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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Ultimo aggiornamento:
13 maggio 2013