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Déplstage endoscoplque du cancer colorectal dans une population à risque moyen

Screening for colorectal cancer with endoscopy in the average risk population

  • Published:
Acta Endoscopica

Résumé

Plusieurs études ont montré que la formation des cancers colorectaux s'échelonne sur plusieurs années, à partir de lésions prémalignes constituées pour la plupart de polypes adénomateux. Les arguments en faveur de l'instauration de programmes généralisés pour les sujets asymptomatiques à risque moyen utilisant des techniques endoscopiques s'appuient sur les résultats des études qui ont démontré une diminution de la mortalité et de l'apparition de carcinomes après polypectomies. Plusieurs études cas-témoins confirment l'efficacité préventive du dépistage par sigmoïdoscopie. L'effet protecteur de l'examen endoscopique se manifesterait pendant 10 ans. Deux techniques sont utilisées à des fins de dépistage: la sigmoïdoscopie et la coloscopie. Elles peuvent servir tout autant au dépistage qu'aux procédures diagnostiques et thérapeutiques. Nous avons comparé la performance de ces techniques en termes d'acceptabilité, taux de complications, proportion de lésions détectables, et coûts. Les deux procédures ne sont pas identiques dans un contexte de dépistage. La coloscopie permet de révéler aussi des lésions proximales qui auraient échappé à la sigmoïdoscopie, mais différents facteurs restreignent son utilisation à grande échelle dans le cadre d'un dépistage: la nécessité d'une bonne formation pour les coloscopistes, les coûts, les taux de complications, l'acceptabilité par la population cible.

Summary

Endoscopic screening represents a promising approach to secondary prevention of colorectal cancer in the general population. Accumulated evidence concerning the role of the sequence adenoma-carcinoma in the development of colorectal cancer supports the hypothesis that endoscopic excision of adenomas might result in the prevention of cancer. Observational studies consistently showed a substantial reduction of incidence and mortality for colorectal cancer among subjects who reported having performed previous endoscopic exams. Two tests have been proposed: sigmoidoscopy and colonoscopy. We discuss a series of issues, related to the performance of the tests, side effects, neoplasia yield and compliance, which might influence the feasibility of a mass screening intervention. We conclude that the proposed tests are not equivalent. The expected increase in the protective effect which can be achieved using colonoscopy should be balanced with the higher complication rate, as well as with the increase in the need of resources, in terms of monetary costs, manpower and expertise.

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  1. CPO-Piemonte, Unità di Epidemiologia dei Tumori, ASO S. Giovanni Battista, Molinette, Via S. Francesco da Paola, 31-10123, Torino, (Italy)

    C. Senore, Paola Armaroli & N. Segnan

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  1. C. Senore
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Senore, C., Armaroli, P. & Segnan, N. Déplstage endoscoplque du cancer colorectal dans une population à risque moyen. Acta Endosc 32, 593–621 (2002). https://doi.org/10.1007/BF03018870

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