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Health Technology Assessment. Dépistage Du Cancer Colorectal : Connaissances Scientifiques Actuelles Et Impact Budgétaire Pour La Belgique

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Health Technology Assessment. Dépistage Du Cancer Colorectal : Connaissances Scientifiques Actuelles Et Impact Budgétaire Pour La Belgique Health Technology Assessment Dépistage du cancer colorectal : connaissances scientifiques actuelles et impact budgétaire pour la Belgique KCE reports vol. 45B Federaal Kenniscentrum voor de gezondheidszorg Centre fédéral dexpertise des soins de santé 2006 Le Centre fédéral dexpertise des soins de santé Présentation : Le Centre fédéral dexpertise des soins de santé est un parastatal, créé le 24 décembre 2002 par la loi-programme (articles 262 à 266), sous tutelle du Ministre de la Santé publique et des Affaires sociales, qui est chargé de réaliser des études éclairant la décision politique dans le domaine des soins de santé et de lassurance maladie. Conseil dadministration Membres effectifs : Gillet Pierre (Président), Cuypers Dirk (Vice-Président), Avontroodt Yolande, De Cock Jo (Vice-Président), De Meyere Frank, De Ridder Henri, Gillet Jean- Bernard, Godin Jean-Noël, Goyens Floris, Kesteloot Katrien, Maes Jef, Mertens Pascal, Mertens Raf, Moens Marc, Perl François Smiets Pierre, Van Massenhove Frank, Vandermeeren Philippe, Verertbruggen Patrick, Vermeyen Karel Membres suppléants : Annemans Lieven, Boonen Carine, Collin Benoît, Cuypers Rita, Dercq Jean- Paul, Désir Daniel, Lemye Roland, Palsterman Paul, Ponce Annick, Pirlot Viviane, Praet Jean-Claude, Remacle Anne, Schoonjans Chris, Schrooten Renaat, Vanderstappen Anne, Commissaire du gouvernement : Roger Yves Direction Directeur général : Dirk Ramaekers Directeur général adjoint : Jean-Pierre Closon Contact Centre fédéral dexpertise des soins de santé (KCE). 62 Rue de la Loi B-1040 Bruxelles Belgium Tel: +32 [0]2 287 33 88 Fax: +32 [0]2 287 33 85 Email : [email protected] Web : http://www.centredexpertise.fgov.be Health Technology Assessment Dépistage du cancer colorectal : connaissances scientifiques actuelles et impact budgétaire pour la Belgique KCE reports vol. 45B CHRIS DE LAET, MATTIAS NEYT, IMGARD VINCK, MURIELLE LONA, IRINA CLEEMPUT, STEFAAN VAN DE SANDE Federaal Kenniscentrum voor de gezondheidszorg Centre fédéral dexpertise des soins de santé 2006 KCE reports vol.45B Titre : Health Technology Assessment. Dépistage du cancer colorectal : connaissances scientifiques actuelles et impact budgétaire pour la Belgique Auteurs : Chris De Laet, Mattias Neyt, Imgard Vinck, Murielle Lona, Irina Cleemput, Stefaan Van De Sande Experts externes : Norbert Blanckaert (UZ Leuven), Jerôme de Roubaix (Communauté française), André Dufour (SSMG), Frans Govaerts (Domus Medica), Stefaan Gryspeerdt (SZ Roeselaere), Michel Melange (UCL Mont Godinne), Marc Polus (CHU Sart Tilman), Peter Suenaert (UZ Antwerpen), Eric Van Cutsem (UZ Leuven), Elizabeth Van Eycken (Registre National du Cancer), Pieter Vandenbulcke (Vlaamse Gemeenschap) Validateurs : Jean Faivre (CHU Dijon, France), Marc Peeters (UZ Gent), Marjolein Van Ballegooijen (Erasmus University Medical Center Rotterdam, Pays-Bas) Conflict of interest : Aucun conflit déclaré Disclaimer: Les experts externes et validateurs ont collaboré à la rédaction du rapport scientifique mais ne sont pas responsables des recommandations aux Autorités. Les recommandations aux Autorités ont été rédigées par le Centre dexpertise (KCE) Mise en Page : Dimitri Bogaerts Bruxelles, 19 décembre 2006 Etude nr 2006-12 Domaine : Health Technology Assessment (HTA) MeSH : Colorectal Neoplasms ; Costs and Cost Analysis ; Mass Screening NLM classification : WI 529 Langage : français, anglais Format : Adobe® PDF (A4) Dépôt légal : D/2006/10.273/58 La reproduction partielle de ce document est autorisée à condition que la source soit mentionnée. Ce document est disponible en téléchargement sur le site Web du Centre fédéral dexpertise des soins de santé. Comment citer ce rapport ? De Laet C, Neyt M, Vinck I, Lona M, Cleemput I, Van De Sande S. Health Technology Assessment. Dépistage du cancer colorectal : connaissances scientifiques actuelles et impact budgétaire pour la Belgique. Health Technology Assessment (HTA). Bruxelles: Centre fédéral d'expertise des soins de santé (KCE); 2006. KCE reports 45 B (D/2006/10.273/58) KCE reports vol.45B Dépistage du Cancer Colorectal i PREFACE Le cancer colorectal constitue en ordre de fréquence la troisième cause de cancer chez les hommes et la deuxième chez les femmes. Il occupe aussi la deuxième position en ce qui concerne la mortalité par cancer. Loccurrence du cancer colorectal augmente avec lâge, et chaque année, le diagnostic de ce cancer est posé chez environ 7700 Belges. La durée de vie après diagnostic ainsi que le traitement du cancer colorectal sont très étroitement liés au stade de la maladie au moment du diagnostic: plus la tumeur est