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

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168 Screening for Colorectal Cancer: Appendices KCE reports vol.45 Nr Title Issued by Type 11 American Cancer Society guidelines on screening and surveillance for the early detection of adenomatous polyps and colorectal cancer - update 2004 56. 12 Colorectal cancer screening and surveillance: clinical guidelines and rationale - update based on new evidence 55. American Cancer Society (ACS) U.S. Multisociety Task Force on Colorectal Cancer (AGA/ASGE/ACP/A CG) Target population CPG Average risk patients 50 y. CPG Average risk patients 50 y. and otherwise asymptomatic Screening methods / options considered combined 4. Colonoscopy 5. DCBE 1. FOBT 2. FS 3. FOBT and FS 4. Double Contrast Barium Enema (DCBE) 5. Colonoscopy 1. FOBT 2. FS 3. FOBT and FS 4. Colonoscopy 5. Double Contrast Barium Enema (DCBE) Interval annually/every 5 years Colonoscopy: every 10 years DCBE (acceptable modality, but not recommended): every 5 years 1. FOBT: annually 2. FS: every 5 years 3. FOBT and FS: annual FOBT and FS every 5 years 4. DCBE: every 5 years 5. Colonoscopy: every 10 years 1. FOBT: annually 2. FS: every 5 years 3. FOBT and FS: annual FOBT and FS every 5 years 4. Colonoscopy: every 10 years 5. DCBE: every 5 years Supporting evidence classes & quality rating B Colonoscopy: Grade B DCBE: Grade B The type of evidence is not specifically stated for each recommendation Evidence given but not explicitly rated Rating system trials B. Controlled trials, no randomizatio n C. Observation al trials D. Opinion of expert panel Conclusions Colonoscopy every 10 years DCBE: acceptable modality, but not recommended None The following options are acceptable choices for colorectal cancer screening in average-risk adults: FOBT, FS, FOBT + FS, DCBE, colonoscopy. Since each of the following tests has inherent characteristics related to accuracy, prevention potential, costs, and risks, individuals should have an opportunity to make an informed decision when choosing a screening test. None Men and women at average risk should be offered screening with one of the following options beginning at age 50 years. The rationale for presenting multiple options is that no single test is of unequivocal superiority and that giving patients a choice allows them to apply personal preferences and may increase the likelihood that screening will occur. The strategies are not equal with regard to evidence of effectiveness, magnitude of effectiveness, risk, or up-front costs. FOBT: yearly screening using a guaiac-based test with dietary restriction or an immunochemical test without dietary restriction. Two samples from each of 3 consecutive stools should be examined without rehydration. Patients with a positive test on any specimen should be followed up with colonoscopy. FS: every 5 years. Combined FOBT and FS: FOBT every year combined with FS every 5 years. When both tests are performed, the FOBT should be done first. Colonoscopy: every 10 years. Grades of recommendati on B Colonoscopy: Grade B DCBE: Grade B Not included Not included
KCE reports vol.45 Screening for Colorectal Cancer: Appendices 169 Nr Title Issued by Type 13 Preventive health care, 2001 update: colorectal cancer screening 28. 14 Guidelines for the Prevention, Early Detection and Management of Colorectal Cancer 50 Canadian Task Force on Preventive Health Care (CTFPHC) Australian Cancer Network Colorectal Cancer Guidelines Revision Target population CPG Asymptomatic patients 50 y. old with no other risk factors CPG Asymptomatic patients 50 y. old with no other risk factors Screening methods / options considered 1. FOBT 2. FS 3. FOBT + FS 4. Colonoscopy FOBT + colonoscopy for the follow-up of test positive cases Interval Supporting evidence classes & quality rating Not stated 1. Level I 2. Levels II-2 & III 3. Level I 4. Level II-3 Not stated Level I Rating system See Appendix 2 (CTSPHCgrading) See Appendix 2 (NHMRCgrading) Conclusions DCBE: every 5 years. 1. Screening with FOBT (Hemoccult): There is good evidence to include screening with Hemoccult test in the periodic health examination of asymptomatic patients over age 50 with no other risk factors. However, there remain concerns about the high rate of falsepositive results, feasibility and small clinical benefit of such screening. The number needed to screen for 10 years to avert 1 death from colorectal cancer is 1173. For patients being screened with Hemoccult, it is recommended that they avoid red meat, cantaloupe and melons, raw turnips, radishes, broccoli and cauliflower, vitamin C supplements and aspirin and nonsteroidal anti-inflammatory drugs for 3 days before fecal samples are collected. However, a recent meta-analysis of 4 randomized controlled trials found no improvement in positivity rates or change in compliance rates with moderate dietary restrictions. 2. Screening with sigmoidoscopy or a combination of FOBT and FS. 3. There is insufficient evidence to include or exclude colonoscopy as an initial screening in periodic health examination. Although colonoscopy is the best method for detecting adenomas and carcinomas, it may not be feasible to screen asymptomatic patients because of patient compliance and the expertise and equipment required and the potential costs. On the other hand, if colonoscopy were an effective screening strategy when performed at less frequent intervals, these issues might be of less concern. 1. Organised screening with FOBT, performed at least once every two years, is recommended for the Australian population over 50 years of age. 2. Given the uncertainties relating to the most Grades of recommendati on 1. FOBT: Grade A 2. FS: Grade B 3. FOBT + FS: Grade C 4. Colonoscopy: Grade C FOBT strongly recommended
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