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 2014-09

Libby G, Brewster DH, Steele RJC. Impact of faecal occult blood test screening on emergency admissions and short-term outcomes for colorectal cancer. Br J Surg. 2014; Available from: doi: 10.1002/bjs.9613. PMID: 25219923.

CONCLUSION: People who participated in FOBT screening had fewer emergency admissions and a shorter LOS. Deprivation was associated negatively with participation, but the impact of FOBT participation on emergency admissions was independent of deprivation level. The reduction in LOS has potential to reduce financial costs.

Brenner H, Altenhofen L, Stock C, Hoffmeister M. Prevention, Early Detection, and Overdiagnosis of Colorectal Cancer Within 10 Years of Screening Colonoscopy in Germany. Clin Gastroenterol Hepatol. 2014; Available from: doi: 10.1016/j.cgh.2014.08.036. PMID: 25218160.

CONCLUSIONS: Based on a 10-year analysis of data from a national registry in Germany, screening colonoscopies have large potential for prevention and early detection of CRC, with low risk of overdiagnosis.

Kearns B, Whyte S, Chilcott J, Patnick J. Guaiac faecal occult blood test performance at initial and repeat screens in the English Bowel Cancer Screening Programme. Br J Cancer. 2014; Available from:

Conclusions: Performance measures for gFOBT screening were generally lower in the repeat screen compared with the initial screen. Screening for CRC using gFOBT is likely to be cost-effective; however, the use of different screening modalities may result in additional benefits. Future economic evaluations of gFOBT should not assume equal sensitivities between screening rounds.

Zorzi M, Senore C, Da Re F, Barca A, Bonelli LA, Cannizzaro R, et al. Quality of colonoscopy in an organised colorectal cancer screening programme with immunochemical faecal occult blood test: the EQuIPE study (Evaluating Quality Indicators of the Performance of Endoscopy). Gut. 2014; Available from: doi: 10.1136/gutjnl-2014-307954.

Conclusions The quality of colonoscopy was affected by patient-related, endoscopist-related and centre-related characteristics. Policies addressing organisational issues should improve the quality of colonoscopy in our programme and similar programmes.

Allison JE, Fraser CG, Halloran SP, Young GP. Population screening for colorectal cancer means getting FIT: the past, present, and future of colorectal cancer screening using the fecal immunochemical test for hemoglobin (FIT). Gut Liver. 2014;8(2):117–30. Available from: doi: 10.5009/gnl.2014.8.2.117. PMID: 24672652.

 Fecal immunochemical tests for hemoglobin (FIT) are changing the manner in which colorectal cancer (CRC) is screened. Although these tests are being performed worldwide, why is this test different from its predecessors? What evidence supports its adoption? How can this evidence best be used? This review addresses these questions and provides an understanding of FIT theory and practices to expedite international efforts to implement the use of FIT in CRC screening.

Bevan R, Rubin G, Sofianopoulou E, Patnick J, Rees CJ. Implementing a national flexible sigmoidoscopy screening program: results of the English early pilot. Endoscopy. 2014; Available from: doi: 10.1055/s-0034-1378119. PMID: 25268309.

Conclusion: Delivery of an FSIG screening program to prevent CRC is feasible and should be implemented using a simple invitation system. The national Bowel Scope program subsequently commenced at pilot sites in May 2013, with full implementation planned by 2016


Nota bibliográfica cribado c colorrectal 2014-07/08

Honein-AbouHaidar GN, Rabeneck L, Paszat LF, Sutradhar R, Tinmouth J, Baxter NN. Evaluating the impact of public health initiatives on trends in fecal occult blood test participation in Ontario.BMC Cancer. 2014;14(1):537. Available from:  doi: 10.1186/1471-2407-14-537. PMID: 25062552.

CONCLUSION: Although observed increases in FOBT participation cannot be definitively attributed to the various initiatives, the results of the two statistical approaches suggest a causal association between the observed increases in FOBT participation and most of these initiatives.

