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

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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
KCE reports vol.45 Screening for Colorectal Cancer: Appendices 133 amount per package of realised test and for the transmission of the information mentioned above. The central administration assures the education of GPs, they coordinate the management of the invitations and they register the follow-up of the screened individuals. They gather all the information that is necessary for the evaluation at the national level and they transfer the data to the Institut de Veille Sanitaire 551 that is charged with the evaluation of the screening program at the national level. In order to guarantee a rigorous organisation of the screening program several quality indicators have been set. There are some requirements in order to be recognised as a central laboratory: Personnel that is adequately educated to interpret FOBT Performing an internal quality control Interpreting the tests following certain modalities (for instance double, simultaneous interpretation by 2 qualified laboratory technicians) Guaranteeing that results are sent at last 2 working days after the reception: o Having obtained the permission of the post office to store and send the samples o Having obtained a convention with health insurance and the structure de gestion GP s receive specific colorectal cancer screening training. Those who don t participate to the education program are excluded from the screenings program. 7.7.2 Groups at increased or high risk 5 groups of persons are excluded from the screening program: 7.8 UK 7.8.1 Average risk groups Persons having had a recent digestive symptomatology should have a coloscopic or other examination offered Persons having had a normal colonoscopy less than 5 years ago Persons with a history of colorectal cancer or colorectal polyps and that are following a endoscopical control program Persons having a parent with colorectal cancer before the age of 65 or having two parents with colorectal cancer. A screening by colonoscopy from the age of 45 (or 5 years prior to age of diagnosis in index case) is recommended In case of severe extra-intestinal disease (ethical motive) or if screening is not indicated at that moment (for example in case of depression: ethical and efficacy motive) Several pilot projects 552, 553 have preceeded the national Bowel Cancer Screening Program 554 that was scheduled to start in april 2006 and to be rolled-
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