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Stratégie de dépistage des cancers colorectaux chez les sujets à risque élevé

Screening strategy of colorectal cancers in high risk cases

  • Published:
Acta Endoscopica

Résumé

Les études épidémiologiques ont permis de connaïtre les sujets à risque élevé de cancer colorectal. Le niveau de risque dans certains de ces groupes justifie une stratégie de dépistage individuel, même si la relative faible prévalence de ces cas fait qu'ils ne sont à l'origine que d'un nombre modeste de cancers colorectaux. Près de 10% de la population générale et 20% des sujets atteints de cancer colorectal ont un antécédent familial de cancer colorectal. Le niveau de risque dans les groupes à risque élevé, conditionne la stratégie de dépistage à proposer à ces sujets. Chez les apparentés au 1er degré de sujets atteints d'un cancer colorectal, ce risque varie avec l'âge au diagnostic du cas index et le nombre de parents atteints. Le risque cumulé se situe entre 10 et 20% pour les individus ayant un parent au 1er degré atteint avant l'âge de 45 ans ou pour ceux ayant au moins 2 apparentés atteints: il paraît alors suffisamment élevé pour proposer une coloscopie de dépistage. Une coloscopie est également recommandée chez les sujets ayant une rectocolite hémorragique ou une maladie de Crohn étendue (pancolite) évoluant depuis plus de 15 ans et chez les sujets ayant des antécédents personnels de cancer colorectal ou d'adénome de plus de 1 cm.

Summary

Epidemiological studies enable us to find out which subjects are at high risk of colorectal cancer. The risk level amongst some of these groups justifies an individual screening strategy, even if the relatively low prevalence of these cases means that they only give rise to a limited number of colorectal cancers. A family history of colorectal cancer is found in nearly 10% of the general population and in 20% of subjects with colorectal cancer. The risk level in high risk groups determines the screening strategy to be offered to these subjects. Among first degree relatives of patients with colorectal cancer, this risk varies with age at diagnosis of the index case, and with the number of affected relatives. The cumulated lifetime risk is comprised between 10 and 25% for individuals with one relative affected before the age of 45 or for those with at least two affected relatives, which is high enough to warrant colonoscopic screening. Colonoscopy is also recommended in subjects with either a haemorrhagic rectocolitis or extended Crohn's disease (pancolitis) which has been developing for at least 15 years, and in subjects with a personal history of colorectal cancer or an adenoma larger than 1 cm.

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Authors and Affiliations

  1. Registre Bourguignon des Cancers Digestifs EPI-INSERM 0106, Faculté de Médecine, BP 87900, 21079, Dijon Cedex, France

    Anne-Marie Bouvier, J. Faivre & Catherine Lejeune

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  1. Anne-Marie Bouvier
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  2. J. Faivre
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  3. Catherine Lejeune
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Correspondence to Anne-Marie Bouvier.

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Bouvier, AM., Faivre, J. & Lejeune, C. Stratégie de dépistage des cancers colorectaux chez les sujets à risque élevé. Acta Endosc 32, 623–631 (2002). https://doi.org/10.1007/BF03018871

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  • DOI: https://doi.org/10.1007/BF03018871

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