SNFGE SNFGE
 
Thématique :
- Endoscopie/Imagerie
Originalité :
Très original
Solidité :
Très solide
Doit faire évoluer notre pratique :
Pas encore
 
 
Nom du veilleur :
Docteur Jean-Michel ROUILLON
Coup de coeur :
 
 
The American Journal of Gastroenterology
  2017/07  
 
  2017 Jul;112(7):1016-1030.  
  doi: 10.1038/ajg.2017.174  
 
  Colorectal Cancer Screening: Recommendations for Physicians and Patients From the U.S. Multi-Society Task Force on Colorectal Cancer.  
 
  Rex DK, Boland CR, Dominitz JA, Giardiello FM, Johnson DA, Kaltenbach T, Levin TR, Lieberman D, Robertson DJ  
  https://www.ncbi.nlm.nih.gov/pubmed/28555630  
 
 

Abstract

This document updates the colorectal cancer (CRC) screening recommendations of the U.S. Multi-Society Task Force of Colorectal Cancer (MSTF), which represents the American College of Gastroenterology, the American Gastroenterological Association, and The American Society for Gastrointestinal Endoscopy. CRC screening tests are ranked in 3 tiers based on performance features, costs, and practical considerations. The first-tier tests are colonoscopy every 10 years and annual fecal immunochemical test (FIT). Colonoscopy and FIT are recommended as the cornerstones of screening regardless of how screening is offered. Thus, in a sequential approach based on colonoscopy offered first, FIT should be offered to patients who decline colonoscopy. Colonoscopy and FIT are recommended as tests of choice when multiple options are presented as alternatives. A risk-stratified approach is also appropriate, with FIT screening in populations with an estimated low prevalence of advanced neoplasia and colonoscopy screening in high prevalence populations. The second-tier tests include CT colonography every 5 years, the FIT-fecal DNA test every 3 years, and flexible sigmoidoscopy every 5 to 10 years. These tests are appropriate screening tests, but each has disadvantages relative to the tier 1 tests. Because of limited evidence and current obstacles to use, capsule colonoscopy every 5 years is a third-tier test. We suggest that the Septin9 serum assay (Epigenomics, Seattle, Wash) not be used for screening. Screening should begin at age 50 years in average-risk persons, except in African Americans in whom limited evidence supports screening at 45 years. CRC incidence is rising in persons under age 50, and thorough diagnostic evaluation of young persons with suspected colorectal bleeding is recommended. Discontinuation of screening should be considered when persons up to date with screening, who have prior negative screening (particularly colonoscopy), reach age 75 or have <10 years of life expectancy. Persons without prior screening should be considered for screening up to age 85, depending on age and comorbidities. Persons with a family history of CRC or a documented advanced adenoma in a first-degree relative age <60 years or 2 first-degree relatives with these findings at any age are recommended to undergo screening by colonoscopy every 5 years, beginning 10 years before the age at diagnosis of the youngest affected relative or age 40, whichever is earlier. Persons with a single first-degree relative diagnosed at ≥60 years with CRC or an advanced adenoma can be offered average-risk screening options beginning at age 40 years.

 
Question posée
 
Quelles sont les recommandations de l'US multisociety task force pour le dépistage du cancer colorectal aux Etats-Unis ?
 
Question posée
 
3 niveaux d'option de dépistage sont retenues aux USA : coloscopie tous les 10 ans ou FIT annuel, CT coloscanner tous les 5 ans couplé à un FIT DNA tous les 3 ans et une coloscopie courte tous les 5 à 10 ans et enfin en troisième niveau une capsule colique tous les 5 ans.
 
Commentaires

Le dépistage aux USA repose sur un choix plus grand du patient.
Les Afro-américains sont dépistés plus tôt à partir de 45 ans et enfin en l'absence de tests antérieurs et s'il n'y a pas de co-morbidité, le dépistage continue à s'effectuer plus tard qu'en France jusqu'à 85 ans. Donc 3 particularités Nord américaines par rapport au choix de dépistage proposé en France...
Les résultats de ces deux politiques différentes seront à suivre et à comparer.

 
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