Cubiella J, Castro I, Hernandez V, Gonzalez-Mao MC, Rivera C, Iglesias F, et al. Characteristics of Adenomas Detected by Fecal Immunochemical Test in Colorectal Cancer Screening. Cancer Epidemiol Biomarkers Prev. 2014; Available from:  doi: 10.1158/1055-9965.EPI-13-1346.

CONCLUSIONS: European guidelines classification and adenoma location coORelates with the likelihood of a positive FIT result. IMPACT: This information allows us to understand the FIT impact in colorectal cancer prevention. Likewise, it should be taken into account in the development of new colorectal adenomas biomarkers.

Hoffman MD, MPH RM. In persons at average risk, stool DNA tests had higher sensitivity than FIT for detecting colorectal cancer. Ann Intern Med. Philadelphia; 2014;161(2). Available from:  

 Hoffman remarks on Imperiale et al’s study that determined whether a noninvasive, multitarget stool DNA test accurately detects colorectal cancer in persons at average risk, and how it compares with a fecal immunochemical test (FIT). The DNA tests had over twice as many abnormal results as FIT, with a higher rate of false-positive results. This means that more colonoscopies would need to be performed to detect an advanced neoplasm with DNA testing than with FIT testing. However, interpreting false-positive results is complicated because colonoscopy is an imperfect gold standard and DNA testing can detect molecular abnormalities potentially arising from extracolonic neoplasia. Further diagnostic testing could increase the costs and risks of screening. Having unexplained positive DNA test results might also be stressful to patients. DNA testing is a marvelous example of translational research, but it doesn't seem ready for prime time.

Brenner H, Altenhofen L, Stock C, Hoffmeister M. Incidence of colorectal adenomas: Birth cohort analysis among 4.3 million participants of screening colonoscopy. Cancer Epidemiol Biomarkers Prev. 2014; Available from:  doi: 10.1158/1055-9965.EPI-14-0367.

CONCLUSIONS. Annual incidence rates of colorectal adenomas are below 2.5% and 2% among men and women, respectively, and show little variation by age. IMPACT. Risk of clinically manifest colorectal cancer is expected to be very small within 10 years and beyond after negative colonoscopy for men and women at all ages. The use of re-screening after a negative screening colonoscopy above 60 years of age may be very limited.

Shah R, Jones E, Vidart V, Kuppen PJK, Conti JA, Francis NK. Biomarkers for Early Detection of Colorectal Cancer and Polyps: Systematic Review. Cancer Epidemiol Biomarkers Prev. 2014; Available from:  doi: 10.1158/1055-9965.EPI-14-0412.
Combinations of fecal and serum biomarkers produce higher sensitivities, specificities and PPVs for early detection of CRC and adenomas. Further research is required to validate these biomarkers in a well-structured population-based study.
Brett, AS. Flexible sigmoidoscopy for colorectal cancer screening: More evidence, persistent ironies. JAMA. 2014;312(6):601–2. Available from:

Holme Ø, Løberg M, Kalager M, Al E. Effect of flexible sigmoidoscopy screening on colorectal cancer incidence and mortality: A randomized clinical trial. JAMA. 2014;312(6):606–15. Available from:

There was no difference between the flexible sigmoidoscopy only vs the flexible sigmoidoscopy and FOBT screening groups.Conclusions and Relevance In Norway, once-only flexible sigmoidoscopy screening or flexible sigmoidoscopy and FOBT reduced colorectal cancer incidence…

Blom J, Kilpeläinen S, Hultcrantz R, Törnberg S. Five-year experience of organized colorectal cancer screening in a Swedish population - increased compliance with age, female gender, and subsequent screening round. J Med Screen. 2014;21(3):144–50. Available from:  doi: 10.1177/0969141314545555. PMID: 25070434.

CONCLUSION: The strong organization of the programme contributed to a high compliance rate, that increased by screening round. The lower participation rate among men and among individuals at younger ages needs further attention.

