Der Onkologe

, Volume 14, Issue 2, pp 131–141 | Cite as

Früherkennung und Primärprävention des Dickdarmkrebses

  • A. Eickhoff
  • D. Hartmann
  • J. Striegel
  • J.F. Riemann
Leitthema
  • 105 Downloads

Zusammenfassung

Das kolorektale Karzinom (KRK) ist in der westlichen Welt und in Deutschland eine häufige Erkrankung mit hoher Sterblichkeit. Durch die Anwendung von Maßnahmen der Primärprävention kann eine Inzidenzreduktion von ca. 50% erwartet werden. Primärprävention beim KRK ist nicht nur erwiesenermaßen effektiv, sondern auch ökonomisch sinnvoll. Diese Maßnahmen sind zwar bekannt, werden jedoch nur von 20% der Bevölkerung umgesetzt. Aus diesem Grund kommen heute den sekundären Präventivmaßnahmen in Form von Polypen- und Karzinomfrüherkennung eine umso größere Bedeutung zu. Folgende zwei Screening-Optionen stehen in Deutschland optional zur Verfügung: Die Ileokoloskopie mit Vollendung des 55. Lebensjahres in 10-jährlichen Intervallen oder alternativ die Untersuchung auf okkultes Blut im Stuhl (FOBT) ab dem 50. Lebensjahr in jährlichem Intervall oder optional zur Koloskopie ab dem 56. Lebensjahr in zweijährigem Abstand. Aufgrund seiner Vorteile wird die primäre Koloskopie inzwischen als Screening-Option der ersten Wahl in den Leitlinien empfohlen.

Schlüsselwörter

Kolorektales Karzinom Primärprävention Sekundärprävention Screening Koloskopie 

Early detection and primary prevention of colorectal cancer

Abstract

Colorectal cancer is the second leading cause of cancer-related deaths in Germany. Its incidence rate can be reduced by 50% through primary prevention, which is effective and economical. However, most people are not aware of the powerful tools of primary prevention; therefore, secondary prevention is the strategy of choice. The recommended secondary prevention strategy in Germany contains two options for the patients. First, complete colonoscopy beginning with the age of 56 repeated every 10 years. Second, the annual fecal occult blood test beginning with the age of 50; after 55 years it is performed biennially if FOBT screening is preferred. Based on data from the literature, primary screening with colonoscopy has become the preferred choice of many experts and it is now recommended in the guidelines.

