Skip to main content
SpringerLink
Log in

Vorsorge/Prävention

Gibt es Alternativen zur Vorsorgekoloskopie?

Screening/prevention

Alternatives to screening colonoscopy

  • Schwerpunkt
  • Published:
Der Gastroenterologe Aims and scope

Zusammenfassung

Die Koloskopie ist der Goldstandard für die Darmkrebsvorsorge in Deutschland. Die Invasivität der Untersuchung und eine niedrige Teilnahmerate machen alternative Methoden wünschenswert. Der biochemische FOBT ist der einzige Test mit nachgewiesener Senkung der KRK-bedingten Mortalität. Nachteil des Tests ist die mäßige Sensitivität für Karzinome und geringe Sensitivität für Adenome. Immunologische FOBT weisen eine höhere Detektionsrate für kolorektale Neoplasien auf. Beide Testverfahren können jedoch keine nicht blutenden Läsionen nachweisen. Für den Einsatz des M2-PK-Stuhltests liegen bisher keine ausreichenden Untersuchungen an asymptomatischen Studienkollektiven vor. Ein Problem scheint v. a. die geringe Spezifität des Tests zu sein. Genetische Stuhluntersuchungen sind bisher ebenfalls keine sinnvolle Alternative. Die Datenlage zur CT-Kolonographie ist widersprüchlich. Probleme stellen die mangelnde Standardisierung des Verfahrens und die Strahlenexposition dar. Untersuchungen zur medikamentösen Prävention waren vorwiegend enttäuschend. Entweder war kein protektiver Effekt nachweisbar oder die Nebenwirkungsrate überwog den möglichen protektiven Effekt.

Abstract

Colonoscopy is the gold standard for colorectal cancer screening in Germany. However, due to the invasiveness of the procedure and low attendance rates alternative screening methods are warranted. Biochemical FOBT is the only test with proven reduction of colorectal cancer mortality. The disadvantages of the test are a moderate sensitivity for colorectal cancer and low sensitivity for adenomas. Immunological FOBT show a higher detection rate for colorectal neoplasia. Both tests are only able to detect bleeding colorectal neoplasia. For the M2-PK stool test no larger studies using asymptomatic people are available. A major drawback of the test seems to be the low specificity. Genetic stool testing does not seem to be a suitable alternative screening test. The data concerning CT colonography are inconsistent. Problems of the test include inadequate standardization of the procedure and concerns about radiation exposure. Studies about medical prevention of colorectal neoplasia have been disappointing. Either no protective effect was found or the protective effect was offset by the side effects of the medication.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Arber N, Eagle CJ, Spicak J et al. (2006) Celecoxib for the prevention of colorectal adenomatous polyps. New England J Med 355: 885–895

    Article  CAS  Google Scholar 

  2. Baron JA, Cole BF, Sandler RS et al. (2003) A randomized trial of aspirin to prevent colorectal adenomas. N Engl J Med 348: 891–899

    Article  PubMed  CAS  Google Scholar 

  3. Baron JA, Sandler RS, Bresalier RS et al. (2006) A randomized trial of rofecoxib for the chemoprevention of colorectal adenomas. Gastroenterology 131: 1674–1682

    Article  PubMed  CAS  Google Scholar 

  4. Benamouzig R, Deyra J, Martin A et al. (2003) Daily soluble aspirin and prevention of colorectal adenoma recurrence: one-year results of the APACC trial. Gastroenterology 125: 328–336

    Article  PubMed  CAS  Google Scholar 

  5. Bertagnolli MM, Eagle CJ, Zauber AG et al. (2006) Celecoxib for the prevention of sporadic colorectal adenomas. New Engl J Med 355: 873–884

    Article  PubMed  CAS  Google Scholar 

  6. Bresalier RS, Sandler RS, Quan H et al. (2005) Cardiovascular events associated with rofecoxib in a colorectal adenoma chemoprevention trial. New Engl J Med 352: 1092–1102

    Article  PubMed  CAS  Google Scholar 

  7. Cotton PB, Durkalski VL, Pineau BC et al. (2004) Computed tomographic colonography (virtual colonoscopy): a multicenter comparison with standard colonoscopy for detection of colorectal neoplasia. Jama 291: 1713–1719

    Article  PubMed  CAS  Google Scholar 

  8. Faivre J, Dancourt V, Lejeune C et al. (2004) Reduction in colorectal cancer mortality by fecal occult blood screening in a French controlled study. Gastroenterology 126: 1674–1680

    Article  PubMed  Google Scholar 

  9. Guittet L, Bouvier V, Mariotte N et al. (2007) Comparison of a guaiac based and an immunochemical faecal occult blood test in screening for colorectal cancer in a general average risk population. Gut 56: 210–214

    Article  PubMed  CAS  Google Scholar 

  10. Hardt PD, Toepler M, Ngoumou B et al. (2003) Measurement of fecal pyruvate kinase type M2 (tumor M2-PK) concentrations in patients with gastric cancer, colorectal cancer, colorectal adenomas and controls. Anticancer Res 23: 851–853