localisée, meilleur est le pronostique. Ces éléments justifient dexaminer lintérêt dun programme de dépistage. La plupart des recommandations, y compris celles de la Commission Européenne, insistent sur un dépistage de ce cancer à partir de lâge de 50 ans environ. Cependant, les décideurs internationaux ont jusquà présent été très réticents à initier des programmes de dépistage, essentiellement en raison de la faible sensibilité du test le plus utilisé la détection de sang dans les selles - et dun taux de participation potentiellement bas. Au cours des dernières années, un certain nombre de pays européens ont démarré un programme pilote pour évaluer la faisabilité dun dépistage organisé du cancer colorectal. Faut-il en lancer un également en Belgique ? Si les décideurs politiques considèrent comme prioritaire un programme de dépistage du cancer colorectal au niveau communautaire et fédéral, alors ce rapport fournit les bases scientifiques pour avancer dans cette direction. Indiscutablement, un tel programme doit être organisé de façon professionnelle et être accompagné dun contrôle de la qualité. Un programme de dépistage mal organisé est en effet potentiellement plus néfaste que labsence de programme et constitue un gaspillage de ressources. Le programme de dépistage du cancer colorectal a par ailleurs un prix. Lévaluation de son impact budgétaire est présentée dans ce rapport et peut aussi apporter un éclairage utile à la décision. Jean-Pierre CLOSON Dirk RAMAEKERS Directeur Général Adjoint Directeur Général ii Dépistage du Cancer Colorectal KCE reports vol.45B Résumé du rapport Ce rapport Health Technology Assessment (HTA) fait la synthèse des « données probantes » scientifiques sur lefficacité et le rapport coût-efficacité du dépistage du cancer colorectal . Il examine également de quelle manière un programme potentiel de dépistage du cancer colorectal peut être introduit efficacement en Belgique. A cet effet, nous évaluons systématiquement la littérature scientifique, nous décrivons les directives existantes concernant le dépistage et la surveillance et nous effectuons une estimation de limpact budgétaire résultant de lintroduction dun tel programme. Nous discutons aussi des principales incertitudes liées à lintroduction de ce dépistage en Belgique. Conclusions Pourvu que les exigences organisationnelles soient rencontrées, le dépistage du cancer colorectal satisfait clairement aux critères classiques de Wilson et de Jungner ainsi quà lextension récente de ces critères qui traite des questions pratiques et éthiques. Ces nouveaux critères soulignent principalement que les programmes de dépistage devraient se dérouler de manière concertée avec des garanties de qualité et un contrôle de qualité, être accessible à tous et contenir une information complète et facilement compréhensible sur les avantages attendus et les inconvénients possibles. Lobjectif est que chacun puisse décider en toute liberté et en toute connaissance de cause de participer au programme. Pour le dépistage du cancer colorectal, nous constatons que, dans le passé, seul le dépistage opportuniste était dusage dans la plupart des pays. Ces dernières années, un certain nombre de pays ont initié des projets pilotes de dépistage organisé. Le but principal de ces projets pilotes est de déterminer la forme optimale de dépistage pour ces pays. En Belgique, le cancer colorectal est la troisième forme la plus fréquente de cancer chez les hommes et la deuxième forme chez les femmes ; ce cancer représente la deuxième cause de mortalité due au cancer. Lapparition du cancer colorectal augmente avec lâge et chaque année, le cancer colorectal est diagnostiqué chez environ 7.700 belges. La survie après le diagnostic et le traitement du cancer colorectal est fortement associée au stade de la maladie au moment du diagnostic: le diagnostic est dautant meilleur que la tumeur est bien localisée. Cest la raison principale pour laquelle la détection précoce du cancer colorectal devrait être envisagée. La plupart des cancers colorectaux apparaissent chez des individus sans indication apparente de risque élevé mais un quart des cancer colorectaux apparaissent chez les personnes présentant un risque élevé connu, soit lié à des antécédents familiaux, soit lié à des antécédents personnels. Ce groupe (selon nos estimations environ 15% de la population) ne rentre pas en ligne de compte pour un programme de dépistage. Néanmoins, il est important que ces individus bénéficient dun suivi. Dès lors, nous avons donné, dans ce rapport, un aperçu des directives qui existent pour les personnes à risque accru. Au niveau mondial, il existe de nombreuses directives sur le dépistage et le suivi du cancer colorectal et nous décrivons plusieurs dentre elles. Toutes les directives recommandent le dépistage à partir de 50 ans, mais elles ne se prononcent pas sur la limite dâge supérieure et ni sur les techniques optimales de dépistage. Lorsque le FOBT
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