Green Terri, Richardson Ann, Parry Susan
Department of Management, University of Canterbury, Christchurch, New Zealand.
N Z Med J. 2012 Jun 8;125(1356):85-95.
To estimate the colonoscopy burden of introducing population screening for colorectal cancer in New Zealand.
Screening for colorectal cancer using biennial immunochemical faecal occult blood tests offered to people aged 50-74 years of age was modelled using population estimates from Statistics New Zealand for 2011-2031. Modelling to determine colonoscopy requirements was based on participation and test positivity rates from published results of screening programmes. Estimates of the number of procedures required for ongoing adenoma surveillance were calculated using screening literature results of adenoma yield, and New Zealand Guidelines for Adenoma Surveillance. Sensitivity analysis was undertaken on key parameters.
For a test positivity of 6.4%, biennial screening using immunochemical faecal occult blood testing with a 60% participation rate, would require 18,000 colonoscopies nationally, increasing to 28,000 by 2031. The majority of procedures are direct referrals from a positive FOBT, with surveillance colonoscopy numbers building over time.
Colonoscopy requirements for immunochemical faecal occult blood based population screening for colorectal cancer are high. Significant expansion of services is required and careful management of surveillance procedures to ensure timely delivery of initial colonoscopies whilst maintaining symptomatic services. A model re-run informed by data from the screening pilot will allow improved estimates for the New Zealand setting.
评估在新西兰引入结直肠癌人群筛查的结肠镜检查负担。
利用新西兰统计局2011 - 2031年的人口估计数据，对向50 - 74岁人群每两年提供一次免疫化学粪便潜血检测进行结直肠癌筛查进行建模。基于已发表的筛查项目结果中的参与率和检测阳性率，对确定结肠镜检查需求进行建模。根据腺瘤检出率的筛查文献结果和新西兰腺瘤监测指南，计算持续腺瘤监测所需的检查数量。对关键参数进行敏感性分析。
对于6.4%的检测阳性率，参与率为60%的每两年一次免疫化学粪便潜血检测筛查，全国将需要18,000例结肠镜检查，到2031年将增至28,000例。大多数检查是由粪便潜血检测阳性直接转诊而来，随着时间推移，监测结肠镜检查数量会增加。
基于免疫化学粪便潜血检测的结直肠癌人群筛查对结肠镜检查的需求很高。需要大幅扩大服务，并对监测程序进行仔细管理，以确保及时进行初次结肠镜检查，同时维持针对有症状患者的服务。根据筛查试点数据重新运行模型将有助于更准确地估计新西兰的情况。
