programas cribado cancer


Nota Bibliográfica

Esta Nota es una recopilación de publicaciones (artículos, informes, libros) sobre cribado de cáncer resultado de una revisión no sistemática de la literatura.

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Josep A Espinás. Pla Director d'Oncología de Catalunya.
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Nota bibliográfica cribado c colorrectal 2013-09

Lo SH, Waller J, Wardle J, von Wagner C. Comparing barriers to colorectal cancer screening with barriers to breast and cervical screening: a population-based survey of screening-age women in Great Britain. J Med Screen. 2013;20(2):73–9. Available from: doi: 10.1177/0969141313492508.
Conclusion This was the first study to compare barriers to participation in organised screening programmes for CRC, breast and cervical cancer. Cancer screening tests share many barriers, but dislike of the test appears to be a stronger barrier to CRC screening. Women who are non-participants in more than one programme may have more global barriers to screening, such as cancer fatalism. The findings suggest that uptake of CRC screening could be improved by targeting the unpleasantness of stool sampling.

Ferrat E, Le Breton J, Veerabudun K, Bercier S, Brixi Z, Khoshnood B, et al. Colorectal cancer screening: factors associated with colonoscopy after a positive faecal occult blood test. Br J Cancer.; 2013; doi: 10.1038/bjc.2013.476; 10.1038/bjc.2013.476.
Conclusion:Socio-economic factors, GP-related factors, and history of previous FOBT influenced colonoscopy uptake after a positive FOBT. Interventions should target GPs and individuals performing their first screening FOBT and/or living in socio-economically deprived areas.British Journal of Cancer advance online publication. 29 August 2013; doi:10.1038/bjc.2013.476

Shaukat A, Mongin SJ, Geisser MS, Lederle FA, Bond JH, Mandel JS, et al. Long-term mortality after screening for colorectal cancer. N Engl J Med. 2013;369(12):1106–14. Available from: doi: 10.1056/NEJMoa1300720. PMID: 24047060.
CONCLUSIONS: The effect of screening with fecal occult-blood testing on colorectal-cancer mortality persists after 30 years but does not influence all-cause mortality. The sustained reduction in colorectal-cancer mortality supports the effect of polypectomy. (Funded by the Veterans Affairs Merit Review Award Program and others.).

Levin TR, Corley DA. Colorectal-cancer screening--coming of age. N Engl J Med. 2013;369(12):1164–6. Available from: doi: 10.1056/NEJMe1308253. PMID: 24047066.

Holme O, Bretthauer M, Fretheim A, Odgaard-Jensen J, Hoff G. Flexible sigmoidoscopy versus faecal occult blood testing for colorectal cancer screening in asymptomatic individuals. Cochrane database Syst Rev.2013;9:CD009259. doi: 10.1002/14651858.CD009259.pub2.
RESULTS: We identified nine studies comprising 338,467 individuals randomised to screening and 405,919 individuals to the control groups. Five studies compared flexible sigmoidoscopy to no screening and four studies compared repetitive guaiac-based FOBT (annually and biennially) to no screening. We did not consider that study risk of bias reduced our confidence in our results. We did not identify any studies comparing the two screening methods directly. When compared with no screening, colorectal cancer mortality was lower with flexible sigmoidoscopy (relative risk 0.72; 95% CI 0.65 to 0.79, high quality evidence) and FOBT (relative risk 0.86; 95% CI 0.80 to 0.92, high quality evidence). In the …

Wise J. Bowel screening has long term benefits, research shows. BMJ. 2013;347:f5773. Available from: PMID: 24062190


Nota bibliográfica cribado c colorrectal 2013-07/08

Ladabaum U, Allen J, Wandell M, Ramsey SD. Colorectal Cancer Screening with Blood-Based Biomarkers: Cost-Effectiveness of Methylated Septin 9 DNA vs. Current Strategies. Cancer Epidemiol Biomarkers Prev 2013 Jun 24 DOI:10.1158/1055-9965.EPI-13-0204. PMID:23796793.

Conclusions: mSEPT9 appears to be effective and cost-effective compared with no screening. In order to be cost-effective compared with established strategies, mSEPT9 or blood-based biomarkers with similar test performance characteristics would need to achieve substantially higher uptake and adherence rates than the alternatives. It remains to be proven whether CRC screening with a blood test can improve screening uptake or long-term adherence compared with established strategies. Impact: Our study offer insights into the potential role of CRC screening with blood-based biomarkers.

