Colorectal-Cancer-Screening Update; Status in Austria and European Countries; and Quality Assurance of Screening-Colonoscopy

Research areas: Prevention and screening, Health economics

Duration: July 2012 - Nov 2012
Publications:
LBI-HTA Project report No. 41a:http://eprints.hta.lbg.ac.at/981
LBI-HTA Project report No. 41b:http://eprints.hta.lbg.ac.at/982
LBI-HTA Project report No. 41c:http://eprints.hta.lbg.ac.at/983

Additional team: Ines Schumacher
Initiator: Main Association of Austrian Social Security Institutions, Vienna
Language: German (except for non-economic part of CRC-screening update: English)

Background:
Colorectal cancers (CRC) are among the most common. The age standardized incidence in Austria was 40 per 100,000 males and 22 per 100,000 females per year (Statistik Austria, 2009). For males CRC are the most common in terms of incidence after prostate and lung cancers, for females after breast cancers. In the United States CRC are the third leading cause of cancer deaths.

The rate of CRC incidence is fairly similar across Europe. CRC develop over a long time from pre-cancerous stages, that are relatively easy to detect and that are as a rule treatable fairly easily. Early (pre)stages of CRC have a significantly better prognosis. This is why screening for CRC has been introduced in several countries in one form or another.

In Austria screening for CRC has been included in the remuneration scheme of mandatory health insurance as an intervention of early detection since 2005 (“Vorsorgeuntersuchung”). The Main Association of Austrian Social Insurance Institutions and the Austrian Society of Gastroenterology and Hepatology initiated a project for quality assurance in screening-colonoscopy in 2007.

Research Objectives:
Part “Evidence CRC-Screening”
1. What is the evidence for first-line screening-tests? Which program strategies (organized vs. opportunistic screening, choice of first-line screening-test or tests) are possible for CRC-screening? What is the evidence from economic evaluations?
Several first-line screening-tests (FOBT, flexible sigmoidoscopy, colonoscopy) are established in CRC-screening among asymptomatic populations. Others are discussed (e.g. CT-colonography/ virtual colonoscopy). Based on a 2010 report for the Swiss Cancer League (http://eprints.hta.lbg.ac.at/873/) an update will be done. The same will be undertaken for economic evaluations (update of report http://eprints.hta.lbg.ac.at/874/).

Part “Status CRC-screening in Austria and screening-active countries in Europe” (not a comprehensive review of all European countries)
2. What are the positions towards CRC-screening methods (Austria, EU Guideline, selected European countries)?
Position papers that serve as the foundations of CRC-screening strategies (first-line screening-test(s), program logistics, communication strategy, invitation system, quality assurance etc.) from Austria (states/ Bundesländer, if applicable) and selected European countries are presented. The aim of this part is to introduce various ways of going about CRC-screening and to compare them.

Part “Status quality assurance of screening-colonoscopy in Austria and Europe” (not a comprehensive review of all European countries)
Position papers, that serve as the foundation of quality assurance of screening-colonoscopy from Austria and selected European countries are presented. Proposed or already implemented quality indicators are highlighted. The aim of this part is to present ways of organizing quality assurance of screening-colonoscopy in practice.

Methods:
Updates of systematic literature searches for systematic reviews, randomized controlled trials and economic evaluations from 2010 - 2012 to answer question one.
Search for recent position papers and recommendations (published in the last 2-4 years) and contact to experts in the practice of CRC-screening (strategies, quality assurance of screening-colonoscopy) to answer questions two and three.

Time Schedule:
Mid July – mid August 2012
• Project protocol
• Initial searches
• Update of systematic search of the literature, inclusion/ exclusion of articles, extraction of data
• Informal survey of status CRC-screening and quality assurance of screening-colonoscopy
Mid August – mid September 2012
• Finalization of research and collection of materials
• Writing of report
Mid September 2012
• Informal presentation of progress
Mid September – end of October 2012
• Finalization of report
Mid November 2012
• Publication