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 2013-03

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.


Nota bibliográfica cribado c colorrectal 2013-02

Adler A, Wegscheider K, Lieberman D, Aminalai A, Aschenbeck J, Drossel R, et al. Factors determining the quality of screening colonoscopy: a prospective study on adenoma detection rates, from 12 134 examinations (Berlin colonoscopy project 3, BECOP-3). Gut 2013 February 01;62(2):236-241. DOI:10.1136/gutjnl-2011-300167.

Conclusions The outcome quality of screening colonoscopies is mainly influenced by individual colonoscopist factors (ie, CME activities) and instrument quality.


Nota bibliográfica cribado c colorrectal 2013-01

van Dam L, Kuipers EJ, Steyerberg EW, van Leerdam ME, de Beaufort ID. The price of autonomy: should we offer individuals a choice of colorectal cancer screening strategies? The Lancet Oncology 2013 1;14(1):e38-e46. DOI:10.1016/S1470-2045(12)70455-2.

Summary A difference between colorectal cancer screening and screening for most other types of cancer is that various screening methods are available. A choice between screening methods is common in the USA. Most European programmes currently offer a single screening method, since it is recommended that only screening strategies with sufficient evidence for a reduction in colorectal cancer mortality are introduced. Faecal occult blood testing is widely accepted in Europe, and evidence on the effectiveness of flexible sigmoidoscopy is increasing. The availability of multiple effective screening options warrants deliberation on whether individuals should be given a choice between strategies. In this Personal View, we present arguments in favour and against offering a choice of screening strategies, together with the evidence substantiating these views. We also focus on screening invitees' autonomy, which is a crucial parameter in the debate.

Martinez ME, Thompson P, Messer K, Ashbeck EL, Lieberman DA, Baron JA, et al. One-year risk for advanced colorectal neoplasia: u.s. Versus u.k. Risk-stratification guidelines. Ann Intern Med 2012 Dec 18;157(12):856-864. DOI:10.7326/0003-4819-157-12-201212180-00005; 10.7326/0003-4819-157-12-201212180-00005. PMID:23247939.

CONCLUSION: Application of the U.K. guidelines in the United States could identify a subset of high-risk patients who may warrant a 1-year clearing colonoscopy without substantially increasing rates of colonoscopy. PRIMARY FUNDING SOURCE: European Union Public Health Programme.

Parente F, Boemo C, Ardizzoia A, Costa M, Carzaniga P, Ilardo A, et al. Outcomes and cost evaluation of the first two rounds of a colorectal cancer screening program based on immunochemical fecal occult blood test in northern Italy. Endoscopy 2013 Jan;45(1):27-34. DOI:10.1055/s-0032-1325800; 10.1055/s-0032-1325800. PMID:23254404.

Conclusions: Compliance and diagnostic yield of i-FOBT screening were satisfactory. Most detected cancers were at a very early stage. Program costs were reasonable and did not increase with repeat screening. Screening could contribute to decreasing the cost of CRC care by improving the stage at diagnosis.

European Colorectal Cancer Screening Guidelines Working Group:. European guidelines for quality assurance in colorectal cancer screening and diagnosis: Overview and introduction to the full Supplement publication. Endoscopy 2013 Jan;45(1):51-59. DOI:10.1055/s-0032-1325997. PMID:23212726.

The editors have prepared the present overview to inform readers of the comprehensive scope and content of the guidelines.

Hassan C, Pickhardt PJ. Cost-effectiveness of CT colonography. Radiol Clin North Am 2013 Jan;51(1):89-97. DOI:10.1016/j.rcl.2012.09.006; 10.1016/j.rcl.2012.09.006. PMID:23182509.

