{"id":1815,"date":"2006-10-01T01:00:00","date_gmt":"2006-10-01T00:00:00","guid":{"rendered":"https:\/\/angh.net\/abstracts\/le-depistage-organise-du-cancer-colorectal-par-hemoccult-est-faisable-en-france-premiers-resultats-dun-departement-pilote\/"},"modified":"2018-10-20T18:39:40","modified_gmt":"2018-10-20T16:39:40","slug":"le-depistage-organise-du-cancer-colorectal-par-hemoccult-est-faisable-en-france-premiers-resultats-dun-departement-pilote","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/le-depistage-organise-du-cancer-colorectal-par-hemoccult-est-faisable-en-france-premiers-resultats-dun-departement-pilote\/","title":{"rendered":"Le d\u00e9pistage organis\u00e9 du cancer colorectal par Hemoccult est faisable en France: premiers r\u00e9sultats d’un d\u00e9partement pilote"},"content":{"rendered":"

2006<\/strong><\/p>\n

Bernard DENIS, Isabelle GENDRE, Philippe PERRIN. Association pour le d\u00e9pistage du cancer colorectal dans le Haut-Rhin (ADECA 68)<\/em><\/p>\n

Gastroent\u00e9rologie <\/strong>– \u00a02006-06-01 –\u00a0 –<\/p>\n

________________________________<\/p>\n

But : rapporter les premiers r\u00e9sultats de la campagne du Haut-Rhin, d\u00e9partement pilote pour le d\u00e9pistage organis\u00e9 du cancer colorectal (CCR).
\nM\u00e9thodes :
\nLa campagne respectait le cahier des charges national : invitation \u00e0 consulter le m\u00e9decin g\u00e9n\u00e9raliste (MG), envoi du test aux non r\u00e9pondants. En cas de non r\u00e9ponse au 1er courrier, une relance \u00e9tait envoy\u00e9e avec un coupon-r\u00e9ponse permettant de sp\u00e9cifier d\u2019\u00e9ventuelles raisons de ne pas participer.
\nR\u00e9sultats :
\nAu 30-04-2006, la campagne \u00e9tait termin\u00e9e dans 25 cantons sur 31. Toute la population cible (186 660 personnes) avait re\u00e7u la 1\u00e8re invitation, 68,7% la lettre de relance et 47,6% le test. 608 MG (97%) avaient b\u00e9n\u00e9fici\u00e9 d\u2019une formation dont 21,4% en individuel. 618 MG (98,6%) participaient avec une moyenne de 108 tests lus par MG. 85,1% des tests distribu\u00e9s par les MG \u00e9taient effectivement r\u00e9alis\u00e9s. 19 343 personnes (10,4%) \u00e9taient exclues dont 46,4% gr\u00e2ce au coupon-r\u00e9ponse (6,5% pour d\u00e9pistage r\u00e9cent, 3,3 % pour risque \u00e9lev\u00e9 et 0,5% pour maladie grave intercurrente). 90 863 personnes (48,7%) avaient r\u00e9alis\u00e9 le test, soit un taux ajust\u00e9 de participation, tenant compte des exclusions, de 54,3% (de 47,9 \u00e0 61,9% selon les cantons). Ce taux augmentait avec l\u2019\u00e2ge (51% entre 50 et 59 ans, 59% entre 60 et 69 ans) et \u00e9tait significativement sup\u00e9rieur chez les femmes (56,6% vs 51,9%, p < 0,01). 77,3% des tests lus \u00e9taient donn\u00e9s par les MG, 5,4% par les centres d\u2019examens de sant\u00e9, 1% par les m\u00e9decins du travail et 15,5% avaient \u00e9t\u00e9 envoy\u00e9s par courrier. L\u2019impact du premier courrier durait 6 mois et conduisait \u00e0 59% des tests lus, celui de la lettre de rappel durait \u00e0 nouveau 6 mois pour 30% des tests lus. Le taux de positivit\u00e9 du test Hemoccult \u00e9tait de 3,3%, croissant avec l\u2019\u00e2ge et significativement plus \u00e9lev\u00e9 chez les hommes (3,9% vs 2,8%, p < 0,01). Une coloscopie \u00e9tait r\u00e9alis\u00e9e dans 84,1% des tests positifs. Le d\u00e9lai entre consultation gastroent\u00e9rologique et coloscopie \u00e9tait < 6 semaines dans 78% des cas. Sur 2 595 coloscopies enregistr\u00e9es, 94,4% \u00e9taient compl\u00e8tes. Elles \u00e9taient r\u00e9alis\u00e9es \u00e0 75,6% en secteur lib\u00e9ral. 48,8% d\u2019entre elles \u00e9taient normales, 45,2% r\u00e9v\u00e9laient un (des) polype(s), dont 81,6% ad\u00e9nomateux. 58,2% des ad\u00e9nomes \u00e9taient sessiles, 34,9% p\u00e9dicul\u00e9s et 6,2% plans. 16% des ad\u00e9nomes mesuraient plus de 20 mm et 26,1% entre 10 et 19 mm. 69,5% des ad\u00e9nomes \u00e9taient tubuleux, 23,9% tubulo-villeux, 2,6% villeux et 4% festonn\u00e9s. 61,4% d\u2019entre eux \u00e9taient en dysplasie de bas grade, 32,2% de haut grade, 4,3% \u00e9taient le si\u00e8ge d\u2019un carcinome in situ et 2,2% d\u2019un carcinome invasif. 95,2% des ad\u00e9nomes \u00e9taient r\u00e9s\u00e9qu\u00e9s par voie endoscopique. La valeur pr\u00e9dictive positive \u00e9tait de 10,3% pour un CCR (hommes 12,8%, femmes 7,1%), 21% pour un ad\u00e9nome avanc\u00e9 et 42,6% pour une n\u00e9oplasie (hommes 52,2%, femmes 31,0%). Les taux de CCR et de n\u00e9oplasies \u00e9taient de 2,9 et 12,2 pour 1 000 personnes d\u00e9pist\u00e9es. 266 CCR \u00e9taient d\u00e9pist\u00e9s : 82,2% \u00e9taient localis\u00e9s, dont 27,0% in situ. 49,7% des CCR invasifs \u00e9taient de stade I et 24,1% de stade II. 17,6% des CCR \u00e9taient localis\u00e9s au rectum et 25,0% au colon proximal. Le taux de n\u00e9oplasies avanc\u00e9es proximales augmentait avec l\u2019\u00e2ge (25,4% apr\u00e8s 65 ans vs 16,5%, p < 0,01) mais ne variait pas selon le sexe. Une strat\u00e9gie de d\u00e9pistage fond\u00e9e sur la recto-sigmo\u00efdoscopie aurait manqu\u00e9 21,4% des personnes avec n\u00e9oplasies avanc\u00e9es, sans diff\u00e9rence significative selon le sexe et l\u2019\u00e2ge.
\nLe co\u00fbt global de ce programme de d\u00e9pistage (sans les coloscopies) \u00e9tait de 2,3 millions d\u2019Euros : les co\u00fbts fixes \u00e9taient de 1,6 million (4,3 \u20ac par an par personne \u00e9ligible) et les co\u00fbts variables de 0,7 million (3,3 \u20ac par personne d\u00e9pist\u00e9e). Le co\u00fbt global par personne d\u00e9pist\u00e9e \u00e9tait de 26 \u20ac et le co\u00fbt pour d\u00e9pister soit un ad\u00e9nome avanc\u00e9 soit un cancer pr\u00e9coce (in situ ou stade I) \u00e9tait de 3650 \u20ac.
\nConclusion :
\nLes r\u00e9sultats des essais contr\u00f4l\u00e9s europ\u00e9ens sont reproductibles \u00e0 un co\u00fbt acceptable en population g\u00e9n\u00e9rale fran\u00e7aise. Les MG sont demandeurs et pr\u00eats \u00e0 s\u2019approprier le d\u00e9pistage du CCR. Le taux de participation de notre d\u00e9partement devrait approcher 55% en fin de campagne. La participation des hommes et des moins de 60 ans doit \u00eatre am\u00e9lior\u00e9e.<\/p>\n","protected":false},"excerpt":{"rendered":"