    PubMed  CAS  Google Scholar 

  11. Haug U, Rothenbacher 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: 1329–1334

    PubMed  CAS  Google Scholar 

  12. Imperiale TF (2003) Aspirin and the prevention of colorectal cancer. N Engl J Med 348: 879–880

    Article  PubMed  Google Scholar 

  13. Imperiale TF, Ransohoff DF, Itzkowitz SH et al. (2004) Fecal DNA versus fecal occult blood for colorectal-cancer screening in an average-risk population. N Engl J Med 351: 2704–2714

    Article  PubMed  CAS  Google Scholar 

  14. Itzkowitz SH, Jandorf L, Brand R et al. (2007) Improved fecal DNA test for colorectal cancer screening. Clin Gastroenterol Hepatol 5: 111–117

    Article  PubMed  CAS  Google Scholar 

  15. Jorgensen OD, Kronborg O, Fenger C (2002) A randomised study of screening for colorectal cancer using faecal occult blood testing: results after 13 years and seven biennial screening rounds. Gut 50: 29–32

    Article  PubMed  CAS  Google Scholar 

  16. Kim DH, Pickhardt PJ, Taylor AJ et al. (2007) CT colonography versus colonoscopy for the detection of advanced neoplasia. N Engl J Med 357: 1403–1412

    Article  PubMed  CAS  Google Scholar 

  17. Koss K, Maxton D, Jankowski JA (2007) Faecal dimeric M2 pyruvate kinase in colorectal cancer and polyps correlates with tumour staging and surgical intervention. Colorectal Dis (in press)

  18. Levi Z, Rozen P, Hazazi R et al. (2007) A quantitative immunochemical fecal occult blood test for colorectal neoplasia. Ann Intern Med 146: 244–255

    PubMed  Google Scholar 

  19. Mandel JS, Church TR, Ederer F, Bond JH (1999) Colorectal cancer mortality: effectiveness of biennial screening for fecal occult blood. J Natl Cancer Inst 91: 434–437

    Article  PubMed  CAS  Google Scholar 

  20. Morikawa T, Kato J, Yamaji Y et al. (2005) A comparison of the immunochemical fecal occult blood test and total colonoscopy in the asymptomatic population. Gastroenterology 129: 422–428

    PubMed  Google Scholar 

  21. Pickhardt PJ, Choi JR, Hwang I et al. (2003) Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. N Engl J Med 349: 2191–2200

    Article  PubMed  CAS  Google Scholar 

  22. Pignone M, Campbell MK, Carr C, Phillips C (2001) Meta-analysis of dietary restriction during fecal occult blood testing. Eff Clin Pract 4: 150–156

    PubMed  CAS  Google Scholar 

  23. Psaty BM, Potter JD (2006) Risks and benefits of celecoxib to prevent recurrent adenomas. New Engl J Med 355: 950–952

    Article  PubMed  CAS  Google Scholar 

  24. Rockey DC, Paulson E, Niedzwiecki D et al. (2005) Analysis of air contrast barium enema, computed tomographic colonography, and colonoscopy: prospective comparison. Lancet 365: 305–311

    PubMed  CAS  Google Scholar 

  25. Schmiegel W, Pox C, Adler G et al. (2004) S3-Guidelines Conference „Colorectal Carcinoma“ 2004. Z Gastroenterol 42: 1129–1177

    Article  PubMed  CAS  Google Scholar 

  26. Scholefield JH, Moss S, Sufi F et al. (2002) Effect of faecal occult blood screening on mortality from colorectal cancer: results from a randomised controlled trial. Gut 50: 840–844

    Article  PubMed  CAS  Google Scholar 

  27. 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. Intern J Cancer 119: 2651–2656

    Article  CAS  Google Scholar 

  28. Solomon SD, McMurray JJ, Pfeffer MA et al. (2005) Cardiovascular risk associated with celecoxib in a clinical trial for colorectal adenoma prevention. New Engl J Med 352: 1071–1080

    Article  PubMed  CAS  Google Scholar 

  29. Vogel T, Driemel C, Hauser A et al. (2005) Comparison of different stool tests for the detection of cancer of the colon. Dtsch Med Wochenschr 130: 872–877

    Article  PubMed  CAS  Google Scholar 

  30. Webendorfer S, Messerer P, Eberle F, Zober A (2004) Precautions for intestinal cancer in the workplace. An initiative for secondary prevention in the BASF joint-stock company. Dtsch Med Wochenschr 129: 239–243

    Article  PubMed  CAS  Google Scholar 

  31. Weingarten MA, Zalmanovici A, Yaphe J (2005) Dietary calcium supplementation for preventing colorectal cancer and adenomatous polyps. Cochrane database of systematic reviews (Online):CD003548

    Google Scholar 

  32. Zentralinstitut für die kassenärztliche Versorgung in der Bundesrepublik Deutschland. Projekt wissenschaftliche Begleitung von Früherkennungs-Koloskopien in Deutschland. Berichtszeitraum 2006

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Medizinische Klinik, Ruhr-Universität Bochum, Knappschaftskrankenhaus, In der Schornau 23–25, 44892, Bochum, Deutschland

    C. Pox & S. Schmiegel

Authors
  1. C. Pox
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Schmiegel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. Pox.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pox, C., Schmiegel, S. Vorsorge/Prävention. Gastroenterologe 3, 100–105 (2008). https://doi.org/10.1007/s11377-008-0170-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11377-008-0170-5

Schlüsselwörter

Keywords

Search

Navigation