Colorectal Cancer Screening by Colonoscopy, CT-Colonography, or Fecal Immunochemical Test
Mené en Italie auprès de 16 087 personnes invitées par courrier à participer à un programme de dépistage du cancer colorectal (âge : 54 à 65 ans), cet essai compare, du point de vue du taux de participation puis du taux de détection d'un adénome avancé et d'un cancer colorectal, l'efficacité de quatre méthodes de dépistage (test immunochimique fécal ; purge partielle ou complète de l'intestin puis colographie par tomodensitométrie ; coloscopie)
Colorectal cancer (CRC) screening is nowadays implemented in more than 50 countries worldwide. These screening programs differ according to the screening methods and the level of organization, from opportunistic to organized population screening. Imaging of the colon by colonoscopy, and ct-colonography (CTC) as first alternative, is the primary screening method in the United States as well as in several European countries such as Germany and Poland. Many other countries, in particular those with organized call-recall population screening, prefer a noninvasive stool test for primary screening. Testing for occult blood in feces was developed a century ago by Ismar Boas in Berlin, among others. He and his contemporaries did not aim to identify patients with colorectal cancer, a rare disease at that time. They instead used it for patients with peptic ulcer and gastric cancer, by far the most common malignancy then. In the present day, guaiac fecal occult blood testing is rapidly replaced by fecal immunochemical testing (FIT). This is related to easier handling, higher participation, higher sensitivity for advanced adenomas as well as cancer, automatic processing, and yield of quantitative results. The latter allows adjusting the cut-off to match available colonoscopy resources.
The international differences in CRC screening illustrate that there is no optimal…
Journal of the National Cancer Institute , éditorial en libre accès, 2016