Faivre J, Tazi M A, Launoy G
Faculté de Médecine, Registre Bourguignon des Cancers Digestifs, Dijon.
Rev Epidemiol Sante Publique. 1996;44 Suppl 1:S7-14.
Considering the present state of knowledge, only the strategy of screening for intestinal tumours at the asymptomatic stage could reduce such a problem as colorectal cancer. Data from case-control studies provide evidence of the efficacy of screening by rigid proctosigmoidoscopy. But compliance with such a strategy is not known. The effectiveness of screening by sigmoidoscopy has yet to be demonstrated. A European controlled study of flexible sigmoidoscopy in association with the Hemoccult test versus the Hemoccult test alone has been set up. Evaluation by a randomized screening trial with a single flexible sigmoidoscopic examination at age 55 to 60 years has also been suggested. Case-control studies and a randomized study conducted among volunteers demonstrate that it is possible to reduce mortality from colorectal cancer in people who accept screening with faecal occult blood testing, using the Hemocult test. Four population-based studies have been set up in Europe (in England, Denmark, France and Sweden). They are based on a biannual Hemoccult test. Compliance in the test group ranges between 55% and 65% in the first screening campaign and remains high in the following screening campaigns. In France, to achieve this goal, the test must be proposed by GPs and then mailed to those who do not consult GPs. Reliable mortality data will be available within 1 to 3 years. The results of the European trials must be awaited to know if screening biennually is effective in reducing colorectal cancer mortality.
鉴于目前的知识水平，只有在无症状阶段筛查肠道肿瘤的策略才能减少诸如结直肠癌这样的问题。病例对照研究的数据为硬式直肠乙状结肠镜检查筛查的有效性提供了证据。但这种策略的依从性尚不清楚。乙状结肠镜检查筛查的有效性还有待证实。已经开展了一项欧洲对照研究，比较柔性乙状结肠镜检查联合隐血试验与单纯隐血试验的效果。也有人建议通过在55至60岁时进行单次柔性乙状结肠镜检查的随机筛查试验来进行评估。病例对照研究以及在志愿者中进行的一项随机研究表明，使用Hemocult试验接受粪便隐血检测筛查的人群中，有可能降低结直肠癌死亡率。欧洲（英国、丹麦、法国和瑞典）已经开展了四项基于人群的研究。这些研究基于每两年进行一次的Hemoccult试验。在首次筛查活动中，试验组的依从率在55%至65%之间，在随后的筛查活动中仍然很高。在法国，为实现这一目标，该试验必须由全科医生提出，然后邮寄给那些不咨询全科医生的人。1至3年内将获得可靠的死亡率数据。必须等待欧洲试验的结果，以了解每两年进行一次筛查是否能有效降低结直肠癌死亡率。
