Matarese Vincenzo Giancarlo, Feo Carlo V, Pezzoli Alessandro, Trevisani Lucio, Brancaleoni Massimiliano, Gullini Sergio
Unit of aGastroenterology and Endoscopy, Sant'Anna University Hospital of Ferrara, Ferrara, Italy.
Eur J Cancer Prev. 2007 Aug;16(4):292-7. doi: 10.1097/01.cej.0000236242.48242.48.
The aim of this study was three-fold: (a) to present a surveillance plan for colorectal cancer prevention with colonoscopy, focused on first-degree relatives of colorectal cancer patients in the province of Ferrara (Italy); (b) to analyse the cost of colonoscopy at the University Hospital of Ferrara; and (c) to analyse the cost of the surveillance plan in our province. In January 2000, in the province of Ferrara, following a campaign of public sensitization, a plan of surveillance with colonoscopy was started, addressing the population at an increased risk for colorectal cancer (i.e. over 45-year-old first-degree relatives of patients with either colorectal cancer or adenomatous polyps revealed before 60 years of age). In addition, we estimated the cost of colonoscopy both at the University Hospital of Ferrara and of the surveillance plan. Between January 2000 and October 2003, 585 individuals at increased risk were interviewed. Five hundred and forty-four (94%) accepted to undergo a colonoscopy. By October 2003, 439 (81%) colonoscopies had been performed. Colonoscopy was normal in 330 individuals (75%). In 109 individuals (25%), 144 lesions were found: 35 patients (32%) had hyperplastic polyps, 66 (61%) had adenomas, and eight (7%) adenocarcinomas (six Dukes A, one Dukes B, and one Dukes C stage). Out of a total of 101 adenomas, 68 were tubular adenomas (67%), 24 tubulo-villous adenomas (24%), and nine adenomas with high-grade dysplasia (9%). The cost of colonoscopy at our hospital and the costs of the surveillance plan amounted to euro 130.84 (euro 169.57 with single biopsy) and euro 43,103.66 (euro 42 310.34/year), respectively. These data show (a) the efficacy of colonoscopy in the early diagnosis of colorectal cancer and premalignant lesions in first-degree relatives of colorectal cancer patients; (b) the low cost of colonoscopy at the centre performing the surveillance; and (c) the feasibility of screening and surveillance programmes for colorectal cancer prevention.
（a）提出一项针对结直肠癌预防的结肠镜监测计划，重点关注费拉拉省（意大利）结直肠癌患者的一级亲属；（b）分析费拉拉大学医院结肠镜检查的成本；（c）分析我省监测计划的成本。2000年1月，在费拉拉省，经过公众宣传活动后，启动了一项结肠镜监测计划，针对结直肠癌风险增加的人群（即45岁以上的结直肠癌患者或60岁之前发现的腺瘤性息肉患者的一级亲属）。此外，我们估计了费拉拉大学医院结肠镜检查的成本以及监测计划的成本。在2000年1月至2003年10月期间，对585名风险增加的个体进行了访谈。544人（94%）接受了结肠镜检查。到2003年10月，已进行了439例（81%）结肠镜检查。330名个体（75%）的结肠镜检查结果正常。在109名个体（25%）中发现了144处病变：35名患者（32%）有增生性息肉，66名（61%）有腺瘤，8名（7%）有腺癌（6例杜克A期，1例杜克B期，1例杜克C期）。在总共101例腺瘤中，68例为管状腺瘤（67%），24例为管状绒毛状腺瘤（24%），9例为高级别不典型增生腺瘤（9%）。我院结肠镜检查的成本以及监测计划的成本分别为130.84欧元（单次活检为169.57欧元）和43,103.66欧元（42,310.34欧元/年）。这些数据表明：（a）结肠镜检查在结直肠癌患者一级亲属中早期诊断结直肠癌和癌前病变方面的有效性；（b）进行监测的中心结肠镜检查成本较低；（c）结直肠癌预防筛查和监测计划的可行性。
