Screening for colorectal cancer

Findings by SBU Alert

This is a translation of version 1, published on April 11, 2000. The latest version of this report is not available in English.

Cancer of the colon and rectum is third most common cause of death from cancer. Each year, approximately 2 500 people in Sweden die because of the disease. The risk of being affected is the same in men and women and increases with age. One way to reduce morbidity and mortality is to detect cancer at an early stage where surgical intervention has good results. General screening in the population can be conducted with the help of a test that measures occult blood in the feces (Hemoccult). Individuals who are included in the program receive a sample kit by mail. An envelope containing a feces sample is sent to a laboratory for analysis. If blood is found in the feces further studies are conducted. Surgery is often performed in patients found to have cancer.

The effects of screening on mortality have been studied in four large randomized studies. Furthermore, the costs and cost effectiveness have been estimated in several studies. The results uniformly show that screening reduces mortality from colorectal cancer. The absolute risk is reduced between 0.08 percent to 0.26 percent. SBU has calculated the economic impact of conducting a screening program throughout Sweden which is similar in design to a program in Denmark. Analysis shows that the number of deaths could be reduced by approximately 400 per year at a cost of 139 million SEK. The cost of avoiding one case of death from colorectal cancer would be approximately 300 000 SEK.

Alert finds there is good* scientific evidence concerning the effects of this method on mortality. There is moderate* evidence concerning the risks and side effects. There is moderate* evidence concerning the costs and cost-effectiveness of screening for colorectal cancer.

The scientific findings suggest that screening helps reduce mortality from colorectal cancer. The reported effects vary in different studies due to variations in program design. The potential benefits in terms of life years gained that can be achieved through a general screening program must be weighed against the costs and potential negative effects. The introduction of general screening for colorectal cancer in Sweden would require extensive organizational change and a major redistribution of qualified staff from other activities in health care. Due to uncertainty concerning optimum program design, the negative consequences, the necessity to redistribute healthcare resources, and deficient knowledge concerning psychological impact and cost effectiveness, a general screening program for colorectal cancer should not be undertaken at this time. Until further notice, screening for colorectal cancer should take place only within the framework of scientific assessments.

*This assessment by SBU Alert uses a 4-point scale to grade the quality and evidence of the scientific documentation. The grades indicate: (1) good, (2) moderate, (3) poor, or (4) no scientific evidence on the subject.

This summary is based on a report prepared at SBU in collaboration with Assoc Prof Gunnar Arbman, MD PhD, Vrinnevisjukhuset i Norrköping, Hans Brevinge, MD, Sahlgrenska University Hospital, Karin Bäckman, Econ, Linköpings Universitet, and Prof Lars Påhlman, MD PhD, Uppsala University Hospital. It has been reviewed by Assoc Prof Göran Ekelund, MD PhD, Malmö University Hospital.

Alert is a joint effort by the Swedish Council on Technology Assessment in Health Care (SBU), the Medical Products Agency, the National Board of Health and Welfare, and the Federation of Swedish County Councils.

References

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