2006 Bernard DENIS, Isabelle GENDRE, Philippe PERRIN. Association pour le d\u00e9pistage du cancer colorectal dans le Haut-Rhin (ADECA 68) Gastroent\u00e9rologie – \u00a02006-06-01 –\u00a0 – ________________________________ But : rapporter les premiers r\u00e9sultats de la campagne du Haut-Rhin, d\u00e9partement pilote pour le d\u00e9pistage organis\u00e9 du cancer colorectal (CCR). M\u00e9thodes : La campagne respectait le cahier des charges […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[4],"tags":[17],"class_list":["post-1815","post","type-post","status-publish","format-standard","hentry","category-gastroenterologie","tag-17"],"yoast_head":"\nLe d\u00e9pistage organis\u00e9 du cancer colorectal par Hemoccult est faisable en France: premiers r\u00e9sultats d'un d\u00e9partement pilote - Abstracts des congr\u00e8s de l'ANGH<\/title>\n<meta name=\"description\" content=\"ANGH R\u00e9sum\u00e9s congr\u00e8s H\u00e9patologie Gastroent\u00e9romogie Hepatology Gastroenterology Etudes cliniques Clinical study\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/angh.net\/abstracts\/le-depistage-organise-du-cancer-colorectal-par-hemoccult-est-faisable-en-france-premiers-resultats-dun-departement-pilote\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Le d\u00e9pistage organis\u00e9 du cancer colorectal par Hemoccult est faisable en France: premiers r\u00e9sultats d'un d\u00e9partement pilote - 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