Launoy G, Herbert C, Vallée J P, Desoubeaux N, Réaud J M, Ollivier V, Bouvier V, Flachs A, Arsène D, Valla A, Gignoux M
Registre des Cancers Digestifs du Calvados.
Gastroenterol Clin Biol. 1996;20(3):228-36.
Screening for colorectal cancer is a major public health problem in France as in most developed countries. Several controlled trials are on-going in Europe. The aim of the study was to determine requirements for success of mass-screening for colorectal cancer in France.
A mass-screening program has been conducted between April 1991 and June 1994 in the department of Calvados for 164,364 people aged 45-74 years. The screening test was first proposed by general practitioners and occupational doctors during appointments. Secondly, a postal invitation to obtain the test, free of charge, by doctor or chemist, was sent.
Global participation rate was 43.4%; 40.2% of tests were distributed during the first phase, 47.1% during the second phase and 12.7% were distributed by a private health institute. Participation was higher for females (47.1%) than males (39.2%) and for urban districts (46.5%) than rural districts (24.4%). In case of positive test, colonoscopy has been more frequently achieved in urban districts and when test has been distributed by a physician. Positivity rate was 2.8%. Positive predictive value was 8.0% for a cancer and 13.5% for an adenoma larger than 1 cm. Because both positivity rate and positive predictive value were higher for males than females and increased with age, rate of cancer or large adenoma screened was almost three times higher for males than females and markedly increased with age.
In France, different recruitment methods have to be used to reach a satisfactory participation to a mass-screening campaign. Such a program requires involvement of general practitioners and close coordination between practitioners and health care insurance agencies.
与大多数发达国家一样，在法国，结直肠癌筛查是一个重大的公共卫生问题。欧洲正在进行多项对照试验。本研究的目的是确定法国大规模结直肠癌筛查成功的要求。
1991年4月至1994年6月期间，在卡尔瓦多斯省对164364名45 - 74岁的人群开展了一项大规模筛查项目。筛查测试首先由全科医生和职业医生在预约时提出。其次，通过邮寄邀请，让医生或药剂师免费提供该测试。
总体参与率为43.4%；40.2%的测试在第一阶段分发，47.1%在第二阶段分发，12.7%由一家私立健康机构分发。女性（47.1%）的参与率高于男性（39.2%），城市地区（46.5%）高于农村地区（24.4%）。检测呈阳性时，城市地区以及由医生分发测试时，结肠镜检查的完成率更高。阳性率为2.8%。癌症的阳性预测值为8.0%，直径大于1厘米的腺瘤的阳性预测值为13.5%。由于男性的阳性率和阳性预测值均高于女性，且随年龄增加，筛查出的癌症或大腺瘤的发生率男性几乎是女性的三倍，且随年龄显著增加。
在法国，必须采用不同的招募方法以实现大规模筛查活动的满意参与度。这样一个项目需要全科医生的参与以及从业者与医疗保险机构之间的密切协调。
