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Endoscopy 1999; 31(8): 673-683
DOI: 10.1055/s-1999-129
Special Topic
Georg Thieme Verlag Stuttgart ·New York

14. Appropriateness of Colonoscopy: Screening for Colorectal Cancer in Asymptomatic Individuals [1]

B. Burnand*, M. Bochud*, F. Froehlich**, R. W. Dubois***, J.-P. Vader*, J.-J. Gonvers**
  • * Institut Universitaire de Médecine Sociale et Préventive, Lausanne, Switzerland
  • ** Policlinique Médicale Universitaire, Lausanne, Switzerland
  • *** Protocare Sciences, Santa Monica, USA
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Publication History

Publication Date:
31 December 1999 (online)

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Introduction

Colorectal cancer is an important component of the burden of disease in developed countries because it is widespread and has a high morbidity and mortality rate [1]. In Europe, the annual age-standardized incidence (world population) of colorectal cancer is between 20 and 45 per 100 000 among males and between 15 and 30 per 100 000 among females [2]. Incidence rates increase in a regular fashion with age [2] [3] [4] . “Screening, in the context of colorectal cancer, identifies individuals who are more likely to have colorectal cancer or adenomatous polyps from among those without signs or symptoms of the disease” [1]. Screening may detect cancers at an early stage. If detected at an early stage, treatment may be curative and improve prognosis. Screening may be acceptable to many patients and generally feasible in practice.

In November 1998, a multidisciplinary European expert panel convened in Lausanne, Switzerland, to discuss and develop criteria for the appropriate use of gastrointestinal endoscopy, a widely-used procedure, regarded as highly accurate and safe. The RAND appropriateness method was chosen for this purpose, because it allows the development of appropriateness criteria based on published evidence and supplemented by explicit expert opinion. A detailed description of the RANTD appropriateness method, including the literature search process [5], and of the whole process, as well as the global results of the panel [6], are published as separate articles in the issue of the Journal. The literature review was based on a systematic search of Medline, Embase and the Cochrane Library conducted up to the end of 1997 and completed with some key articles published in 1998. Updating and revision of the literature review is currently ongoing.

This article contains three parts: 1. the review of the literature that was used by the panelists to support their ratings of appropriateness of use of colonoscopic screening for colorectal cancer in asymptomatic patients without personal history of colorectal cancer or polyps; 2. an overview of the main panel results; 3. a summary of the published evidence and of the panel based appropriateness criteria.

1 The European Panel on Appropriateness of Gastrointestinal Endoscopy (EPAGE, Lausanne, Switzerland)

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1 The European Panel on Appropriateness of Gastrointestinal Endoscopy (EPAGE, Lausanne, Switzerland)

Dr. Bernard Burnand

IUMSP

Bugnon 17

CH-1005 Lausanne

Switzerland

Phone: + 41-21-3144954

Email: Bernard.Burnand@inst.hospvd.ch