programas cribado cancer


Nota Bibliográfica

Esta Nota es una recopilación de publicaciones (artículos, informes, libros) sobre cribado de cáncer resultado de una revisión no sistemática de la literatura.

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Josep A Espinás. Pla Director d'Oncología de Catalunya.
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Nota bibliográfica cribado c colorrectal 2014-02

Saini SD. Dedicated Outreach Is Effective in Increasing Uptake of Colorectal Cancer Screening in an Underserved Population. Gastroenterology. 2014;146(2):577–9. Available from:

Church TR, Wandell M, Lofton-Day C, Mongin SJ, Burger M, Payne SR, et al. Prospective evaluation of methylated SEPT9 in plasma for detection of asymptomatic colorectal cancer. Gut. 2014;63(2):317–25. Available from: doi: 10.1136/gutjnl-2012-304149.

Conclusions Our study using the blood based mSEPT9 test showed that CRC signal in blood can be detected in asymptomatic average risk individuals undergoing screening. However, the utility of the test for population screening for CRC will require improved sensitivity for detection of early cancers and advanced adenomas.Clinical Trial Registration Number: NCT00855348

Brenner H, Hoffmeister M, Jansen L. Comparisons of colorectal cancer mortality between screening participants and the general population are strongly biased unless an incidence-based mortality approach is used. J Clin Epidemiol. 2014;67(2):184–9. Available from:

A common approach in the evaluation of screening for colorectal cancer (CRC) is comparing observed numbers of CRC deaths in screening participants with expected numbers derived from CRC mortality in the general population. We aimed to illustrate and quantify an often-overlooked bias that may occur in such studies if CRC mortality in the general population is not restricted by the date of diagnosis (whereas screening participants by definition do not have a prior CRC diagnosis). We illustrate and quantify the expected bias using cancer registry data from the United States. Unless an incidence-based mortality approach is used, expected numbers of CRC deaths in screening cohorts (and hence estimated screening effects) are substantially overestimated. Overestimation of expected CRC deaths is most severe (more than fivefold) during the first year of follow-up and rapidly decreases in the subsequent years. Nevertheless, overestimation of 5- and 10-year cumulative numbers of expected CRC deaths is still as high as 60–70% and 20–30%, respectively. Substantial bias even persists if the initial years of follow-up are excluded from the analyses. Careful restriction of expected CRC deaths by an incidence-based mortality approach is indispensable for deriving valid screening effect estimates.

Ransohoff DF. What is the effect of more sensitive diagnostic technology? Lancet Oncol. 2014;15(3):256–7. Available from: doi: SD. Dedicated Outreach Is Effective in Increasing


Nota bibliográfica cribado c colorrectal 2014-01

Rabeneck L, Tinmouth JM, Paszat LF, Baxter NN, Marrett LD, Ruco A, et al. Ontario’s ColonCancerCheck: Results from Canada's first province-wide colorectal cancer screening program. Cancer Epidemiol Biomarkers Prev. 2014; Available from: doi: 10.1158/1055-9965.EPI-13-0956.

Conclusions: These results provide an early indication of Program performance and provide findings relevant to other organized CRC screening programs. Impact: The greater cancer detection rate in those at increased risk due to family history who undergo colonoscopy screening suggests that a strategy of risk stratification will enhance the impact of FOBT-based screening programs.

Zubero MB, Arana-Arri E, Pijoan JI, Portillo I, Idigoras I, López-Urrutia A, et al. Population-based colorectal cancer screening: comparison of two fecal occult blood test. Front Pharmacol. 2014;4(January):1–8. Available from: doi: 10.3389/fphar.2013.00175.

