109 - Colorectal cancer screening
Autor(s): A. Ederle, L. Benazzato, P. Inturri, A.L. Iasci, A. Fantin
Issue: RIMeL - IJLaM, Vol. 4, N. 2, 2008 (MAF Servizi srl ed.)
Page(s): 109-113
In Italy, colorectal cancer is the third cancer as incidence among men and the second among women. The incidence has increased between the mid-1980s and the mid-1990s, followed by a small reduction of mortality. The primary goal of screening is the detection of invasive (malignant) tumors at early stage, but the detection and removal of their precursor lesions (i.e. polyps) is a main purpose as well. Up to today, the first level screening tests are guaiac or fecal immunochemical tests (FIT) for fecal occult blood (FOB) and flexible sigmoidoscopy (FS). The immunochemical tests have a better cost-benefit ratio compared with guaiac test, and should be offered every two years to people aged between 50 and 75 years. As for FS, studies have showed that this endoscopic procedure may prevent as much as 75% of colorectal cancer directly or indirectly, after detection of polyps, as indication for colonoscopy. There are not definitive data about the length of protective effect of a single FS, although a “once in life” FS to people aged between 58 and 60 years is recommended. Colonoscopy is not a first level screening test, but it is indicated when a first level test is positive, the family history is positive for colorectal cancer, in the surveillance of persons with risk factors (ulcerative colitis, polyposis, etc.). In ULSS 20 Verona since 2003 FS is offered to people aged 60 years and FOBT to people aged 61-69 years. Correct attendance is 43% for FS and 52% for FOBT. Cancer were found in 110 persons and high risk adenomas in 697 persons.