Kantonsspital Aarau AG, Division of Rheumatology, Aarau, Switzerland.
Division of Gastroenterology, Kantonsspital Uri, Altdorf, Switzerland.
Z Gastroenterol. 2022 May;60(5):761-778. doi: 10.1055/a-1796-2471. Epub 2022 May 11.
The success of colorectal cancer (CRC) screening depends mainly on screening quality, patient adherence to surveillance, and costs. Consequently, it is essential to assess the performance over time.
In 2000, a closed cohort study on CRC screening in individuals aged 50 to 80 was initiated in Uri, Switzerland. Participants who chose to undergo colonoscopy were followed over 18 years. We investigated the adherence to recommended surveillance and collected baseline characteristics and colonoscopy data. Risk factors at screening for the development of advanced adenomas were analyzed. Costs for screening and follow-up were evaluated retrospectively.
1278 subjects with a screening colonoscopy were included, of which 272 (21.3%; 69.5% men) had adenomas, and 83 (6.5%) had advanced adenomas. Only 59.8% participated in a follow-up colonoscopy, half of them within the recommended time interval. Individuals with advanced adenomas at screening had nearly five times the risk of developing advanced adenomas compared to individuals without adenomas (24.3% vs. 5.0%, OR 4.79 CI 2.30-9.95). Individuals without adenomas developed advanced adenomas in 4.9%, including four cases of CRC; three of them without control colonoscopy. The villous component in adenomas smaller than 10 mm was not an independent risk factor. Costs for screening and follow-up added up to CHF 1'934'521 per 1'000 persons screened, almost half of them for follow-up examinations; 60% of these costs accounted for low-risk individuals.
Our findings suggest that follow-up of screening colonoscopy should be reconsidered in Switzerland; in particular, long-term adherence is critical. Costs for follow-up could be substantially reduced by adopting less expensive long-term screening methods for low-risk individuals.
结直肠癌（CRC）筛查的成功主要取决于筛查质量、患者对监测的依从性和成本。因此，评估其随时间的表现至关重要。
2000 年，在瑞士乌里启动了一项针对 50 至 80 岁人群的 CRC 筛查的封闭队列研究。选择接受结肠镜检查的参与者随访 18 年。我们调查了推荐监测的依从性，并收集了基线特征和结肠镜检查数据。分析了筛查时发生高级腺瘤的风险因素。回顾性评估了筛查和随访的成本。
共纳入 1278 例接受筛查性结肠镜检查的受试者，其中 272 例（21.3%；69.5%为男性）患有腺瘤，83 例（6.5%）患有高级腺瘤。仅有 59.8%的人参加了随访结肠镜检查，其中一半人在推荐的时间间隔内进行。与无腺瘤的人相比，筛查时患有高级腺瘤的人发生高级腺瘤的风险几乎高出五倍（24.3%比 5.0%，OR 4.79，CI 2.30-9.95）。无腺瘤的人发生高级腺瘤的比例为 4.9%，包括 4 例 CRC；其中 3 例无对照结肠镜检查。直径小于 10mm 的腺瘤中绒毛成分不是独立的危险因素。筛查和随访的成本总计为每 1000 人筛查 1934521 瑞士法郎，其中近一半用于随访检查；这些成本的 60%用于低危人群。
我们的研究结果表明，瑞士应重新考虑对筛查性结肠镜检查的随访；特别是，长期的依从性至关重要。通过为低危人群采用更廉价的长期筛查方法，可以大幅降低随访成本。