Løberg M, Kalager M, Holme Ø, Hoff G, Adami H-O, Bretthauer M. Long-Term Colorectal-Cancer Mortality after Adenoma Removal. N Engl J Med. 2014;371(9):799–807. Available from:  doi: 10.1056/NEJMoa1315870.

Levy BT, Bay C, Xu Y, Daly JM, Bergus G, Dunkelberg J, et al. Test Characteristics of Faecal Immunochemical Tests (FIT) Compared with Optical Colonoscopy. J Med Screen. 2014;21(3):133–43. Available from:  doi: 10.1177/0969141314541109.

Conclusions The sensitivity of a single-sample FIT for advanced adenomas or cancer was low. Individuals with distal adenomas had a higher odds of testing positive than those with proximal lesions or no lesions.

Kapidzic A, Grobbee EJ, Hol L, van Roon AHC, van Vuuren AJ, Spijker W, et al. Attendance and Yield Over Three Rounds of Population-Based Fecal Immunochemical Test Screening. Am J Gastroenterol. 2014;109(8):1257–64. Available from:  doi: 10.1038/ajg.2014.168.

CONCLUSIONS: Repeated biennial FIT screening is acceptable with increased participation in successive screening rounds, and >70% of all eligible subjects participating at least once over three rounds. The decline in screen-detected AN over three screening rounds is compatible with a decreased prevalence of AN as a result of repeated FIT screening. These findings provide strong evidence for the effectiveness of FIT screening and stress the importance of ongoing research over multiple screening rounds.

Clark BT, Rustagi T, Laine L. What Level of Bowel Prep Quality Requires Early Repeat Colonoscopy: Systematic Review and Meta-Analysis of the Impact of Preparation Quality on Adenoma Detection Rate. Am J Gastroenterol. 2014; Available from:  

CONCLUSIONS: ADR is not significantly different with intermediate-quality vs. high-quality bowel preparation. Our results confirm the need for early repeat colonoscopy with low-quality bowel preparation, but suggest that patients with intermediate/fair preparation quality may be followed up at standard guideline-recommended surveillance intervals without significantly affecting quality as measured by ADR.

Kaminski MF, Polkowski M, Kraszewska E, Rupinski M, Butruk E, Regula J. A score to estimate the likelihood of detecting advanced colorectal neoplasia at colonoscopy. Gut. 2014;63(7):1112–9. Available from:  doi: 10.1136/gutjnl-2013-304965. PMID: 24385598.

CONCLUSIONS: Developed and internally validated score consisting of simple clinical factors successfully estimates the likelihood of detecting advanced colorectal neoplasia in asymptomatic Caucasian patients. Once externally validated, it may be useful for counselling or designing primary prevention studies.

Wong MCS, Lam TYT, Tsoi KKF, Hirai HW, Chan VCW, Ching JYL, et al. A validated tool to predict colorectal neoplasia and inform screening choice for asymptomatic subjects. Gut. 2014;63(7):1130–6. Available from:  doi: 10.1136/gutjnl-2013-305639. PMID: 24045331.

CONCLUSIONS: The scoring system based on age, gender, smoking, family history, Body Mass Index and self-reported diabetes is useful in predicting the risk of colorectal neoplasia


Nota bibliográfica cribado c colorrectal 2014-06

Cohen-Cline H, Wernli KJ, Bradford SC, Boles-Hall M, Grossman DC. Use of interactive voice response to improve colorectal cancer screening. Med Care. 2014;52(6):496–9. Available from: doi: 10.1097/MLR.0000000000000116. PMID: 24638119.

DISCUSSION: Our analysis provides “real-world” evidence that IVR is effective when delivered by a commercial health plan, and may be a useful tool for increasing adherence to screening guidelines among patients outside an integrated care practice.

Digby J, McDonald PJ, Strachan JA, Libby G, Steele RJC, Fraser CG. Deprivation and faecal haemoglobin: implications for bowel cancer screening. J Med Screen. 2014;21(2):95–7. Available from: doi: 10.1177/0969141314535388.

