.3.3 Third criterion ................................................................................................................................59 5.3.4 Forth criterion ................................................................................................................................60 5.3.5 Criteria five to eight ......................................................................................................................60 5.4 STRATEGIES AND TESTS CONSIDERED...........................................................................................60 5.4.1 Fecal occult blood tests (FOBT).................................................................................................61 5.4.2 Flexible sigmoidoscopy..................................................................................................................66 5.4.3 Colonoscopy ...................................................................................................................................68 5.4.4 Double contrast barium enema (DCBE)...................................................................................71 5.4.5 Virtual colonoscopy.......................................................................................................................71 5.4.6 Other techniques ...........................................................................................................................72 5.5 EVIDENCE FOR PERFORMANCE OF STRATEGIES AND TESTS IN SCREENING CONDITIONS ............................................................................................................................................72 5.5.1 Guaiac Fecal Occult Blood Tests (FOBT).................................................................................73 5.5.2 Immunochemical Fecal Occult Blood Tests .............................................................................79 5.5.3 Flexible Sigmoidoscopy (FS).........................................................................................................82 5.5.4 FOBT and FS combined................................................................................................................84 5.5.5 Colonoscopy ...................................................................................................................................86 5.5.6 Double contrast barium enema (DCBE)...................................................................................86 5.5.7 Virtual colonoscopy.......................................................................................................................87 5.5.8 Other techniques ...........................................................................................................................90 5.6 POTENTIAL HARMS OF CRC SCREENING ......................................................................................91 5.6.1 False positive results, overinvestigation and complications of colonoscopy .....................91 5.6.2 False-negative results.....................................................................................................................92 5.6.3 Studies on CRC screening harms ...............................................................................................92 5.6.4 Psychological morbidity ................................................................................................................93 5.6.5 Inappropriate use of screening tests ..........................................................................................93 5.7 SCREENING ACCEPTABILITY, ADHERENCE AND COMPLIANCE ..........................................94 5.7.1 Definitions........................................................................................................................................94 5.7.2 Effects of risk perception and risk communication on cancer screening behaviors ........95 5.7.3 Factors influencing CRC screening adherence ........................................................................96 5.7.4 Promoting CRC screening adherence .....................................................................................101 5.7.5 Conclusions...................................................................................................................................103 6 ECONOMIC EVALUATION OF CRC SCREENING: LITERATURE REVIEW.... 104 6.1 INTRODUCTION....................................................................................................................................104
KCE reports vol.45 Screening for Colorectal Cancer 3 6.2 INCLUDED STUDIES..............................................................................................................................105 6.3 ECONOMIC LITERATURE REVIEW...................................................................................................107 6.3.1 Methodology .................................................................................................................................107 6.3.2 Interventions and comparisons .................................................................................................108 6.4 CRITICAL APPRAISAL OF THE STUDIES .........................................................................................121 6.5 CONCLUSION.........................................................................................................................................123 7 ORGANISATION OF COLORECTAL CANCER SCREENING IN VARIOUS COUNTRIES ................................................................................................................ 125 7.1 INTRODUCTION....................................................................................................................................125 7.2 THE NETHERLANDS..............................................................................................................................127 7.2.1 Average risk groups.....................................................................................................................127 7.2.2 Groups at increased or high risk ..............................................................................................128 7.3 FINLAND ...................................................................................................................................................128 7.3.1 Average risk groups.....................................................................................................................128 7.3.2 Groups at increased or high risk ..............................................................................................129 7.4 GERMANY .................................................................................................................................................129 7.4.1 Average risk groups.....................................................................................................................129 7.4.2 Groups at increased or high risk ..............................................................................................130 7.5 ITALY ..........................................................................................................................................................130 7.6 CZECH REPUBLIC...................................................................................................................................131 7.6.1 Average risk groups.....................................................................................................................131 7.6.2 Groups at increased or high risk ..............................................................................................132 7.7 FRANCE .....................................................................................................................................................132 7.7.1 Average risk groups.....................................................................................................................132 7.7.2 Groups at increased or high risk ..............................................................................................133 7.8 UK................................................................................................................................................................133 7.8.1 Average risk groups.....................................................................................................................133 7.8.2 Groups at increased or high risk ..............................................................................................135 7.9 SCOTLAND ..............................................................................................................................................135 7.9.1 Average risk groups.....................................................................................................................135 7.9.2 Groups at increased or high risk ..............................................................................................136 7.10 BELGIUM....................................................................................................................................................136 7.11 AUSTRALIA ...............................................................................................................................................136 7.11.1 Average risk groups.....................................................................................................................136 7.11.2 Groups at increased or high risk ..............................................................................................137 7.12 USA..............................................................................................................................................................138 7.13 CANADA...................................................................................................................................................139 7.13.1 Average risk groups.....................................................................................................................139 7.13.2 Groups at increased or high risk ..............................................................................................141 7.14 NEW ZEALAND ......................................................................................................................................141 7.14.1 Average risk groups.....................................................................................................................141 7.14.2 Groups at increased or high risk ..............................................................................................142 8 IMPLEMENTATION SCENARIOS AND BUDGET IMPACT................................ 