Department of Gastroenterology, School of Medicine, University of Murcia, Service of Gastroenterology, Hospital Universitario Virgen de la Arrixaca, Murcian Biosanitary Research Institute. Murcia, Spain.
Rev Esp Enferm Dig. 2012 Oct-Nov;104(10):537-45. doi: 10.4321/s1130-01082012001000006.
Colorectal cancer is a serious health problem in which screening is capable of reducing both the mortality and the incidence of the disorder. Colonoscopy, the mainstay of this type of screening, allows to establish an early diagnosis and also to eliminate malignant precursor lesions. The screening test which is performed in Spanish programs is the determination of fecal occult blood using the immunochemical method which gives around 70% of positive values for colonoscopy for any type of neoplasia. As a result, in 2009 the National Health System set as an objective that these programs cover 50% of the population by 2015. It is well known that colon screening is highly cost effective with a ratio of around 2500€ per QALY, much lower than ratios of other programs. Only the direct costs of colon and rectal cancer in Spain can be estimated at more than one thousand million euros per year. Early diagnosis and the cancers avoided thanks to screening can reduce these costs by 40%. The impact that the introduction of this screening has on health services can be lessened if the indications for colonoscopy are followed adequately. In conclusion, there is no justification for not acting to prevent CRC and this is especially so in times of crisis as there is no better social cost invested than that which saves suffering, deathsand even money.
结直肠癌是一个严重的健康问题，筛查能够降低死亡率和发病率。结肠镜检查是这种筛查的主要方法，可以进行早期诊断，并消除恶性前体病变。西班牙的筛查试验是使用免疫化学方法检测粪便潜血，对于任何类型的肿瘤，结肠镜检查的阳性率约为 70%。因此，2009 年国家卫生系统设定了一个目标，到 2015 年，这些计划覆盖 50%的人口。众所周知，结直肠癌筛查的成本效益非常高，每 QALY 的成本约为 2500 欧元，远低于其他计划的比率。仅西班牙结直肠癌和直肠癌的直接成本每年就可以估计超过 10 亿欧元。通过筛查进行早期诊断和避免癌症，可以将这些成本降低 40%。如果能够充分遵循结肠镜检查的适应症，那么这种筛查对卫生服务的影响可以减轻。总之，没有理由不采取行动预防 CRC，尤其是在危机时期，没有比预防痛苦、死亡甚至金钱更好的社会成本投资了。
