Efficacy of a Nationwide Screening Colonoscopy Program for Colorectal Cancer
A partir de données allemandes portant sur 2 821 392 coloscopies réalisées entre 2003 et 2008 (âge des participants : 55 à 74 ans), cette étude prospective transversale évalue l'efficacité de la coloscopie pour détecter précocement un cancer colorectal et estime le taux d'effets indésirables associés
Screening colonoscopy examinations for colorectal cancer are offered in the US and some European countries. Data on results and side effects of screening colonoscopy are limited. In autumn 2002, colonoscopy was introduced as part of a nationwide cancer screening program in Germany; it was offered to the general population for individuals 55 years old or older. We collected and analyzed data from this program. We performed a prospective, cross-sectional study, collecting results from 2,821,392 screening colonoscopies, performed at more than 2100 practices, by highly-qualified endoscopists in Germany from January 2003 to December 2008. Data on participation, colorectal adenoma and cancer detection, and complications were collected using standardized documentation forms. The data generated were centrally processed and evaluated. The cumulative participation rate was 17.2% of eligible women and 15.5% of eligible men, 55–74 years old. The adenoma detection rate (ADR) was 19.4%, with a higher rate in men (25.8% vs 16.7% in women). Advanced adenomas were found in 6.4% of patients. Carcinomas were detected in 25,893 subjects (0.9%); most were of an early UICC stage (I=47.3%, II=22.3%, III=20.7%, IV=9.6%). The ADRs for gastroenterologists and non-gastroenterologists were 25.1% and 22.3%, respectively (adjusted odds ratio 1.18; 95% confidence interval 1.16–1.21). The overall complication rate was 2.8/1,000 colonoscopies, the rate of serious complications was 0.58/1,000 colonoscopies. A nationwide colonoscopy screening program that uses highly-qualified endoscopists can detect a significant number of adenomas and early-stage carcinomas. The ADR for gastroenterologists was higher than for non-gastroenterologists.
Gastroenterology , résumé, 2011