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

More documents

Recommendations

Info

164 Screening for Colorectal Cancer: Appendices KCE reports vol.45 Nr Title Issued by Type Statement:Colorectal Cancer Screening and Surveillance 188. 3 The Quebec Association of Gastroenterology position paper on colorectal cancer screening - 2003 181. Statements Committee of the World Gastroenterology Organisation (WGO-OMGE) Quebec Association of Gastroenterology Task Force (AGEQTF) Target population 50 y. old HC/PR Patients 50 y. old at low CRC risk and otherwise asymptomatic Screening methods / options considered 2. FS 3. FOBT & FS combined 4. Colonoscopy 5. DCBE with FS 1. FOBT 2. FS 3. Colonoscopy 4, DCBE 5. Virtual colonoscopy Interval with a sensitive guaiac or immunochemical test 2. FS every 5 years 3. FOBT & FS combined (preferably) 4. colonoscopy every 10 years 5. DCBE with FS every 5 - 10 years 1. Annually or biennially 2. 5 to 10 yearly 3. 5 to 10 yearly 4. 10 yearly 5. Not mentioned Supporting evidence classes & quality rating discussed but not rated 1. FOBT: Level I / Grade A 2. FS: II-2 / Grade B 3. Colonoscopy: Level II (diagnosis CRC/polyps & polypectomy) / Grade C for screening 4. BCBE: II-3 (diagnosis CRC/polyps) / Grade C for screening 5. Virtual colonoscopy: insufficient evidence Rating system See Appendix 2 (CTFPHC) Conclusions offered screening for adenomatous polyps and cancer with one of the follow options: Fecal occult blood testing annually with a sensitive guaiac or immunochemical test, FS every 5 years, preferably both combined, colonoscopy every 10 years, or DCBE with FS every 5 - 10 years. People with 1 or 2 first-degree relatives with colorectal cancer or an adenomatous polyp under age 60 should be offered screening beginning at age 40 with one of the above options. A family history consistent with FAP or HNPCC requires genetic counselling, possibly genetic testing and more intense surveillance at a younger age. There exists Level I evidence that screening reduces the mortality from CRC (A recommendation) and the cost effectiveness of a screening program compares favourably with initiatives for breast and cervical cancer. Fecal occult blood testing (FOBT), endoscopy (including sigmoidoscopy and colonoscopy), barium enema and virtual colonoscopy were considered. Although most clinical efficacy data are available for FOBT and sigmoidoscopy, there are limitations to programs based on these strategies. FOBT has a high false positive rate and a low detection yield, and even a combination of these strategies will miss 24% of cancers. Colonoscopy is the best strategy to both detect and remove polyps and to diagnose colorectal cancer, with double contrast barium enema also being a sensitive detection method. The Task Force recommended the establishment, in Quebec, of a screening program with 5- to 10yearly double contrast barium enema or 10yearly colonoscopy for individuals aged 50 years or older at low risk. The program should include outcome monitoring, public and professional education to increase awareness and promote compliance, and central coordination with other provincial programs. The program should be evaluated; specific billing codes for screening for colorectal cancer would help facilitate this. Formal feasibility, effectiveness and costeffectiveness studies in Quebec are now warranted. Grades of recommendati on Recommendation A on a screening program for CRC
KCE reports vol.45 Screening for Colorectal Cancer: Appendices 165 Nr Title Issued by Type 4 Screening for colorectal cancer: recommendations and rationale 182. 