Bulliard J-L, Garcia M, Blom J, Senore C, Mai V, Klabunde C. Sorting out measures and definitions of screening participation to improve comparability: The example of colorectal cancer. Eur J Cancer. 2014;50(2):434–46. Available from: doi:

Abstract Participation is a key indicator of the potential effectiveness of any population-based intervention. Defining, measuring and reporting participation in cancer screening programmes has become more heterogeneous as the number and diversity of interventions have increased, and the purposes of this benchmarking parameter have broadened. This study, centred on colorectal cancer, addresses current issues that affect the increasingly complex task of comparing screening participation across settings. Reports from programmes with a defined target population and active invitation scheme, published between 2005 and 2012, were reviewed. Differences in defining and measuring participation were identified and quantified, and participation indicators were grouped by aims of measure and temporal dimensions. We found that consistent terminology, clear and complete reporting of participation definition and systematic documentation of coverage by invitation were lacking. Further, adherence to definitions proposed in the 2010 European Guidelines for Quality Assurance in Colorectal Cancer Screening was suboptimal. Ineligible individuals represented 1% to 15% of invitations, and variable criteria for ineligibility yielded differences in participation estimates that could obscure the interpretation of colorectal cancer screening participation internationally. Excluding ineligible individuals from the reference population enhances comparability of participation measures. Standardised measures of cumulative participation to compare screening protocols with different intervals and inclusion of time since invitation in definitions are urgently needed to improve international comparability of colorectal cancer screening participation. Recommendations to improve comparability of participation indicators in cancer screening interventions are made.

Lee JK, Liles EG, Bent S, Levin TR, Corley DA. Accuracy of Fecal Immunochemical Tests for Colorectal CancerSystematic Review and Meta-analysis. Ann Intern Med. 2014;160(3):171–81. Available from:

Conclusion: Fecal immunochemical tests are moderately sensitive, are highly specific, and have high overall diagnostic accuracy for detecting CRC. Diagnostic performance of FITs depends on the cutoff value for a positive test result.


Nota bibliográfica cribado c colorrectal 2013-12

Hamza S, Dancourt V, Lejeune C, Bidan JM, Lepage C, Faivre J. Diagnostic yield of a one sample immunochemical test at different cut-off values in an organised screening programme for colorectal cancer. Eur J Cancer. 2013;49(12):2727–33. Available from: doi:

Conclusion The study suggests that in countries with colonoscopy facilities compatible with a screening test positivity rate of up to 5%, use of a 1-day test with a cut-off value between 100 and 150 ng/mL could be the recommended strategy. Further increasing the cut-off value up to the same positivity rate as Hemoccult could be used in areas with limited access to colonoscopy.

Raginel T, Puvinel J, Ferrand O, Bouvier V, Levillain R, Ruiz A, et al. A population-based comparison of immunochemical fecal occult blood tests for colorectal cancer screening. Gastroenterology. Centre Hospitalier Universitaire (CHU) de Caen, Caen, France; Normandie University, Caen, France.; 2013;144(5):918–25. doi: 10.1053/j.gastro.2013.01.042; 10.1053/j.gastro.2013.01.042.

CONCLUSIONS: Based on results from a large, population-based study, the OC Sensor FIT identifies patients with colorectal cancer with greater accuracy than the Magstream FIT. number: NCT01251666.

Lejeune C, Le Gleut K, Cottet V, Galimard C, Durand G, Dancourt V, et al. The cost-effectiveness of immunochemical tests for colorectal cancer screening. Dig Liver Dis. (0). Available from: doi:
Conclusion One-stool immunochemical testing can be considered a promising alternative to the guaiac faecal occult blood test for colorectal cancer mass screening in the general population. Competition between manufacturers should now be introduced to reduce purchase price differences.

Kuipers EJ. Colorectal cancer: Screening one small step for mankind, one giant leap for man. Nat Rev Clin Oncol. 2014;11(1):5–6. Available from:

Laing SS, Bogart A, Chubak J, Fuller S, Green BB. Psychological Distress after a Positive Fecal Occult Blood Test Result among Members of an Integrated Healthcare Delivery System. Cancer Epidemiol Biomarkers Prev. 2013; Available from: doi: 10.1158/1055-9965.EPI-13-0722.

