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

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160 Screening for Colorectal Cancer: Appendices KCE reports vol.45 with the stakeholders. This decision should also address organizational issues including quality control and setting up a screening registry, the scope of the screening such as age groups to be included, target goals such as minimal participation and compliance rates, the timeframe for full implementation (presumably within two to four years, allowing the pilot projects to deliver the necessary information), and the funding of CRC screening. Additionally, a clear clinical pathway for individuals at increased CRC risk should be designed and communicated to the population and to clinicians, GPs as well as gastroenterologists and gastroenterologic surgeons to ensure that individuals who are outside the scope of the mass screening program will adequately be referred to standard care conforming to the existing guidelines. Together with this process, a screening management organization should be defined and implemented, preferably not only for CRC screening but conjointly for different mass screening programs, and international (European) cooperation might be considered. This screening management organization should also take care of the indispensable quality assurance and organize the most cost-efficient way to deliver FOBT screening. Whether this screening management organization would be located at the federal or at the community level is a political decision. To address the uncertainties surrounding the implementation of a FOBT based screening program we recommend the implementation of a few pilot screening programs. We estimate that these pilot programs should run for two to four years with intermediate evaluations. Those pilot programs should address and test the design of the program, the organisation and implementation of a screening registry, negotiations with suppliers on the price of test kits to be used in a screening program, and the colonoscopy capacity as well as quality assurance. The pilot programs should also specifically address the following uncertainty issues: participation rates, compliance and acceptance of the screening program in Belgium, prevalence of increased CRC risk, positivity rates and sensitivityspecificity of FOBT in real world circumstances, CRC and adenoma detection rates by colonoscopy after positive FOBT, and harms caused by the screening program. Moreover, these pilot programs should assess the feasibility of both the GP system and/or the mailing system in the Belgian context, and the impact of this choice on participation rates in the screening program. Optionally the performance of iFOBT compared to gFOBT could be tested in selected areas. Based on the results of the pilot projects either the initial goals of the mass screening program might have to be adapted (e.g. concerning participation) or the program might have to be redefined (e.g. a call-centre is needed to increase efficiency of the program). Re-evaluation of the organizational and financing issues might be necessary as a consequence of such decisions.
KCE reports vol.45 Screening for Colorectal Cancer: Appendices 161 10 APPENDICES APPENDIX FOR CHAPTER 3 MEDLINE SEARCH FOR CRC RISK STRATIFICATION Medline search (October, 31st 2006) on risk estimations in increased groups with familial CRC history # Search History Results 1 colorectal cancer.mp. 29.497 2 family history.mp. 25.178 3 relative risk.mp. 29.428 4 absolute risk.mp. 1.561 5 lifetime risk.mp. 1.163 6 3 or 4 or 5 31.551 7 1 and 2 and 6 73 8 limit 7 to yr="2000 - 2006" 35 9 from 8 keep: 16
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