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DOI: 10.1055/a-1796-2471
Colorectal cancer surveillance by colonoscopy in a prospective, population-based long-term Swiss screening study – outcomes, adherence, and costs
Langzeitüberwachung nach dem kolorektalen Karzinomscreening mittels Koloskopie in einer prospektiven Bevölkerungsstudie in der Schweiz: Resultate, Adhärenz und Kosten![](https://www.thieme-connect.de/media/zfg/202205/lookinside/thumbnails/zfg-0217_10-1055-a-1796-2471-1.jpg)
Abstract
Background The success of colorectal cancer (CRC) screening depends mainly on screening quality, patient adherence to surveillance, and costs. Consequently, it is essential to assess the performance over time.
Methods In 2000, a closed cohort study on CRC screening in individuals aged 50 to 80 was initiated in Uri, Switzerland. Participants who chose to undergo colonoscopy were followed over 18 years. We investigated the adherence to recommended surveillance and collected baseline characteristics and colonoscopy data. Risk factors at screening for the development of advanced adenomas were analyzed. Costs for screening and follow-up were evaluated retrospectively.
Results 1278 subjects with a screening colonoscopy were included, of which 272 (21.3%; 69.5% men) had adenomas, and 83 (6.5%) had advanced adenomas. Only 59.8% participated in a follow-up colonoscopy, half of them within the recommended time interval. Individuals with advanced adenomas at screening had nearly five times the risk of developing advanced adenomas compared to individuals without adenomas (24.3% vs. 5.0%, OR 4.79 CI 2.30–9.95). Individuals without adenomas developed advanced adenomas in 4.9%, including four cases of CRC; three of them without control colonoscopy. The villous component in adenomas smaller than 10 mm was not an independent risk factor. Costs for screening and follow-up added up to CHF 1’934’521 per 1’000 persons screened, almost half of them for follow-up examinations; 60% of these costs accounted for low-risk individuals.
Conclusion Our findings suggest that follow-up of screening colonoscopy should be reconsidered in Switzerland; in particular, long-term adherence is critical. Costs for follow-up could be substantially reduced by adopting less expensive long-term screening methods for low-risk individuals.
Zusammenfassung
Hintergrund Hauptfaktoren einer erfolgreichen Darmkrebs-Früherkennung sind Qualität der Früherkennung, Bereitschaft der Patienten zur Teilnahme an der Überwachung und die Kosten. Eine regelmässige Evaluation des Screening-Programms ist zentral.
Methoden Im Jahr 2000 wurde in Uri, Schweiz, eine geschlossene Kohortenstudie zur Darmkrebsvorsorge bei Personen im Alter von 50 bis 80 Jahren initiiert. Teilnehmer, die sich für eine Koloskopie entschieden, wurden über 18 Jahre beobachtet. Wir untersuchten die Einhaltung der empfohlenen Vorsorgeuntersuchungen und erfassten die Ausgangscharakteristika und Koloskopiedaten. Risikofaktoren beim Screening für die Entwicklung fortgeschrittener Adenome wurden analysiert. Die Kosten für das Screening und die Nachsorge wurden retrospektiv ausgewertet.
Ergebnisse 1278 Personen mit einer Screening-Koloskopie wurden eingeschlossen, von denen 272 (21,3 %; 69,5 % Männer) Adenome und 83 (6,5 %) fortgeschrittene Adenome aufwiesen. Nur 59,8 % nahmen an einer Folgekoloskopie teil und hiervon die Hälfte innerhalb des empfohlenen Zeitraums. Personen mit fortgeschrittenen Adenomen beim Screening hatten ein fast fünfmal höheres Risiko, erneut fortgeschrittene Adenome zu entwickeln, als Personen mit unauffälliger Screeningkoloskopie (24,3 % vs. 5,0 %, OR 4,79 CI 2,30–9,95). 4.9% aller Personen ohne Adenome in der Screening-Kolonoskopie entwickelten im Verlauf fortgeschrittene Adenome, darunter vier CRC Fälle. 3 von diesen 4 CRC Fälle kamen nicht zur Kontrollkoloskopie. Die Kosten für das Screening und die Nachuntersuchung beliefen sich auf CHF 1’934’521 pro 1000 untersuchte Personen, fast die Hälfte davon entfiel auf die Nachuntersuchung. 60 % dieser Kosten entfielen auf Personen mit niedrigem Risiko.
Schlussfolgerung Unsere Ergebnisse deuten darauf hin, dass die Nachsorge der Screening-Koloskopie in der Schweiz neu überdacht werden sollte, da die Adhärenz über längeren Zeitraum schlecht ist. Die Kosten für die Nachuntersuchungen könnten erheblich gesenkt werden, wenn bei Personen mit geringem Risiko weniger teure Langzeit-Screening-Methoden angewandt würden.
Schlüsselwörter
Adenom - Karzinom - Koloskopie - Kolorektales Adenom - Kolorektales Karzinom - Kolorektale Polypen - VorsorgeuntersuchungKeywords
Adenoma - Cancer - Colonoscopy - Colorectal adenoma - Colorectal carcinoma - Colorectal polyps - ScreeningPublication History
Received: 07 November 2021
Accepted after revision: 02 March 2022
Article published online:
11 May 2022
© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
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