The importance of screening for colorectal cancer (CCR) no longer needs to be demonstrated. The speakers at the session dedicated to him at 16th Congress of General Medicine France (CMGF – Paris, March 23-25, 2023) summarized the challenge and the means to respond to it.
CRC is the second leading cause of death in men and the third in women, with more than 17,000 deaths per year in total. Nine out of 10 patients (90.2%) survive five years when their cancer is detected at an early (local) stage. They are only 7 out of 10 (71.8%) when it is detected at a regional stage. The proportion drops to 14.3% in cases of metastasized cancer.
Organized screening for CRC is intended for men and women aged 50 to 74 at average risk of developing this cancer (without personal or family history of colorectal cancer or adenoma and having neither suggestive symptoms nor risk factors individuals), i.e. 80% of people in this age group. It consists in proposing the realization of an immunological test for occult blood in the stool, every two years, then a colonoscopy in the event of a positive test. Since 2015, a new screening test has been offered: it is simpler and more efficient.
The participation of the target population in this screening is, to say the least, sub-optimal: it has fluctuated around 30% for several years, making it possible to avoid all the same 2,600 deaths per year. But if it rose to 65%, 6,600 deaths per year would be avoided. The earlier this screening is carried out (from the age of 50), the more it reduces the risk of death from CRC, and the same goes for the later it is continued, or even throughout life.
The risk factors for non-participation are known:
- Male sex.
- Unfavorable health situation: comorbidities, long-term conditions.
- Age less than 65 years old.
- Unfavorable social situation (low level of education, disadvantaged socio-economic level, precarious residence, habitat in a disadvantaged area, loneliness). In the FORCEPS study (Training of general practitioners in the patient-centered approach to CRC screening), precariousness is a major factor in non-participation.
Patients have several ways to retrieve the kit.
- Via a health professional: attending physician, general practitioner, gynecologist, gastroenterologist, doctor practicing in a health insurance health center and since 2022, pharmacist. Other health professionals are also likely to deliver it, within the framework of experimentation or research. Physicians mostly screen elderly people. Nine out of ten actually perform the test, a score close to that of pharmacists (88%).
- By a Regional Cancer Screening Coordination Center (CRCDC), which offers the test every two years to the target audience and sends it to anyone who has participated at least once in one of the last three campaigns and has not responded to subsequent proposals.
- By online order at monkit.depistage-colorectal.fr since 2022. People who enter the program by this means (62% of them) go to the doctor little or not at all.
The FORCEPS study showed that a patient-centred approach improves the screening rate of GP patients. This approach consists of exploring patients’ health and illness experience, trying to understand them in their biopsychosocial wholeness, finding a point of agreement with them and developing a relationship with them.