Impact: Distress from FOBT (+) results declined to near-baseline levels by 4 months. Additional studies are needed to clarify the relationship between long-term distress and follow-up colonoscopy. Cancer Epidemiol Biomarkers Prev; 23(1); 1–6. ©2013 AACR.

Davis TC, Arnold CL, Bennett CL, Wolf MS, Reynolds C, Liu D, et al. Strategies to Improve Repeat Fecal Occult Blood Testing Cancer Screening. Cancer Epidemiol Biomarkers Prev. 2013; Available from: doi: 10.1158/1055-9965.EPI-13-0795.

Conclusion: A mailed pamphlet and FOBT with simplified instructions did not improve annual screening.Impact: Telephone outreach by a nurse manager was effective in improving rates of repeat FOBT, yet this may be too costly for community clinics. Cancer Epidemiol Biomarkers Prev; 1–10. ©2013 AACR


Nota bibliográfica cribado c colorectal 2013-11

Van Roon AHC, Goede SL, van Ballegooijen M, van Vuuren AJ, Looman CWN, Biermann K, et al. Random comparison of repeated faecal immunochemical testing at different intervals for population-based colorectal cancer screening. Gut. 2013;62(3):409–15. Available from: doi: 10.1136/gutjnl-2011-301583. PMID: 22387523.

Conclusion The total number of advanced neoplasia found at repeat FIT screening is not influenced by the interval length within a range of 1–3 years. Furthermore, there is a stable and acceptably high participation in the second screening round. This implies that screening intervals can be tailored to local resources.

Robb KA, Lo SH, Power E, Kralj-Hans I, Edwards R, Vance M, et al. Patient-reported outcomes following flexible sigmoidoscopy screening for colorectal cancer in a demonstration screening programme in the UK. J Med Screen. 2013; Available from: doi: 10.1177/0969141313476629. PMID: 23417540.

CONCLUSIONS: PROMs indicate high acceptability of FS screening in 58-59 year olds, with no adverse effects on colorectal symptoms, health status or psychological wellbeing.

Bowyer HL, Vart G, Kralj-Hans I, Atkin W, Halloran SP, Seaman H, et al. Patient attitudes towards faecal immunochemical testing for haemoglobin as an alternative to colonoscopic surveillance of groups at increased risk of colorectal cancer. J Med Screen. 2013;20(149):156. Available from: doi: 10.1177/0969141313503953. PMID: 24045920.

CONCLUSIONS: FIT may be well-received as an additional method of surveillance for new patients at intermediate risk of CRC. More research is required to better understand potential barriers associated with FIT surveillance for patients with experience of colonoscopic surveillance.

Murphy CC, McQueen A, Bartholomew LK, del Junco DJ, Coan SP, Vernon SW. Factorial Validity and Invariance of Four Psychosocial Constructs of Colorectal Cancer Screening: Does Screening Experience Matter? Cancer Epidemiol Biomarkers Prev. 2013; Available from: doi: 10.1158/1055-9965.EPI-13-0565. PMID: 24057575.

Conclusion: Our findings provide additional support for the construct validity of scales of CRCS benefits, barriers, self-efficacy, and optimism. A greater understanding of the differences between current and never screeners may improve measurement invariance.Impact: Measures of benefits, barriers, self-efficacy, and optimism may be used to specify intervention targets and effectively assess change pre- and post-intervention across screening groups. Cancer Epidemiol Biomarkers Prev; 22(12); 1–8. ©2013 AACR.

Massat NJ, Moss SM, Halloran SP, Duffy SW. Screening and Primary prevention of Colorectal Cancer: a Review of sex-specific and site-specific differences. J Med Screen. 2013;20(3):125–48. Available from: doi: 10.1177/0969141313501292.

Conclusions: We encourage researchers of CRC screening and prevention to publish their results by sex where possible. Pilot studies should be undertaken before implementation of quantitative FIT in a national screening programme to establish the appropriate threshold. Finally, individual risk assessment for CRC and non-CRC events, will be necessary to make an informed decision on whether a patient should receive aspirin chemoprevention.