Conclusions Deprivation and f-Hb are related. This has important implications for selection of cut-off f-Hb for screening programmes, and supports the inclusion of deprivation in risk-scoring systems.

Helander S, Hakama M, Malila N. Effect of a pre-screening survey on attendance in colorectal cancer screening: A double-randomized study in Finland. J Med Screen. 2014;21(2):82–8. Available from: doi: 10.1177/0969141314534229.

Conclusions We believe that the observed reduction in attendance in those who had been sent a questionnaire earlier is generally true. Thus, if any survey is enclosed in the screening invitation, this finding should be taken into account when planning the programme. Any extra effort requested may reduce the attendance proportion for screening, reducing the population level impact of screening.

Yang DX, Gross CP, Soulos PR, Yu JB. Estimating the magnitude of colorectal cancers prevented during the era of screening. Cancer. 2014;n/a–n/a. Available from: doi: 10.1002/cncr.28794.

CONCLUSIONS There has been a significant decline in the incidence of colorectal cancer in the United States, particularly for late-stage disease, during a time of increasing rates of screening.

Van Hees F, Habbema JDF, Meester RG, Lansdorp-Vogelaar I, van Ballegooijen M, Zauber AG. Should Colorectal Cancer Screening Be Considered in Elderly Persons Without Previous Screening?A Cost-Effectiveness Analysis Colorectal Cancer Screening in Unscreened Elderly Persons. Ann Intern Med. 2014;160(11):750–9. Available from:

Conclusion: In unscreened elderly persons CRC screening should be considered well beyond age 75 years. A colonoscopy is indicated at most ages.

Brenner H, Hoffmeister M, Birkner B, Stock C. Men with negative results of guaiac-based fecal occult blood test have higher prevalences of colorectal neoplasms than women with positive results. Int J Cancer. 2014;134(12):2927–34. Available from: doi: 10.1002/ijc.28618. PMID: 24374771.

Our findings underline need to move forward from and overcome shortcomings of gFOBT-based colorectal cancer screening.

Bevan R, Lee TJW, Nickerson C, Rubin G, Rees CJ. Non-neoplastic findings at colonoscopy after positive faecal occult blood testing: Data from the English Bowel Cancer Screening Programme. J Med Screen. 2014;21(2):89–94. Available from: doi: 10.1177/0969141314528889.

Reporting of NNF varies between colonoscopists, and potential underreporting is a limitation of this study. Further study is required to establish the impact of NNF on primary and secondary care.


Nota bibliográfica cribado c colorrectal 2014-05

Daskalakis C, Vernon SW, Sifri R, DiCarlo M, Cocroft J, Andrel Sendecki J, et al. The Effects of Test Preference, Test Access, and Navigation on Colorectal Cancer Screening. Cancer Epidemiol Biomarkers Prev. 2014; Available from: doi: 10.1158/1055-9965.EPI-13-1176.

Conclusions. Preference influences the type of screening tests completed. Test access increases FIT and navigation mainly increases CX. Screening strategies providing access and navigation to both tests may be more effective than preference-tailored approaches. Impact. Preference tailoring in colorectal cancer screening strategies should be avoided if the objective is to maximize screening rates, although other factors (e.g., costs, necessary follow-up) should also be considered.

Boguradzka A, Wiszniewski M, Kaminski MF, Kraszewska E, Mazurczak-Pluta T, Rzewuska D, et al. The effect of primary care physician counseling on participation rate and use of sedation in colonoscopy-based colorectal cancer screening program - a randomized controlled study. Scand J Gastroenterol. 2014; Available from: doi: 10.3109/00365521.2014.913191. PMID: 24797871.

Conclusion. In opportunistic primary colonoscopy screening, PCP's counseling significantly increases participation rate and decreases demand for sedation compared to recruitment with information materials only. NCT01688817.

