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

132 Screening for Colorectal Cancer: Appendices KCE reports vol.45
designed according to the EU recommendations and focused on asymptomatic
individuals aged over 50, with first FOBT, provided and interpreted by GP s, and
if positive patients are referred for colonoscopy performed by a
gastroenterologist. The expenses are covered by health insurance 544.
After 4 years the global data show that about 20% of the targeted population
participates in the program. 97% of GPs in the country joined the program and
20 % of them reached 50% FOBT coverage of targeted population. The data
from practices show that 80-90 % of patients return the test within three
months. However, 10-20 % refuse colonoscopy when FOBT was positive.
7.6.2 Groups at increased or high risk
7.7 FRANCE
People at high risk of having colorectal cancer are recruited by GPs or
gastroenterologists for an early colonoscopy or FOBT testing at age of 40 and
further on a yearly basis although the approach can vary individually.
7.7.1 Average risk groups
In 1998, the Agence nationale d accréditation et d évaluation en santé
(ANAES) recommended in a consensus conference the introduction of an
organised screening program for individuals between 50 and 74 years by means
of a FOBT test every two years 545. In 2002, 22 departments (out of 95) have
been selected for a pilot project. Following the positive experience in those
departments, colorectal cancer screening with FOBT was extended to 50
departments in 2005 and is planned to be nationally implemented by 2007.
Between 2002 and 2004, 2.700.000 persons were invited and 716.000
participated (+/ 26%) 546. The average participation rate in departments with an
activity of more than 1 year and having invited more that 80 % of the population
of the department was 33 %. It also appeared that the participation rate
increases with the duration of the program. In the department Haut Rhin a
participation rate of 53,13 % (2006) was reached 547.
A coupled strategy is used 548. First, invitation letters are sent to individuals from
the target group by a central administration, the structure de gestion
départemental 549. An information leaflet and a brief questionnaire are included
to the invitation letter in order to identify the persons that have to be excluded
from the screening program. Furthermore a self-adhesive label with the
identification data is sent to the individual. The individual has to get the test
from the GP, who has to explain the objectives of the test to allow the patient
to grasp its use and the consequences in case of a positive test result. The test
will be realised at the individual s home. Afterwards individuals have to send the
test to a central laboratory for analysis 550 (centre de lecture). These
laboratories send the test results to the central administration. The central
administration forwards the results to the patient and the GP. Those with a
positive test result are recommended to undergo a colonoscopy. Individuals
who underwent a colonoscopy are excluded from screening for the next 5
years.
If persons did not get tested after the first invitation letter, a reminder with a
test is sent by mail by the central administration to those individuals from the
eligible target population that did not explicitly refuse to undergo the test. The
GP has to indicate the persons that are not eligible to get screened or the
persons that refused the test to the central administration. GP s are paid a fixed