Thématique :
- Endoscopie/Imagerie
- Cancer colorectal (CCR)
Originalité :
Solidité :
Doit faire évoluer notre pratique :
Pas encore
Nom du veilleur :
Docteur Edouard Chabrun
Coup de coeur :
  2015 Aug. pii: S0016-5085(15)01068-9  
  doi: 10.1053/j.gastro.2015.07.042  
  Personalizing Colonoscopy Screening for Elderly Individuals Based on Screening History, Cancer Risk, and Comorbidity Status Could Increase Cost Effectiveness  
  van Hees F, Saini SD, Lansdorp-Vogelaar I, Vijan S, Meester RG, de Koning HJ, Zauber AG, van Ballegooijen M  


Colorectal cancer (CRC) screening decisions for elderly individuals are often made based primarily on age-other factors that affect the effectiveness and cost effectiveness of screening are often not considered. We investigated the relative importance of factors that could be used to identify elderly individuals most likely to benefit from CRC screening and determined the maximum ages at which screening remains cost effective based on these factors.


We used a microsimulation model (Microsimulation Screening Analysis-Colon) that was calibrated to the incidence of CRC in the US and the prevalence of adenomas reported in autopsy studies to determine the appropriate age to stop colonoscopy screening in 19,200 cohorts (of 10 million individuals), defined by sex, race, screening history, background risk for CRC, and comorbidity status. We applied a willingness-to-pay threshold of $100,000 per quality-adjusted life-year (QALY) gained.


Less-intensive screening history, higher background risk for CRC, and fewer comorbidities were associated with cost-effective screening at older ages. Sex and race had only a small effect on the appropriate age to stop screening. For some individuals likely to be screened in current practice (for example, 74-year-old white women with moderate comorbidities, half the average background risk for CRC, and negative findings from a screening colonoscopy 10 y prior), screening resulted in a loss of QALYs, rather than a gain. For some individuals unlikely to be screened in current practice (for example, 81-year-old black men with no comorbidities, an average background risk for CRC, and no prior screening), screening was highly cost effective. Although screening some previously screened, low-risk individuals was not cost effective even when they were 66 years old, screening some healthy, high-risk individuals remained cost effective until they reached an age of 88 years.


The current approach to CRC screening in elderly individuals, in which decisions are often based primarily on age, is inefficient, resulting in underuse of screening for some and overuse of screening for others. CRC screening could be more effective and cost effective if individual factors for each patient are considered.

Question posée
Dépistage du CCR chez les personnes âgées : existe-t-il des facteurs, autres que l’âge, qui permettraient de justifier ou non cet examen ? Quel est l’âge maximal où de dépistage serait utile et économique ?
Question posée
Ne tenir compte que de l’âge avancé pour arrêter le dépistage du CCR est insuffisant. Il faudrait prendre en compte d’autres facteurs personnels.

La période de dépistage est une recommandation et non une obligation. Nous pouvons nous adapter à chaque cas. Mais il n’existe pas encore de critères objectifs d’adaptation.