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Zie ook literatuurlijst specifiek bij darmkanker van arts-bioloog drs. Engelbert Valstar

7 november 2019: Periodieke controle van mensen op ontstaan van darmkanker via met name de ontlastingstest en vervolgens door endoscopie enz. blijkt niet voor iedereen een voordeel te geven. Uit verschillende studies blijkt dat het voordeel van vroeg ontdekken geen effect heeft op overall overleving enz. 

Een panel van specialisten hebben nieuwe richtlijnen gemaakt. Zie daar voor dit rapport:  Colorectal cancer screening with faecal immunochemical testing, sigmoidoscopy or colonoscopy: a clinical practice guideline

Abstract staat onderaan artikel hier het advies gevisualiseerd in een beeldgrafiek:

Visual summary of recommendation

No screeningFITEvery yearFITEvery two yearsSigmoidoscopySingleColonoscopySingleFavours noscreeningFavoursscreeningWe suggest no screeningInterventions comparedRecommendationsScreening optionsPopulationWe suggest using a tool such as the QCancer® calculatorto estimate the risk of colorectal cancer for each personin the next 15 years. This calculates risk, based on:Understanding a person’s risk of cancer can help todetermine the benefits and harms of different screeningtests for their individual situation.Faecal testingwith a faecalimmunochemicaltest (FIT) everyyearFaecal testingwith a faecalimmunochemicaltest (FIT) everytwo yearsEndoscopicexamination ofonly the lowerpart of the colonEndoscopicexamination ofthe entire colonFavours noscreeningFavoursscreeningColonoscopy offered if FITor sigmoidoscopy positivePeople with an estimated 15 yearrisk of colorectal cancerbelow3%We suggest screening with oneof the four screening optionsPeople with an estimated 15 yearrisk of colorectal cancerabove3%Estimating riskHealthy adults with nohistory of screeningAged 50 to 79AgeSmoking statusMedical and family historyBMISexEthnicityLink to QCancer®calculatorqcancer.org/15yr/colorectal/StrongAll or nearly all informed people would likely want this option.Benefits outweigh harms for almost everyone.WeakMost people would likely want this option.Benefits outweigh harms for the majority, but not for everyone.WeakMost people would likely want this option.Benefits outweigh harms for the majority, but not for everyone.StrongAll or nearly all informed people would likely want this option.Benefits outweigh harms for almost everyone.StrongAll or nearly all informed people would likely want this option.Benefits outweigh harms for almost everyone.WeakMost people would likely want this option.Benefits outweigh harms for the majority, but not for everyone.WeakMost people would likely want this option.Benefits outweigh harms for the majority, but not for everyone.StrongAll or nearly all informed people would likely want this option.Benefits outweigh harms for almost everyone.
Visit the MAGICapp multiple comparison tool to compare and choose optionsEvidence summariesScreening options should be chosen in shared decision making, based on a person’s individual risk of cancer

7 januari 2019: Bron: BMJ GUT

Een thuis uit te voeren ontlastingstest spoort vaak vroegtijdig kwaadaardige poliepen en al ontstane darmkanker op. Door de vroegtijdige ontdekking en het operatief weghalen van de kwaadaardige poliepen hopen veel mensen het ontstaan van darmkanker te voorkomen. Dat dit echter geen zekerheid is blijkt uit een Engelse studie binnen de deelnemers van een screeningprogramma bij mensen met een gemiddeld risico op darmkanker. Patienten uit de grotere screeningstudie hadden 3 tot 4 kleine darmpoliepen laten weghalen of een poliep met een diameter van minimaal 10 mm. of groter. (leeftijd van de patiënten varieerde van 60 - 72 jaar).

Na drie jaar bleek een jaarlijkse ontlastingstest i.p.v. coloscopie weliswaar veel goedkoper en de zorgkosten te drukken. Maar de betrouwbaarheid liet veel te wensen over. Een jaarlijkse ontlastingstest had tegenover de coloscopie maar liefst 30 tot 40 procent van het ontwikkelen van darmkanker gemist en 50 tot 70 procent aanwezige adenocarcinomen waren niet opgemerkt.

prikken in ontlasting

Ook op het bevolkinsonderzoek via de ontlastingstest is al veel kritiek geweest en daaraan zal deze studie dus niet echt positief aan bijdragen denk ik.

De onderzoekers stellen deze conclusies:

  • Betekenis van deze studie
  • Hoe kan dit van invloed zijn op de klinische praktijk in de nabije toekomst?
  • Vervanging van 3 jaarlijkse colonoscopiebewaking bij intermediair risico-patiënten met een jaarlijkse FIT zou het aantal colonoscopieën met ≥70% kunnen verminderen en aanzienlijke kostenbesparingen opleveren.
  • De jaarlijkse FIT zou echter 30% -40% van de darmkankers (CRC's) en 40% -70% van de adenocarcinomen (AA's) kunnen missen, afhankelijk van de gebruikte grenzen voor wel of niet een coloscopie.
Figure 1

Participant flow diagram from invitation through to year 3 colonic examination. *Two hundred and ninety-five potentially eligible individuals were not invited as they were excluded after the eligibility assessment (186 in order to prevent over-investigation as they had already undergone more than one colonoscopy and 109 due to informed dissent, clinical reasons, death or emigration) and a further 1547 individuals were not invited as the sample size of 8000 had already been met.†Two thousand and fifty-five individuals were not recruited due to lack of consent; one consented but did not return their FIT; and four consented but returned a FIT that could not be analysed. AAs, advanced adenomas; CRC, colorectal cancer; FIT, faecal immunochemical test; gFOBT, guaiac faecal occult blood test. 

