Report in English with a Dutch summary (KCE reports 45A)
Report in English with a Dutch summary (KCE reports 45A)
Report in English with a Dutch summary (KCE reports 45A)
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<strong>KCE</strong> <strong>reports</strong> vol.45 Screen<strong>in</strong>g for Colorectal Cancer: Appendices 165<br />
Nr Title Issued by Type<br />
4 Screen<strong>in</strong>g for colorectal<br />
cancer: recommendations<br />
and rationale 182.<br />
5 Recommendations on cancer<br />
screen<strong>in</strong>g <strong>in</strong> the European<br />
Union 179.<br />
U.S. Preventive<br />
Services Task Force<br />
(USPSTF)<br />
EU Advisory<br />
Committee on<br />
Cancer Prevention<br />
(ACPG)<br />
Target<br />
population<br />
CPG Men and women <br />
50 y. old<br />
HC/PR Men and women<br />
aged 50 to<br />
approximately 74 y.<br />
Screen<strong>in</strong>g<br />
methods /<br />
options<br />
considered<br />
1. home FOBT<br />
2. FS<br />
3. home FOBT +<br />
FS<br />
4. Colonoscopy<br />
FOBT screen<strong>in</strong>g<br />
test +<br />
colonoscopy for<br />
the follow-up of<br />
test positive cases<br />
Interval<br />
1. FOBT yearly<br />
2. FS every 5 y.<br />
3. home FOBT +<br />
FS<br />
4. Colonoscopy<br />
every 10 y.<br />
annually or<br />
biennially<br />
Support<strong>in</strong>g<br />
evidence classes<br />
& quality rat<strong>in</strong>g<br />
1. FOBT: Direct<br />
evidence, Level I,<br />
<strong>in</strong>ternal validity<br />
good, external<br />
validity good<br />
2. FS: Direct<br />
evidence, Level II,<br />
<strong>in</strong>ternal validity<br />
good, external<br />
validity fair<br />
3. FOBT and FS:<br />
Direct evidence<br />
not sure, Level II,<br />
<strong>in</strong>ternal validity<br />
fair, external<br />
validity fair<br />
4. BCBE: No<br />
direct evidence,<br />
Level III, <strong>in</strong>ternal<br />
validity fair,<br />
external validity<br />
fair<br />
5. Colonoscopy:<br />
Direct evidence<br />
not sure, Level II,<br />
<strong>in</strong>ternal validity<br />
fair, external<br />
validity fair<br />
Evidence<br />
discussed but not<br />
rated<br />
Rat<strong>in</strong>g<br />
system<br />
See<br />
Appendix 2<br />
(UPSTF)<br />
Conclusions<br />
The USPSTF strongly recommends that cl<strong>in</strong>icians<br />
screen men and women aged 50 and older who<br />
are at average risk for colorectal cancer. For<br />
those at higher risk, such as those <strong>with</strong> a firstdegree<br />
relative diagnosed <strong>with</strong> colorectal cancer<br />
before age 60, it is reasonable to beg<strong>in</strong> screen<strong>in</strong>g<br />
at a younger age. Screen<strong>in</strong>g options for colorectal<br />
cancer <strong>in</strong>clude home fecal occult blood test<br />
(FOBT), FS, the comb<strong>in</strong>ation of home FOBT and<br />
FS, colonoscopy, and double-contrast barium<br />
enema. The choice of screen<strong>in</strong>g strategy should<br />
be based on patient preferences, medical<br />
contra<strong>in</strong>dications, patient adherence, and<br />
resources for test<strong>in</strong>g and follow-up<br />
There are <strong>in</strong>sufficient data to determ<strong>in</strong>e which<br />
particular screen<strong>in</strong>g strategy is best <strong>in</strong> terms of<br />
the balance of benefits and harms or costeffectiveness.<br />
Studies reviewed by the USPSTF<br />
<strong>in</strong>dicate that colorectal cancer screen<strong>in</strong>g is likely<br />
to be cost effective (cost<strong>in</strong>g less than $30,000 per<br />
additional year of life ga<strong>in</strong>ed) regardless of which<br />
screen<strong>in</strong>g method is used.<br />
None As colorectal cancer is a major health problem <strong>in</strong><br />
many European countries fecal occult blood<br />
screen<strong>in</strong>g should be seriously considered as a<br />
preventive measure. The decision on whether or<br />
not to embark on these screen<strong>in</strong>g programs must<br />
depend on the availability of the professional<br />
expertise and the priority sett<strong>in</strong>g for healthcare<br />
resources. If screen<strong>in</strong>g programs are<br />
implemented they should use the fecal occult<br />
blood screen<strong>in</strong>g test and colonoscopy should be<br />
used for the follow-up of test positive cases.<br />
Screen<strong>in</strong>g should be offered to men and women<br />
aged 50 years to approximately 74 years. The<br />
screen<strong>in</strong>g <strong>in</strong>terval should be 1 or 2 years. Other<br />
screen<strong>in</strong>g methods such as immunological tests,<br />
FS and colonoscopy can at present not be<br />
recommended for population screen<strong>in</strong>g.<br />
Grades of<br />
recommendati<br />
on<br />
Grade A<br />
No grad<strong>in</strong>g<br />
(HC/PR)