Document Detail


Colorectal cancer screening in evolution: Japan and the USA.
MedLine Citation:
PMID:  20586866     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Colorectal cancer (CRC) is one of the most common cancers in both Japan and the USA. Age-adjusted incidence of CRC has been in decline in the USA since 1985, while rates in Japan have been increasing. The decline in the USA is commonly attributed to CRC screening programs but there is little direct evidence to support this assertion. The current screening recommendations in the USA cover several options including colonoscopy and computerized tomographic colonography (CTC). The Japanese CRC screening program is centered on fecal immunochemistry testing (FIT). The US government Medicare program's approval of colonoscopy as a primary screening test has lead to a large increase in the number of patients undergoing the procedure. However, the benefit achieved from this change in screening program emphasis is not clear. Simulation models demonstrate that a screening program centered on FIT achieves 94% of the benefit that an all-colonoscopy program is able to accomplish but at a lower cost per life year gained. Clinical studies of colonoscopy have failed to demonstrate the 76-90% declines in CRC incidence predicted by the National Polyp Study published in 1993. A potential reason for this failure is the quality of colonoscopy performance. Until more compelling data becomes available demonstrating the utility of colonoscopy as a primary screening modality, there is little incentive to alter the proven cost-effective approach to CRC screening currently in practice in Japan.
Authors:
William A Ross
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of gastroenterology and hepatology     Volume:  25 Suppl 1     ISSN:  1440-1746     ISO Abbreviation:  J. Gastroenterol. Hepatol.     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-06-30     Completed Date:  2010-10-27     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8607909     Medline TA:  J Gastroenterol Hepatol     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  S49-56     Citation Subset:  IM    
Affiliation:
Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA. wross@mdanderson.org
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MeSH Terms
Descriptor/Qualifier:
Canada / epidemiology
Colonography, Computed Tomographic / trends
Colonoscopy / trends
Colorectal Neoplasms / diagnosis*,  economics,  epidemiology
Computer Simulation
Cost-Benefit Analysis
Evidence-Based Medicine
Health Care Costs
Humans
Incidence
Japan / epidemiology
Mass Screening / economics,  trends*
Models, Economic
Practice Guidelines as Topic
Predictive Value of Tests
Quality Indicators, Health Care / trends
Time Factors
United States / epidemiology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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