Of those invited, 2060 were not recruited: 2055 did not consent and five consented but did not return an analysable FIT. A further 11 were excluded due to withdrawal of consent, baseline CRC, baseline high-risk adenomas, prolonged baseline episode or symptomatic exam before year 1 (figure 1). Therefore, 5938 of 8009 (74.1%) invitees were recruited, having consented and returned an analysable FIT (table 1). Return of FIT was 97% at years 2 and 3 (table 2). Participation was similar among men and women and across age groups (online supplementary tables 1 and 2).

Figure 1

Het volledige studierapport: Faecal immunochemical tests (FIT) versus colonoscopy for surveillance after screening and polypectomy: a diagnostic accuracy and cost-effectiveness study is gratis in te zien.

Hier het abstract: 

Source: BMJ Gut: 

http://dx.doi.org/10.1136/gutjnl-2018-317297

Abstract

Objective The English Bowel Cancer Screening Programme (BCSP) recommends 3 yearly colonoscopy surveillance for patients at intermediate risk of colorectal cancer (CRC) postpolypectomy (those with three to four small adenomas or one ≥10 mm). We investigated whether faecal immunochemical tests (FITs) could reduce surveillance burden on patients and endoscopy services.

Design Intermediate-risk patients (60–72 years) recommended 3 yearly surveillance were recruited within the BCSP (January 2012–December 2013). FITs were offered at 1, 2 and 3 years postpolypectomy. Invitees consenting and returning a year 1 FIT were included. Participants testing positive (haemoglobin ≥40 µg/g) at years one or two were offered colonoscopy early; all others were offered colonoscopy at 3 years. Diagnostic accuracy for CRC and advanced adenomas (AAs) was estimated considering multiple tests and thresholds. We calculated incremental costs per additional AA and CRC detected by colonoscopy versus FIT surveillance.

Results 74% (5938/8009) of invitees were included in our study having participated at year 1. Of these, 97% returned FITs at years 2 and 3. Three-year cumulative positivity was 13% at the 40 µg/g haemoglobin threshold and 29% at 10 µg/g. 29 participants were diagnosed with CRC and 446 with AAs. Three-year programme sensitivities for CRC and AAs were, respectively, 59% and 33% at 40 µg/g, and 72% and 57% at 10 µg/g. Incremental costs per additional AA and CRC detected by colonoscopy versus FIT (40 µg/g) surveillance were £7354 and £180 778, respectively.

Conclusions Replacing 3 yearly colonoscopy surveillance in intermediate-risk patients with annual FIT could reduce colonoscopies by 71%, significantly cut costs but could miss 30%–40% of CRCs and 40%–70% of AAs.

Trial registration number ISRCTN18040196; Results.

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

 

Based on benefits, harms, and burdens of screening, the panel inferred that most informed individuals with a 15-year risk of colorectal cancer of 3% or higher are likely to choose screening, and most individuals with a risk of below 3% are likely to decline screening. Given varying values and preferences, optimal care will require shared decision making.

Practice Rapid Recommendations

Colorectal cancer screening with faecal immunochemical testing, sigmoidoscopy or colonoscopy: a clinical practice guideline

BMJ 2019367 doi: https://doi.org/10.1136/bmj.l5515 (Published 02 October 2019)Cite this as: BMJ 2019;367:l5515

Visual summary of recommendation

No screeningFITEvery yearFITEvery two yearsSigmoidoscopySingleColonoscopySingleFavours noscreeningFavoursscreeningWe suggest no screeningInterventions comparedRecommendationsScreening optionsPopulationWe suggest using a tool such as the QCancer® calculatorto estimate the risk of colorectal cancer for each personin the next 15 years. This calculates risk, based on:Understanding a person’s risk of cancer can help todetermine the benefits and harms of different screeningtests for their individual situation.Faecal testingwith a faecalimmunochemicaltest (FIT) everyyearFaecal testingwith a faecalimmunochemicaltest (FIT) everytwo yearsEndoscopicexamination ofonly the lowerpart of the colonEndoscopicexamination ofthe entire colonFavours noscreeningFavoursscreeningColonoscopy offered if FITor sigmoidoscopy positivePeople with an estimated 15 yearrisk of colorectal cancerbelow3%We suggest screening with oneof the four screening optionsPeople with an estimated 15 yearrisk of colorectal cancerabove3%