Keywords

Colorectal cancer Primary prevention Secondary prevention Screening Colonoscopy 

Notes

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Literatur

  1. 1.
    American Gastronterological Association (2003) Colorectal screening and Surveillance: Clinical guidelines and ratinale – Update based on new evidence. Gastroenterology 124: 544–560CrossRefGoogle Scholar
  2. 2.
    Arbeitsgemeinschaft Bevölkerungsbezogener Krebsregister in Deutschland (Hrsg) (2002) Krebs in Deutschland – Häufigkeiten und Trends. 3. erweiterte, aktualisierte Auflage. Saarbrücken, S 104Google Scholar
  3. 3.
    Atkin WS, Cook CF, Cuzick J et al. (2002) Single flexible sigmoidoscopy screening to prevent colorectal cancer: baseline findings of a UK multicentre randomized trial. Lancet 359: 1291–300CrossRefPubMedGoogle Scholar
  4. 4.
    Bond JH (2001) Colon polyps and cancer. Endoscopy 33: 46–54PubMedCrossRefGoogle Scholar
  5. 5.
    Boyle P, Ferlay J (2005) Cancer incidence and mortality in Europe, 2004. Ann Oncol 16: 481–488PubMedCrossRefGoogle Scholar
  6. 6.
    Brenner H, Arndt V, Stürmer T et al. (2001) Long lasting reduction of risk of colorectal cancer following screening endoscopy. Br J Cancer 85: 972–976PubMedCrossRefGoogle Scholar
  7. 7.
    Recommendations statement from the Canadian Task Force on Preventive Health Care (2001) Colorectal cancer screening. CMAJ 165: 206–208Google Scholar
  8. 8.
    Eickhoff A, Riemann JF (2007) Koloskopiesysteme der Zukunft. Der Gastroenterolge 2: 118–125CrossRefGoogle Scholar
  9. 9.
    Eickhoff A, Van Dam J, Jakobs R et al. (2007) Computer-assisted colonoscopy (the NeoGuide Endoscopy System): results of the first human clinical trial („PACE study“). Am J Gastroenterol 102: 261–266PubMedCrossRefGoogle Scholar
  10. 10.
    Eliakim R, Fireman Z, Gralnek IM et al. (2006) Evaluation of the PillCam Colon capsule in the detection of colonic pathology: results of the first multicenter, prospective, comparative study. Endoscopy 38: 963–970PubMedCrossRefGoogle Scholar
  11. 11.
    Ell C, Rabenstein T (2003) Dickdarmkrebs in Deutschland Reale und virtuelle Koloskopie. Internist 44: 294–301PubMedGoogle Scholar
  12. 12.
    Gonzalez CA (2006) The European Prospective Investigation into Cancer and Nutrition (EPIC). Public Health Nutr 9: 124–126PubMedCrossRefGoogle Scholar
  13. 13.
    Hardcastle JD, Chamberlain J0, Robinson MHE et al. (1996) Randomized, controlled trial of faecal occult blood screening for colorectal cancer. Lancet 348: 1472–1477PubMedCrossRefGoogle Scholar
  14. 14.
    Hardt PD, Mazurek S, Toepler M et al. (2004) Faecal tumour M2 pyruvate kinase: a new, sensitive screening tool for colorectal cancer. Br J Cancer 91: 980–984PubMedGoogle Scholar
  15. 15.
    Hartmann D, Bassler B, Schilling D et al. (2006) Colorectal polyps: detection with dark-lumen MR colonography versus conventional colonoscopy. Radiology 238: 143–149PubMedCrossRefGoogle Scholar
  16. 16.
    Haug U, Rothebacher D, Wente MN et al. (2007) Tumour M2-PK as a stool marker for colorectal cancer: comparative analysis in a large sample of unselected older adults vs colorectal cancer patients. Br J Cancer 96: 1329–1334PubMedGoogle Scholar
  17. 17.
    Hewitson P, Glasziou P, Irwing L et al. (2007) Screening for colorectal cancer using the faecal occult blood test, Hemoccult. Cochrane Database Syst Rev (in press)Google Scholar
  18. 18.
    Imperiale TF, Wagner DR, Lin CY et al. (2000) Risk of advanced proximal neoplasms in asymptomatic adults according to the distal colorectal findings. N Engl J Med 343: 169–174PubMedCrossRefGoogle Scholar
  19. 19.
    Imperiale TF, Wagner DR, Lin CY et al. (2002) Results of screening colonoscopy among persons 40 to 49 years of age. N Engl J Med 346: 1781–1785PubMedCrossRefGoogle Scholar
  20. 20.
    Jorgensen OD, Kronborg O, Fenger C (2002) A randomized study of screening for colorectal cancer using faecal occult blood testing: results after 13 years and seven biennial screening rounds. Gut 50: 29–32PubMedCrossRefGoogle Scholar
  21. 21.
    Kassenärztliche Bundesvereinigung (2007) Drei Jahre Früherkennungskoloskopie in Deutschland – Ergebnisse der wissenschaftlichen Begleitung 2003–2005Google Scholar
  22. 22.
    Kewenter J, Brevinge H, Engaras B et al. (1994) Results of screening, rescreening and follow-up in a prospective randomized study for detection of colorectal cancer by fecal-occult-blood testing. Scand J Gastroenterol 29: 468–473PubMedCrossRefGoogle Scholar
  23. 23.
    Kim DH, Pickhardt PJ, Taylor AJ et al. (2007) CT colonography versus colonoscopy for the detection of advanced neoplasia. N Engl J Med 357: 1403–1412PubMedCrossRefGoogle Scholar
  24. 24.
    Kullmann F (2003) Dickdarmkrebs in Deutschland – Karzinogenese und hereditäre Karzinome. Internist 44: 254–267PubMedGoogle Scholar
  25. 25.
    Lieberman DA, Weiss DG, Bond JH et al. (2000) Use of colonoscopy to screen asymptomatic adults for colorectal cancer. N Engl J Med 343: 162–168PubMedCrossRefGoogle Scholar
  26. 26.