Simulation modeling is extensively applied to CT colonography (CTC) to define its long-term efficacy and cost-effectiveness for colorectal cancer (CRC) screening. CTC is effective in reducing CRC incidence and mortality (40%-77% and 58%-84%, respectively). Several factors may explain this variability. CTC is cost-effective compared with no screening, indicating that it represents an attractive test noncompliance with the available options. CTC needs to achieve a higher attendance rate or cost less than colonoscopy to be cost-effective relative to colonoscopy. Fortunately, both conditions appear to be achievable if CTC becomes a widely utilized and reimbursed screening tool.


Nota bibliográfica cribado c colorrectal 2012-12

Waller J, Macedo A, von Wagner C, Simon AE, Jones C, Hammersley V, et al. Communication about colorectal cancer screening in Britain: public preferences for an expert recommendation. Br J Cancer 2012 Dec 4;107(12):1938-1943.
DOI:10.1038/bjc.2012.512; PMID:23175148. PMCID:PMC3516693.

Conclusion:Most British adults want full information on risks and benefits of screening but they also want a recommendation from an authoritative source. An 'expert' view may be an important part of autonomous health decision-making.

Elmunzer BJ, Hayward RA, Schoenfeld PS, Saini SD, Deshpande A, Waljee AK. Effect of Flexible Sigmoidoscopy-Based Screening on Incidence and Mortality of Colorectal Cancer: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. PLoS Med 2012 12/04;9(12):e1001352.

A systematic review and meta-analysis of randomized trials conducted by B. Joseph Elmunzer and colleagues reports that that flexible sigmoidoscopy-based screening reduces the incidence of colorectal cancer in average-risk patients, as compared to usual care or no screening.

European Colorectal Cancer Screening Guidelines,Working Group. European guidelines for quality assurance in colorectal cancer screening and diagnosis: Overview and introduction to the full Supplement publication. Endoscopy 2012;45:51-59.
 DOI:10.1055/s-0032-1325997. PMID:23212726. Enlace:


Nota bibliográfica cribado c colorrectal 2012-11

Knudsen AB, Hur C, Gazelle GS, Schrag D, McFarland EG, Kuntz KM. Rescreening of Persons With a Negative Colonoscopy Result: Results From a Microsimulation Model. Ann Intern Med 2012 11/06;157(9):611-620. Enlace:

Conclusion: Compared with the currently recommended strategy of continuing colonoscopy every 10 years after an initial negative examination, rescreening at age 60 years with annual HSFOBT, annual FIT, or CTC every 5 years provides approximately the same benefit in life-years with fewer complications at a lower cost. Therefore, it is reasonable to use other methods to rescreen persons with negative colonoscopy results.Primary Funding Source: National Cancer Institute.

Kershenbaum A, Flugelman A, Lejbkowicz F, Arad H, Rennert G. Excellent performance of Hemoccult Sensa in organised colorectal cancer screening. Eur J Cancer 2012 Oct 22 DOI:10.1016/j.ejca.2012.09.020; 10.1016/j.ejca.2012.09.020. PMID:23099005.

RESULTS: During an 18month period (July 2007-December 2008) 382,792 FOBT tests (in 325,851 people) were performed by the target population, of them 85% Jews and 15% Arabs. Seven hundred and eighteen colorectal cancers and 2652 adenomas were detected. The overall test positivity rate in repeatedly-tested people was 4.2%. The overall detection rate of colorectal cancer in the subsequent tests was 1.7/1000 reflecting 91% of the expected period-incidenc.

Haug U, Knudsen AB, Kuntz KM. How should individuals with a false-positive fecal occult blood test for colorectal cancer be managed? A decision analysis. Int J Cancer 2012 Nov 1;131(9):2094-2102. DOI:10.1002/ijc.27463; 10.1002/ijc.27463. PMID:22307927.

In conclusion, the ContinueFOBT_long strategy was advantageous regarding both clinical benefit and required resources. Specifying an appropriate management strategy for individuals with a prior fpFOBT may substantially reduce required resources within a FOBT-based CRC screening program without limiting its effectiveness.Nota bilbiogràfica


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