Pickhardt PJ, Kim DH, Pooler BD, Hinshaw JL, Barlow D, Jensen D, et al. Assessment of volumetric growth rates of small colorectal polyps with CT colonography: a longitudinal study of natural history. The Lancet Oncology 2013 7;14(8):711-720. DOI:

Interpretation Volumetric growth assessment of small colorectal polyps could be a useful biomarker for determination of clinical importance. Advanced adenomas show more rapid growth than non-advanced adenomas, whereas most other small polyps remain stable or regress. Our findings might allow for less invasive surveillance strategies, reserving polypectomy for lesions that show substantial growth. Further research is needed to provide more information regarding the ultimate fate of unresected small polyps without significant growth. Funding.

Hubbard RA, Johnson E, Hsia R, Rutter CM. The cumulative risk of false-positive fecal occult blood test after 10 years of colorectal cancer screening. Cancer Epidemiology Biomarkers & Prevention 2013 July 18 DOI:10.1158/1055-9965.EPI-13-0254.

Conclusions: Most patients participating in annual FOBT screening over 10 years will not have a positive result, reinforcing the potential value of this regimen as a non-invasive alternative to colonoscopy. Impact: Annual stool-based screening is a screening alternative resulting in substantially fewer colonoscopies than once per decade colonoscopy.

Portillo I, Idígoras I, Ojembarrena E, Arana-Arri E, Zubero MB, Pijoán JI, et al. Principales resultados del programa de cribado de cáncer colorrectal en el País Vasco. Gaceta Sanitaria 2013 0;27(4):358-361. DOI:

ResumenObjetivo Describir la estrategia del Programa de Cribado de Cáncer Colorrectal en el País Vasco y los principales resultados de participación en la primera ronda (2009-2011). Método Estudio retrospectivo de las invitaciones realizadas en 2009-2011 y comparación de las tasas de participación y positividad de la prueba de sangre oculta en heces por sexo y grupos de edad. Resultados Se obtuvieron 235.371 invitaciones válidas (personas correctamente localizadas), con una participación media del 64,3% (intervalo de confianza del 95% [IC95%]: 64,1-64,5) y con diferencias significativas (p entre mujeres (67,1%; IC95%: 66,9-67,4) y hombres (61,4%; IC95%: 61,1-61,7). El porcentaje de positivos fue superior (p IC95%: 8,9-9,2) que en las mujeres (4,8%; IC95%: 4,7-4,9). Conclusiones Las tasas de participación en el programa se consideraron adecuadas en comparación con los estudios revisados. Estas tasas podrían estar relacionadas con la estrategia de invitación y con factores culturales y sociales. Objective To describe the procedures of the colorectal cancer screening program in the Basque Country (Spain), and the main results of the first rounds in 2009-2011. Method We carried out a retrospective study of invitations to attend screening between 2009 and 2011. Participation rates and the number of positive results of the fecal occult blood test (FOBT) were analyzed by sex and age group. Results There were 235.371 valid invitations (sent to the correct addresses), with an average participation rate of 64.3% (95%CI: 64.1-64.5%). Significant differences were found (p FOBT results was higher (p 

GISCoR Working Group “Interval cancers and sensitivity estimate”. Detection of the interval cancers and estimate of the sensitivity of colorectal cancer screening programmes. Epidemiol Prev 2013(2-3 suppl).


Nota bibliográfica cribado c colorrectal 2013-05

Brenner H, Altenhofen L, Stock C, Hoffmeister M. Natural history of colorectal adenomas: Birth cohort analysis among 3.6 million participants of screening colonoscopy. Cancer Epidemiology Biomarkers & Prevention 2013 April 30 DOI:10.1158/1055-9965.EPI-13-0162.

Conclusions: Despite low annual transition rates, cumulative transition rates from advanced adenoma to CRC carriage are expected to exceed 60%, 50% and 40% for age intervals 55-80, 65-80 and 70-80 years, respectively, in both sexes. Cumulative transition rates from non-advanced adenoma to CRC carriage are expected to be close to 30% for age interval 55-80, but less than 2% for age interval 75-80. Impact: Our results enhance the empirical basis for modelling CRC screening strategies.

Senore C, Ederle A, Benazzato L, Arrigoni A, Silvani M, Fantin A, et al. Offering people a choice for colorectal cancer screening. Gut 2013 May;62(5):735-740. DOI:10.1136/gutjnl-2011-301013; 10.1136/gutjnl-2011-301013. PMID:22442162.

CONCLUSIONS: A strategy involving the sequential offer of FS and FIT is a feasible and efficient approach. FIT in people not attending for FS increases screening uptake and detection of advanced adenomas and CRCs.

Castells A, Bessa X, Quintero E, Bujanda L, Cubiella J, Salas D, et al. Risk of Advanced Proximal Neoplasms According to Distal Colorectal Findings: Comparison of Sigmoidoscopy-Based Strategies. Journal of the National Cancer Institute 2013 May 24  DOI:10.1093/jnci/djt117.
Conclusions Whereas the NORCCAP criteria achieved the highest sensitivity for APN detection, the UK recommendations benefited from the lowest number of individuals needed to refer for colonoscopy.