Wernli KJ, Hubbard RA, Johnson E, Chubak J, Kamineni A, Green BB, et al. Patterns of colorectal cancer screening uptake in newly-eligible men and women. Cancer Epidemiol Biomarkers Prev. 2014; Available from: 10.1158/1055-9965.EPI-13-1360.

Conclusions: Patient characteristics associated with initiation of colorectal cancer screening in a newly-eligible population are similar to characteristics associated with overall screening participation in all age-eligible adults. Our results identify patient populations to target in outreach programs. Impact: Disparities in receipt of colorectal cancer screening are evident from onset of an age-eligible cohort, identifying key groups for future interventions for screening


Nota bibliográfica cribado c colorrectal 2014-04

Ouakrim DA, Boussioutas A, Lockett T, Hopper JL, Jenkins MA. Cost-effectiveness of family history-based colorectal cancer screening in Australia. BMC Cancer. 2014;14(1):261. Available from: doi: 10.1186/1471-2407-14-261. PMID: 24735237.

CONCLUSION: The model demonstrates that intensive colorectal cancer screening strategies targeting people at increased risk would be cost-effective in the Australian context. Our findings provide evidence that substantial health benefits can be generated from risk-based CRC screening at a relatively modest incremental cost.

Brenner H, Stock C, Hoffmeister M. Effect of screening sigmoidoscopy and screening colonoscopy on colorectal cancer incidence and mortality: systematic review and meta-analysis of randomised controlled trials and observational studies. BMJ. 2014;348.

Conclusions Compelling and consistent evidence from randomised controlled trials and observational studies suggests that screening sigmoidoscopy and screening colonoscopy prevent most deaths from distal colorectal cancer. Observational studies suggest that colonoscopy compared with flexible sigmoidoscopy decreases mortality from cancer of the proximal colon. This added value should be examined in further research and weighed against the higher costs, discomfort, complication rates, capacities needed, and possible differences in compliance.

Pruitt SL, Leonard T, Zhang S, Schootman M, Halm EA, Gupta S. Physicians, Clinics, and Neighborhoods: Multiple Levels of Influence on Colorectal Cancer Screening. Cancer Epidemiol Biomarkers Prev. 2014;
Available from: doi: 10.1158/1055-9965.EPI-13-1130.

Conclusions: Significant and substantial variability was observed across neighborhood, physician, and clinic levels in CRC test use, suggesting the importance of factors at each of these levels on CRC testing. Impact: Future multilevel research and intervention should consider the simultaneous influences of multiple levels, including clinic, physician, and neighborhood.

Brenner H, Kloor M, Pox CP. Colorectal cancer. Lancet. 2014;383(9927):1490–502. Available from: doi:

 More than 1·2 million patients are diagnosed with colorectal cancer every year, and more than 600 000 die from the disease. Incidence strongly varies globally and is closely linked to elements of a so-called western lifestyle. Incidence is higher in men than women and strongly increases with age; median age at diagnosis is about 70 years in developed countries. Despite strong hereditary components, most cases of colorectal cancer are sporadic and develop slowly over several years through the adenoma–carcinoma sequence. The cornerstones of therapy are surgery, neoadjuvant radiotherapy (for patients with rectal cancer), and adjuvant chemotherapy (for patients with stage III/IV and high-risk stage II colon cancer). 5-year relative survival ranges from greater than 90% in patients with stage I disease to slightly greater than 10% in patients with stage IV disease. Screening has been shown to reduce colorectal cancer incidence and mortality, but organised screening programmes are still to be implemented in most countries.

Logan RF a, Patnick J, Nickerson C, Coleman L, Rutter MD, von Wagner C. Outcomes of the Bowel Cancer Screening Programme (BCSP) in England after the first 1 million tests. Gut. 2012;61(10):1439–46. Available from: doi: 10.1136/gutjnl-2011-300843. PMID: 22156981.
CONCLUSION: In this first round of screening in England uptake and fecal occult blood test positivity was in line with that from the pilot and the original European trials. Although there was the expected improvement in cancer stage at diagnosis, the proportion with left-sided cancers was higher than expected


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