Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), INF 581, 69120 Heidelberg, Germany; Division of Preventive Oncology, German Cancer Research Center (DKFZ), INF 460, 69120 Heidelberg, Germany; German Cancer Consortium (DKTK), INF 280, 69120 Heidelberg, Germany.
Central Research Institute of Ambulatory Health Care in Germany, Berlin, Germany.
Eur J Cancer. 2015 Jul;51(10):1346-53. doi: 10.1016/j.ejca.2015.03.020. Epub 2015 Apr 20.
Endoscopy based screening programmes for colorectal cancer (CRC) are being implemented in an increasing number of countries. In Germany, screening colonoscopy at age 55 or older has been offered since the end of 2002. We aimed to estimate the long-term impact of this offer on CRC prevention.
We estimated numbers of prevented CRC cases by expected age and year of their (prevented) occurrence over four decades (2005-2045) by four state Markov models (non-advanced adenoma, advanced adenoma, preclinical CRC, clinically manifest CRC). Estimates are based on screening colonoscopies reported to the German screening colonoscopy registry in 2003-2012 (N=4,407,971), transition rates between the four states and general population mortality rates.
Numbers of prevented clinically manifest CRC cases are projected to increase from <100 in 2005 to approximately 6500 in 2015, 12,600 in 2025, 15,400 in 2035 and 16,000 in 2045, compared to approximately 58,000 incident cases observed in 2003. The annual number of prevented cases is expected to be higher among men than among women and to strongly vary by age. The vast majority of prevented cases would have occurred at age 75 or older.
Despite modest participation rates, the German screening colonoscopy programme will lead to substantial reductions in the CRC burden. The reductions will be fully disclosed in the long run only and predominantly affect numbers of incident cases above 75years of age. Screening offers would need to start at younger ages in order to achieve more effective CRC prevention at younger ages.
越来越多的国家正在实施基于内镜的结直肠癌（CRC）筛查计划。在德国，自 2002 年底开始为 55 岁及以上人群提供筛查结肠镜检查。我们旨在评估该提议对 CRC 预防的长期影响。
我们通过四个州的马尔可夫模型（非高级腺瘤、高级腺瘤、临床前 CRC、临床显性 CRC），按预期年龄和（预防）发生年份估算 40 年内（2005-2045 年）预防 CRC 病例的数量。估计数基于 2003-2012 年向德国筛查结肠镜检查登记处报告的筛查结肠镜检查结果（N=4,407,971）、四种状态之间的转移率和一般人群死亡率。
预计到 2015 年，预防临床显性 CRC 病例的数量将从 2005 年的<100 例增加到约 6500 例，2025 年增加到 12,600 例，2035 年增加到 15,400 例，2045 年增加到 16,000 例，而 2003 年观察到的新发病例约为 58,000 例。预计男性的预防病例数将高于女性，且年龄差异较大。绝大多数预防病例将发生在 75 岁或以上。
尽管参与率较低，但德国筛查结肠镜检查计划将显著降低 CRC 负担。从长远来看，这些减少只会完全显现，主要影响 75 岁以上的新发病例数。为了在年轻时实现更有效的 CRC 预防，筛查建议需要从更年轻时开始。