143 8.1 SCENARIOS...............................................................................................................................................143 8.1.1 Baseline analysis: biennial screening with unrehydrated gFOBT........................................143 8.1.2 Comparison of 3 different FOBTs............................................................................................147 8.2 RESULTS.....................................................................................................................................................149 8.2.1 Baseline analysis............................................................................................................................149
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<strong>KCE</strong> <strong>reports</strong> vol.45 Screen<strong>in</strong>g for Colorectal Cancer 3<br />
6.2 INCLUDED STUDIES..............................................................................................................................105<br />
6.3 ECONOMIC LITERATURE REVIEW...................................................................................................107<br />
6.3.1 Methodology .................................................................................................................................107<br />
6.3.2 Interventions and comparisons .................................................................................................108<br />
6.4 CRITICAL APPRAISAL OF THE STUDIES .........................................................................................121<br />
6.5 CONCLUSION.........................................................................................................................................123<br />
7 ORGANISATION OF COLORECTAL CANCER SCREENING IN VARIOUS<br />
COUNTRIES ................................................................................................................ 125<br />
7.1 INTRODUCTION....................................................................................................................................125<br />
7.2 THE NETHERLANDS..............................................................................................................................127<br />
7.2.1 Average risk groups.....................................................................................................................127<br />
7.2.2 Groups at <strong>in</strong>creased or high risk ..............................................................................................128<br />
7.3 FINLAND ...................................................................................................................................................128<br />
7.3.1 Average risk groups.....................................................................................................................128<br />
7.3.2 Groups at <strong>in</strong>creased or high risk ..............................................................................................129<br />
7.4 GERMANY .................................................................................................................................................129<br />
7.4.1 Average risk groups.....................................................................................................................129<br />
7.4.2 Groups at <strong>in</strong>creased or high risk ..............................................................................................130<br />
7.5 ITALY ..........................................................................................................................................................130<br />
7.6 CZECH REPUBLIC...................................................................................................................................131<br />
7.6.1 Average risk groups.....................................................................................................................131<br />
7.6.2 Groups at <strong>in</strong>creased or high risk ..............................................................................................132<br />
7.7 FRANCE .....................................................................................................................................................132<br />
7.7.1 Average risk groups.....................................................................................................................132<br />
7.7.2 Groups at <strong>in</strong>creased or high risk ..............................................................................................133<br />
7.8 UK................................................................................................................................................................133<br />
7.8.1 Average risk groups.....................................................................................................................133<br />
7.8.2 Groups at <strong>in</strong>creased or high risk ..............................................................................................135<br />
7.9 SCOTLAND ..............................................................................................................................................135<br />
7.9.1 Average risk groups.....................................................................................................................135<br />
7.9.2 Groups at <strong>in</strong>creased or high risk ..............................................................................................136<br />
7.10 BELGIUM....................................................................................................................................................136<br />
7.11 AUSTRALIA ...............................................................................................................................................136<br />
7.11.1 Average risk groups.....................................................................................................................136<br />
7.11.2 Groups at <strong>in</strong>creased or high risk ..............................................................................................137<br />
7.12 USA..............................................................................................................................................................138<br />
7.13 CANADA...................................................................................................................................................139<br />
7.13.1 Average risk groups.....................................................................................................................139<br />
7.13.2 Groups at <strong>in</strong>creased or high risk ..............................................................................................141<br />
7.14 NEW ZEALAND ......................................................................................................................................141<br />
7.14.1 Average risk groups.....................................................................................................................141<br />
7.14.2 Groups at <strong>in</strong>creased or high risk ..............................................................................................142<br />
8 IMPLEMENTATION SCENARIOS AND BUDGET IMPACT................................ 143<br />
8.1 SCENARIOS...............................................................................................................................................143<br />
8.1.1 Basel<strong>in</strong>e analysis: biennial screen<strong>in</strong>g <strong>with</strong> unrehydrated gFOBT........................................143<br />
8.1.2 Comparison of 3 different FOBTs............................................................................................147<br />
8.2 RESULTS.....................................................................................................................................................149<br />
8.2.1 Basel<strong>in</strong>e analysis............................................................................................................................149
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