Eldridge RC, Doubeni C a, Fletcher RH, Zauber AG, Corley D a, Doria-Rose VP, et al. Uncontrolled confounding in studies of screening effectiveness: an example of colonoscopy. J Med Screen. 2013; Available from: doi: 10.1177/0969141313508282. PMID: 24144847.

CONCLUSION: Health behaviour-related confounders, either alone or in combination, seem unlikely to strongly affect the association between colonoscopy and CRC mortality in observational studies of CRC screening.

Laing SS, Bogart A, Chubak J, Fuller S, Green BB. Psychological Distress after a Positive Fecal Occult Blood Test Result among Members of an Integrated Healthcare Delivery System. Cancer Epidemiol Biomarkers Prev. 2013; Available from: doi: 10.1158/1055-9965.EPI-13-0722.

Conclusions: FOBT (+) results are associated with short-term situational anxiety and CRCspecific mood disturbances. Impact: Distress from FOBT (+) result declined to near baseline levels by 4 months. Additional studies are needed to clarify the relationship between long-term distress and follow-up colonoscopy.

Ghanouni A, Halligan S, Taylor SA, Boone D, Plumb A, Wardle J, et al. Evaluating patients’ preferences for type of bowel preparation prior to screening CT colonography: Convenience and comfort versus sensitivity and specificity. Clin Radiol. 2013;68(11):1140–5. Available from:

To explore the relative value patients place on comfort and convenience versus test sensitivity and specificity in the context of computed tomographic colonography (CTC) screening. Twenty semi-structured interviews were carried out with patients attending hospital for radiological tests unrelated to CTC. Preferences for CTC with different types of bowel preparation for CTC screening were examined and interviews were analysed thematically. The discussion guide included separate sections on CTC, bowel preparation methods (non-, reduced- and full-laxative), and sensitivity and specificity. Patients were given information on each topic in turn and asked about their views and preferences during each section. Following information about the test, patients’ attitudes towards CTC were positive. Following information on bowel preparation, full-laxative purgation was anticipated to cause more adverse physical and lifestyle effects than using reduced- or non-laxative preparation. However, stated preferences were approximately equally divided, largely due to patients anticipating that non-laxative preparations would reduce test accuracy (because the bowel was not thoroughly cleansed). Following information on sensitivity and specificity (which supported patients' expectations), the predominant stated preference was for full-laxative preparation. Patients are likely to value test sensitivity and specificity over a more comfortable and convenient preparation. Future research should test this hypothesis on a larger sample.

Watson J, Shaw K, Macgregor M, Smith S, Halloran S, Patnick J, et al. Use of research questionnaires in the NHS Bowel Cancer Screening Programme in England: impact on screening uptake. J Med Screen. 2013; Available from: doi: 10.1177/0969141313511447. PMID: 24177175.

CONCLUSIONS: Researchers planning studies that include contact with potential participants within the NHS Bowel Cancer and similar screening programmes should be aware of the potential impact on uptake.

Davis TC, Arnold CL, Bennett CL, Wolf MS, Reynolds C, Liu D, et al. Strategies to Improve Repeat Fecal Occult Blood Testing Cancer Screening. Cancer Epidemiol biomarkers Prev. 2013; Available from: doi: 10.1158/1055-9965.EPI-13-0795. PMID: 24192009.

Conclusion: A mailed pamphlet and FOBT with simplified instructions did not improve annual screening. Impact: Telephone outreach by a nurse manager was effective in improving rates of repeat FOBT yet this may be too costly for community clinics


Nota bibliográfica cribado c colorrectal 2013-10

Binefa G, García M, Milà N, Rodríguez L, Rodríguez-Moranta F. Colonoscopy quality assessment in a mass population screening programme based on faecal occult blood test. Rev Esp Enferm Dig. 2013;105:400–8.

Conclusion: although the majority of results reached the recommended standards, some areas have been identified for quality enhancement. Continuous monitoring of quality indicators is essential for improving the current effectiveness of CRC screening programmes


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