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

130 Screening for Colorectal Cancer: Appendices KCE reports vol.45
Since the implementation of the colonoscopy screening program, the national
commission of physicians and health services (Der Bundesausschuss Ärzte und
krankenkassen) has formulated a quality handbook with regard to the structure
and the screening process 532. The following standards have been set:
The performing of colonoscopies is only allowed if permission of
the Kassenärztlichen Vereinigungen is given
Colonoscopy needs to be done by skilled physicians (such
competent physicians are gastroenterologists, internists with
skills in sigmoido/colonoscopy, ...), having performed at least 200
colonoscopies and 50 polypectomies in the 2 years before the
request of the authorisation
For the prolongation of the authorisation physicians have to
perform yearly at least 200 entire colonoscopies and 10
polypectomies
Emergency medical material has to be available
To assure the quality of hygiene, hygienic-microbiological
controls of the cleaning of the endoscope have to be performed
Solely colonoscopies of the entire colon ( bis zum Zoekum bzw.
Ileum ) can be accounted for as screening colonoscopies
The completeness of the examination should be proven by
documentation of photographs
A condition for reimbursement of the examination is a documentation on the
indication, on the parameters of the process (e.g. the completeness of the
examination, polypectomy, entire removal of polyps, complications) and on the
result.
In Saarland 533 a study of the Deutsche Krebsvorschungszentrum (DKFZ) and
The Centralinstitut für die Kassenärztlichen Versorgung examines the efficacy
of a colonoscopy screening program.
7.4.2 Groups at increased or high risk
7.5 ITALY
There is no organised screening program for high risk groups. For patients at
risk such as patients with a positive FOTB test or with a positive family history,
a colonoscopy before the age of 56 is recommended and can be repeated
earlier than after 10 years if needed 530. These colonoscopies are also
reimbursed by the national health insurance.
In Italy, the regions and self-governing provinces are responsible for the
planning of health services. Health care decisions are decentralized while the
State must monitor the situation to ensure that all citizens receive essential
health services 534. The Agreement between State and Regions of March 2005
set up the National Prevention Plan 2005-2007. Development of mammography,
cervical and colorectal screening programs are among the priority objectives.
The plan is coordinated by the National Prevention and Disease Control
Centre (CCM), within the Ministry of Health 535. The goal is to overcome the
obstacles that have prevented a homogeneous development of cancer screening
programs in Italy. Although screening has been shown to be effective in
reducing colorectal cancer mortality, there continue to be difficulties in