Zusammenfassung
In Deutschland starben im Jahr 2002 ca. 29.000 Menschen an einem kolorektalen Karzinom (CRC); das Lebenszeitrisiko, an einem CRC zu erkranken, beträgt mit dem Alter steigend ab dem 50. Lebensjahr in Deutschland 4–6%. Etwa 1/3 aller über 50-Jährigen hat relevante Polypen im Kolorektum, ein ausreichend hoher Prävalenzwert für ein sinnvolles Screening. Im Gegensatz zu den meisten anderen Krebserkrankungen kann man beim CRC außerdem die Krebserkrankung verhindern und nicht nur in einem frühen Stadium erkennen. Die Mortalität des CRC kann durch die Anwendung des Tests auf okkultes Blut (FOBT) bei Personen zwischen dem 45. und 80. Lebensjahr um 14% gesenkt werden. Bereits durch regelmäßige Sigmoidoskopien mit einer konsequenten Polypektomie kann einer Senkung der Karzinominzidenz zwischen 50 und 70% angenommen werden. Die Koloskopie ist zweifelsfrei das Verfahren der Wahl für die Sekundärprävention, da sie die komplette Diagnostik und Behandlung bei vertretbar geringem Risiko vereint. Wirtschaftliche Vorteile einer Vermeidungsstrategie gegenüber der überaus teuren Behandlung des CRC sind nachgewiesen. Aufgrund aller berichteten Daten sind Präventionsmaßnahmen beim CRC nachhaltig zu empfehlen.
Abstract
In Germany approximately 29,000 people died of colorectal carcinoma (CRC) in 2002; the risk of getting CRC is 4–6% in Germany, rising with age from the 50th year of life. About one third of all people over 50 years of age have polyps with the potential for malignant transformation in the colorectum, which is a sufficiently high prevalence rate to justify screening. In contrast to most other cancer diseases, in the case of CRC it is possible to prevent the cancer and not only to detect it at an early stage. Application of the test for occult blood in persons between their 45th and 80th years can reduce the mortality of CRC by 14%. We can assume that already regular sigmoidoscopies with consistent performance of polypectomy when needed could reduce the incidence of CRC by 50–70%. There is no doubt that coloscopy is the technique of choice for secondary prevention, as it unites the possibility of complete diagnosis and treatment with a justifiably low level of risk. The economic advantages of an avoidance strategy compared with the treatment of CRC, which is certainly expensive, have been documented. On the basis of all the data reported, in the case of CRC preventive strategies can be emphatically recommended.
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Layer, G., Riemann, J. Screening des kolorektalen Karzinoms. Radiologe 48, 26–32 (2008). https://doi.org/10.1007/s00117-007-1584-7
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DOI: https://doi.org/10.1007/s00117-007-1584-7
Schlüsselwörter
- Kolorektales Karzinom
- Screening
- Prävention
- Koloskopie
- CT-Kolographie
- MR-Kolographie
- Okkult-Bluttest
- Polyp
- Adenom