Manfredi S, Piette C, Durand G, Plihon G, Mallard G, Bretagne J-F
Service des Maladies de l'Appareil Digestif, Hôpital Pontchaillou, Rennes, France.
Endoscopy. 2008 May;40(5):422-7. doi: 10.1055/s-2007-995430. Epub 2008 Jan 9.
Mass screening for colorectal cancer in France was initiated in pilot regions on the basis of the fecal occult blood test (FOBT) followed by colonoscopy in positive cases. We report the colonoscopy results in one of the first areas to be screened (Ille et Vilaine).
Of the total regional population of 908,449, 187,342 of the 213,635 potential screening candidates who were aged 50 - 74 years were invited for FOBT. Of the 51.3% compliant individuals, 2.6% were positive, and of these 90.7% agreed to undergo colonoscopy (n = 2246). The colonoscopy procedure details, findings, and complications were recorded. Subjects were classified according to the most advanced lesion. Positive predictive values of FOBT were calculated according to sex and age.
Colonoscopy was complete in 96.3% of cases. Only 23 adverse events were encountered (1.02%). Colorectal cancer was diagnosed in 237 cases (10.6%, 78.4% of which were clinical stages I - II). The rates of overall adenomas and advanced adenomas were 33.1 % and 21.6 %, respectively. The risk of cancer and advanced adenoma increased significantly in men and in older people.
The results of mass screening with FOBT followed by colonoscopy in this population-based study are very encouraging in terms of compliance, early findings, and complications. Extension of this program to the whole of France is justified.
法国在试点地区基于粪便潜血试验（FOBT）开展了大规模结直肠癌筛查，检测呈阳性的病例随后接受结肠镜检查。我们报告了首批筛查地区之一（伊勒-维莱讷省）的结肠镜检查结果。
在908,449名地区总人口中，邀请了213,635名年龄在50 - 74岁的潜在筛查对象中的187,342人进行FOBT检测。在51.3%的依从性个体中，2.6%检测呈阳性，其中90.7%同意接受结肠镜检查（n = 2246）。记录了结肠镜检查的操作细节、检查结果及并发症。根据最严重的病变对受试者进行分类。根据性别和年龄计算FOBT的阳性预测值。
96.3%的病例完成了结肠镜检查。仅出现23例不良事件（1.02%）。诊断出237例结直肠癌（10.6%，其中78.4%为临床I - II期）。总体腺瘤和高级别腺瘤的发生率分别为33.1%和21.6%。男性和老年人患癌及高级别腺瘤的风险显著增加。
在这项基于人群的研究中，先进行FOBT检测再进行结肠镜检查的大规模筛查结果在依从性、早期发现及并发症方面都非常令人鼓舞。将该项目推广至法国全国是合理的。
