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Evidenze scientifiche

Le evidenze scientifiche nello screening colorettale

Consulta la sezione "Evidenze scientifiche" delle raccomandazioni per lo screening del colon retto (pdf 115 Kb).

Ricerca del sangue occulto nelle feci (Sof)

Esistono due tipi di test per la ricerca del Sof: quelli al guaiaco e quelli immunochimici. La ricerca del sangue occulto fecale (Sof) con test al guaiaco è associata a una riduzione della mortalità per Ccr: questo effetto protettivo, già osservato in numerosi studi caso-controllo, è stato confermato in quattro trial randomizzati. Su 10 mila persone invitate a effettuare un Sof nell’ambito di un programma di screening, ci si attendono 8,5 morti da Ccr in meno nell’arco di 10 anni, se due terzi effettuano almeno un test.

I test immunochimici hanno dimostrato un migliore rapporto costo-benefici e dovrebbero essere offerti come test di primo livello, ogni due anni, alla popolazione di entrambi i sessi di età compresa tra 50 e 70-74 anni (in accordo con la maggior parte delle esperienze italiane e internazionali).

Rettosigmoidoscopia (Rss)

Ci sono diverse evidenze scientifiche a favore dell’impiego della Rss come test di screening, anche se ancora non sono conclusi i trial in corso. La Rss, seguita da colonscopia totale (Ct) in caso si rilevino lesioni distali a rischio, permette di identificare circa il 70% delle lesioni avanzate prevalenti. Si stima inoltre che un’unica Rss effettuata tra i 55 e i 60 anni possa prevenire il 70% dei tumori distali in soggetti di 58-74 anni e il 50% in persone di 75-79 anni.

A parità di partecipazione allo screening, una sola Rss tra 55 e 60 anni consente di identificare una quota di Ccr e di adenomi avanzati pari almeno al totale di quelli osservati dopo 5 (per il Ccr) e 8 (per gli adenomi avanzati) round di screening con Sof biennale. Nello studio di confronto italiano che ha utilizzato il Sof immunologico, le stime corrispondenti sono di 2-3 round per il Ccr e 4-5 round per gli adenomi avanzati.

Si raccomanda di eseguire una Rss tra 58 e 60 anni. Al termine dei trial in corso, si potrà stimare meglio la durata dell’effetto protettivo e definire l’intervallo ottimale per un’eventuale ripetizione del test.

Bibliografia

Scarica la bibliografia completa (pdf 68 Kb)

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