    Lieberman DA, Weiss DG (2001) One-time screening for colorectal cancer with combined fecal occult-blood testing and examination of the distal colon. N Engl J Med 345: 555–560PubMedCrossRefGoogle Scholar
  27. 27.
    Mandel JS, Bond JH, Church TR et al. (1993) Reducing mortality from colorectal cancer by screening for faecal occult blood. N Engl J Med 328: 1365–1371PubMedCrossRefGoogle Scholar
  28. 28.
    Müller AD, Sonnenberg A (1995) Prevention of colorectal cancer by flexible endoscopy and polypectomy. A case-control study of 32.702 veterans. Ann Intern Med 123: 1741–1748CrossRefGoogle Scholar
  29. 29.
    Newcomb PA, Norfleet RG, Storer BE et al. (1992) Screening sigmoidoscopy and colorectal cancer mortality. J Natl Cancer Inst 84: 1572–1575PubMedCrossRefGoogle Scholar
  30. 30.
    Ouyang DL, Cehn JL, Getzenberg RH, Schoen RE (2005) Noninvasive testing for colorectal cancer: a review. Am J Gastroenterol 100: 1393–1403PubMedCrossRefGoogle Scholar
  31. 31.
    Painter J, Saunders DB, Bell GD (1999) Depth of insertion at flexible sigmoidoscopy: implications for colorectal cancer screening and instrument design. Endoscopy 31: 227–231PubMedCrossRefGoogle Scholar
  32. 32.
    Pignone M, Rich M, Teutsch SM (2002) Screening for colorectal cancer in adults at average risk: A summary of the evidence for the US Preventive Service Task Force. Ann Int Med 137: 132–141PubMedGoogle Scholar
  33. 33.
    Pox C, Schulmann K, Schmiegel W (2003) Dickdarmkrebs in Deutschland Konventionelles und molekulares Screening (Stuhltests). Internist 44: 254–267Google Scholar
  34. 34.
    Ramsey SD, Mandelson MT, Berry K (2003) Cancer-attributable costs of diagnosis and care for persons with screen-detected versus symptom-detected colorectal cancer. Gastroenterology 125: 1645–1650PubMedCrossRefGoogle Scholar
  35. 35.
    Rex DK, Chak A, Vasudeva R et al. (1999) Prospective determination of distal colon findings in average-risk patients with proximal colon cancer. Gastrointest Endosc 49: 727–730PubMedCrossRefGoogle Scholar
  36. 36.
    Scheppach W, Melcher R, Lührs H, Menzel T (2000) Primärprävention des sporadischen kolorektalen Karzinoms durch Ernährungsmodifikation und Medikamente? Internist 41: 868–875PubMedCrossRefGoogle Scholar
  37. 37.
    Schmiegel W, Pox C, Adler G et al. (2004) S3-Leitlinienkonferenz „Kolorektales Karzinom“ 2004. Z Gastroenterol 42: 1129–1177PubMedCrossRefGoogle Scholar
  38. 38.
    Schoenfeld P, Cash B, Flood A et al. (2005) Colonoscopic screening of average-risk women for colorectal neoplasia. N Engl J Med 352: 2061–2068PubMedCrossRefGoogle Scholar
  39. 39.
    Schoofs N, Deviere J, Van Gossum A (2006) PillCam colon capsule endoscopy compared with colonoscopy for colorectal tumor diagnosis: a prospective pilot study. Endoscopy 38: 971–977PubMedCrossRefGoogle Scholar
  40. 40.
    Selby JV, Friedman GD, Quesenberry CP et al. (1992) A case-control study of screening sigmoidoscopy and mortality from colorectal cancer. N Engl J Med 326: 653–657PubMedCrossRefGoogle Scholar
  41. 41.
    Shastri YM, Naumann M, Oremek GM et al. (2006) Prospective multicenter evaluation of fecal tumor pyruvate kinase type M2 (M2-PK) as a screening biomarker for colorectal neoplasia. Int J Cancer 119: 2651–2656PubMedCrossRefGoogle Scholar
  42. 42.
    Sieg A (2003) Fur Die BNG-Studiengruppe. Screening colonoscopy among persons 50 to 60 years of age with and without familial risk of colorectal cancer – a prospective multicenter trial. Z Gastroenterol 41: 1077–1082PubMedCrossRefGoogle Scholar
  43. 43.
    Sieg A, Theilmeier A (2006) Ergebnisse der Vorsorge – Koloskopie 2005. Dtsch Med Wochenschr 131: 379–383PubMedCrossRefGoogle Scholar
  44. 44.
    Sonnenberg A, Delco F, Inadomi JM (2000) Cost-effectiveness for colonoscopy in screening for colorectal cancer. Ann Intern Med 133: 573–584PubMedGoogle Scholar
  45. 45.
    Sonnenberg A, Delco F (2002) Cost-effectiveness of a single colonoscopy in screening for colorectal cancer. Arch Intern Med 162: 163–168PubMedCrossRefGoogle Scholar
  46. 46.
    Tomeo CA (1999) Harvard Report on cancer prevention. Cancer Causes and Control 10: 167–180PubMedCrossRefGoogle Scholar
  47. 47.
    Towler B, Irwig L, Glasziou P et al. (1998) A systematic review of the effects of screening for colorectal cancer using the faecal occult blood test. BMJ 317: 559–565PubMedGoogle Scholar
  48. 48.
    Vucelic B, Rex D, Pulanic R et al. (2006) The aer-o-scope: proof of concept of a pneumatic, skill-independent, self-propelling, self-navigating colonoscope. Gastroenterology 130: 672–677PubMedCrossRefGoogle Scholar
  49. 49.
    Winawer SJ, Zauber AG, O’Brien MJ et al. (1993) Randomized comparison of surveillance intervals after colonoscopic removal of newly diagnosed adenomatous polyps. N Engl J Med 328: 901–990PubMedCrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag 2008

Authors and Affiliations

  • A. Eickhoff
    • 1
  • D. Hartmann
    • 1
  • J. Striegel
    • 1
  • J.F. Riemann
    • 1
  1. 1.Medizinische Klinik CKlinikum der Stadt Ludwigshafen gGmbHLudwigshafenDeutschland

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