Imperiale TF. Sigmoidoscopy Screening: Understanding the Trade-off Between Detection of Advanced Neoplasia and Diagnostic Efficiency. (editorial). Journal of the National Cancer Institute 2013 May 24 DOI:10.1093/jnci/djt132.

Digby J, Fraser CG, Carey FA, McDonald PJ, Strachan JA, Diament RH, et al. Faecal haemoglobin concentration is related to severity of colorectal neoplasia. J Clin Pathol 2013 May;66(5):415-419.
DOI:10.1136/jclinpath-2013-201445; PMID:23418340.
CONCLUSIONS: f-Hb is related to severity of colorectal neoplastic disease. This has ramifications for the selection of the appropriate cut-off concentration adopted for bowel screening programmes.


Nota bibliográfica cribado c colorrectal 2013-04

McDonald R, Tomlins A, Smith S, Harmston C. Outcomes of faecal occult blood tests requested outside the UK National Bowel Cancer Screening Programme. J Clin Pathol 2013 Apr;66(4):330-334. DOI:10.1136/jclinpath-2011-200406; 10.1136/jclinpath-2011-200406. PMID:23288919.
CONCLUSIONS: The number of FOBt requests has increased with the introduction of a colorectal cancer screening programme. The FOBt completion rate and colonic imaging rate in FOBt-positive patients outside the national screening programme was low. Guidelines for the use of FOBt outside of screening are needed.

Garborg K, Holme Ø, Løberg M, Kalager M, Adami HO, Bretthauer M. Current status of screening for colorectal cancer. Annals of Oncology 2013 April 25 DOI:10.1093/annonc/mdt157.

Conclusions FS screening reduces CRC incidence and CRC mortality by removal of adenomas; FOBT reduces CRC mortality by early detection of cancer. Several other tests are available, but none has been evaluated in randomised trials. Screening strategies differ considerably across countries.

Lin OS. Virtual colonoscopy: stamp of approval or word of warning? (Comment). The Lancet 2013 4/6–12;381(9873):1161-1163. DOI:10.1016/S0140-6736(13)60056-2.

van Dam L, Korfage IJ, Kuipers EJ, Hol L, van Roon AHC, Reijerink JCIY, et al. What influences the decision to participate in colorectal cancer screening with faecal occult blood testing and sigmoidoscopy? Eur J Cancer 2013 Abril(0) DOI:10.1016/j.ejca.2013.03.007.

Conclusion Only 12% of non-participants made an informed choice not to participate. These results imply that governments and/or organizations offering screening should focus on adequately informing and educating target populations about the harms and benefits of CRC screening. This may impact uptake of CRC screening.

Cole SR, Tucker GR, Osborne JM, Byrne SE, Bampton PA, Fraser RJ, et al. Shift to earlier stage at diagnosis as a consequence of the National Bowel Cancer Screening Program. Med J Aust 2013 Apr 1;198(6):327-330.PMID:23545032.

CONCLUSIONS: CRCs were diagnosed at a significantly earlier stage in people invited to the NBCSP compared with those who were not invited, regardless of participation status or test result. The NBCSP should lead to reductions in CRC mortality in Australia.


Nota bibliográfica cribado c colorrectal 2013-03

Green BB, Wang C, Anderson ML, Chubak J, Meenan RT, Vernon SW, et al. An Automated Intervention With Stepped Increases in Support to Increase Uptake of Colorectal Cancer ScreeningA Randomized Trial. Annals of Internal Medicine 2013 March 5;158(5_Part_1):301-311.     DOI:10.7326/0003-4819-158-5-201303050-00002.

Conclusion: Compared with usual care, a centralized, EHR-linked, mailed CRC screening program led to twice as many persons being current for screening over 2 years. Assisted and navigated interventions led to smaller but significant stepped increases compared with the automated intervention only. The rapid growth of EHRs provides opportunities for spreading this model broadly.Primary Funding Source: National Cancer Institute, National Institutes of Health.

Sharp L, Tilson L, Whyte S, Ceilleachair A, Walsh C, Usher C, et al. Using resource modelling to inform decision making and service planning: the case of colorectal cancer screening in Ireland. BMC Health Services Research 2013;13(1):105.

CONCLUSIONS: While FIT-based screening would quite quickly generate attractive health outcomes, it has heavy resource requirements. These could impact on the feasibility of a programme based on this screening modality. Staggered age-based roll-out would allow time to increase endoscopy capacity to meet programme requirements. Resource modelling of this type complements conventional cost-effectiveness analyses and can help inform policy making and service planning.


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