5 Recommendations on cancer screening in the European Union 179. U.S. Preventive Services Task Force (USPSTF) EU Advisory Committee on Cancer Prevention (ACPG) Target population CPG Men and women 50 y. old HC/PR Men and women aged 50 to approximately 74 y. Screening methods / options considered 1. home FOBT 2. FS 3. home FOBT + FS 4. Colonoscopy FOBT screening test + colonoscopy for the follow-up of test positive cases Interval 1. FOBT yearly 2. FS every 5 y. 3. home FOBT + FS 4. Colonoscopy every 10 y. annually or biennially Supporting evidence classes & quality rating 1. FOBT: Direct evidence, Level I, internal validity good, external validity good 2. FS: Direct evidence, Level II, internal validity good, external validity fair 3. FOBT and FS: Direct evidence not sure, Level II, internal validity fair, external validity fair 4. BCBE: No direct evidence, Level III, internal validity fair, external validity fair 5. Colonoscopy: Direct evidence not sure, Level II, internal validity fair, external validity fair Evidence discussed but not rated Rating system See Appendix 2 (UPSTF) Conclusions The USPSTF strongly recommends that clinicians screen men and women aged 50 and older who are at average risk for colorectal cancer. For those at higher risk, such as those with a firstdegree relative diagnosed with colorectal cancer before age 60, it is reasonable to begin screening at a younger age. Screening options for colorectal cancer include home fecal occult blood test (FOBT), FS, the combination of home FOBT and FS, colonoscopy, and double-contrast barium enema. The choice of screening strategy should be based on patient preferences, medical contraindications, patient adherence, and resources for testing and follow-up There are insufficient data to determine which particular screening strategy is best in terms of the balance of benefits and harms or costeffectiveness. Studies reviewed by the USPSTF indicate that colorectal cancer screening is likely to be cost effective (costing less than $30,000 per additional year of life gained) regardless of which screening method is used. None As colorectal cancer is a major health problem in many European countries fecal occult blood screening should be seriously considered as a preventive measure. The decision on whether or not to embark on these screening programs must depend on the availability of the professional expertise and the priority setting for healthcare resources. If screening programs are implemented they should use the fecal occult blood screening test and colonoscopy should be used for the follow-up of test positive cases. Screening should be offered to men and women aged 50 years to approximately 74 years. The screening interval should be 1 or 2 years. Other screening methods such as immunological tests, FS and colonoscopy can at present not be recommended for population screening. Grades of recommendati on Grade A No grading (HC/PR)
Page 1 and 2:
Health Technology Assessment Colore
Page 3 and 4:
Health Technology Assessment Colore
Page 5 and 6:
KCE reports vol.45A Colorectale Kan
Page 7 and 8:
Page 9:
Page 12 and 13:
2 Screening for Colorectal Cancer K
Page 14 and 15:
Page 16 and 17:
Page 18 and 19:
Page 20 and 21:
10 Screening for Colorectal Cancer
Page 22 and 23:
Page 24 and 25:
Page 26 and 27:
Page 28 and 29:
Page 30 and 31:
Page 32 and 33:
Page 34 and 35:
Page 36 and 37:
Page 38 and 39:
Page 40 and 41:
Page 42 and 43:
Page 44 and 45:
Page 46 and 47:
Page 48 and 49:
Page 50 and 51:
Page 52 and 53:
Page 54 and 55:
Page 56 and 57:
Page 58 and 59:
Page 60 and 61:
Page 62 and 63:
Page 64 and 65:
Page 66 and 67:
Page 68 and 69:
Page 70 and 71:
Page 72 and 73:
Page 74 and 75:
Page 76 and 77:
Page 78 and 79:
Page 80 and 81:
Page 82 and 83:
Page 84 and 85:
Page 86 and 87:
Page 88 and 89:
Page 90 and 91:
Page 92 and 93:
Page 94 and 95:
Page 96 and 97:
Page 98 and 99:
Page 100 and 101:
Page 102 and 103:
Page 104 and 105:
Page 106 and 107:
Page 108 and 109:
Page 110 and 111:
Page 112 and 113:
Page 114 and 115:
Page 116 and 117:
Page 118 and 119:
Page 120 and 121:
Page 122 and 123:
Page 124 and 125: 114 Screening for Colorectal Cancer
Page 224 and 225:
Page 226 and 227:
Page 228 and 229:
Page 230 and 231:
Page 232 and 233:
Page 234 and 235:
Page 236 and 237:
Page 238 and 239:
Page 240 and 241:
Page 242 and 243:
Page 244 and 245:
Page 246 and 247:
Page 248 and 249:
Page 250 and 251:
Page 252 and 253:
Page 254 and 255:
Page 256 and 257:
Page 259 and 260:
This page is left intentionally bla
Page 261:
KCE reports 1. Effectiviteit en kos
show all

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

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?