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

166 Screening for Colorectal Cancer: Appendices KCE reports vol.45
Nr Title Issued by Type
6 ASGE guideline: colorectal
cancer screening and
surveillance 184.
7 Colorectal Cancer
Screening 58.
8 Report on the Belgian
consensus meeting on
colorectal cancer
screening 185.
Standards of
Practice Committee
of the American
Society for
Gastrointestinal
Endoscopy (ASGE)
National
Comprehensive
Cancer Network
(NCCN)
Belgian
Gastroenterologists
community
Target
population
CPG Men and women
50 y. old
CPG Men and women
50 y. old with:
- No history of
adenoma
- No history of
inflammatory bowel
disease
- Negative family
history: not having a
first degree relative
or two second
degree relatives
with colorectal
cancer or clustering
of HNPCC related
cancers in the
family.
CPG All Belgians 50 y.
old, with exclusion
of increased risk
categories
Screening
methods /
options
considered
1. Preferred
modality:
colonoscopy
Alternatives:
2. FOBT
3. FS
4. FOBT + FS
1. Colonoscopy
(preferred)
2. FOBT+ FS
3. DCBE
Colonoscopy if 2
or 3 positive
FOBT
(Hemoccult) +
colonoscopy for
the follow-up of
test positive cases
Interval
1. colonoscopy
every 10 y
2. FOBT yearly
3. FS every 5 y
4. FOBT yearly
and FS every 5 y
1. Colonoscopy
(preferred)
2. FOBT annually
+ FS every 5 y
3. DCBE every 5 y
Supporting
evidence classes
& quality rating
Evidence
discussed but not
rated
Evidence given but
not explicitly rated
Annually Evidence given but
not explicitly rated
Rating
system
See
Appendix 2
(UPSTF)grading
See
Appendix 2
(NCCN
categories of
consensus)
Conclusions
Colonoscopy is the preferred modality for CRC
screening in average risk patients (B).
Alternative methods for CRC screening in
average-risk patients include:
- yearly FOBT (A),
- FS every 5 years or combined yearly FOBT and
FS every 5 years (B).
Single digital rectal examination FOBT (SRE-
FOBT)has a poor sensitivity for CRC and should
not be performed as a primary screening method
(A).
Studies evaluating virtual colonoscopy and fecal
DNA testing for CRC screening have yielded
conflicting results and therefore cannot be
recommended (A).
1. Colorectal cancer risk assessment in persons
without known family history is advisable by age
40 years to determine the appropriate age for
initiating screening.
2. Individuals with a negative family history for
colorectal neoplasia and associated hereditary
syndromes, and a negative personal history of
colorectal neoplasia, HNPCC associated cancers,
and inflammatory bowel disease, represent the
group at average risk for development of
colorectal cancer.
3. It is recommended that average risk screening
begin at age 50 after discussion of the available
options.
4. Currently recommended options include
annual FOBT (category 1) and FS every 5 years
using a 60 cm or longer scope, or colonoscopy
every 10 years.
5. The NCCN panellists prefer colonoscopy as a
screening modality for individuals at average risk.
6. Double-contrast barium enema every 5 years is
an alternative option.
None The results of several randomised populationbased
studies have shown that screening for
colorectal cancer by FOBT can reduce colorectal
cancer mortality. The time has come to
implement well-organised FOBT screening of the
average-risk population. In order to have a high
level of uptake this program requires a substantial
amount of initial planning and resource allocation,
including defining roles of the different health
Grades of
recommendati
on
Colonoscopy:
grade B
FOBT: grade A
FS or FOBT + FS:
grade B
Category 2A
No grading