Colorectal Cancer Screening in France: Guidelines and Professional Reality

In the field of gastrointestinal disease, colonoscopy is on the way to becoming the primary form of endoscopic examination. In order to assess current practices relating to colonoscopy, the French Society of Digestive Endoscopy (Société Française d'Endoscopie Digestive, SFED) conducted a survey of endoscopic practice on two consecutive days [1]. A questionnaire was sent to 2868 French gastroenterologists in June 1998. A total of 1038 patients' files were sent back within the allotted time (response rate 36 %). The gastroenterologists who responded provided a representative sample from both private and hospital practice.

Activities described in this sample were projected onto the year using the following parameters: 11 months of effective work per year and five days of effective work per week - i.e., 220 working days per year. The population of France is estimated to be 57.66 million. The total number of colonoscopies was estimated to be 1 162 598 endoscopies per year, 74 % of which are total colonoscopies. Eighty-three percent of these colonoscopies were conducted with the patient under general anesthesia with an anesthetist in attendance, and a histological examination was carried out in 45 % of cases. Complications were estimated at three per 1000 colonoscopies. The most important indications were: unexplained abdominal pain in 25 %, polypectomy control in 24 %, and rectal bleeding in 19 %. Colonoscopy was able to identify colonic polyps in 26 % of cases, and diverticulosis in 27 %. The number of polyps discovered was estimated at 300 080, 60 % of which were in the left colon, with a diameter of less than 10 mm in 75 % of cases and between 10 and 20 mm in 18 % of cases. Seventy-three percent of colonoscopies are carried out in private practice, 20 % on an in-patient basis, and 63 % as outpatient procedures.

The French inquiry makes it possible to assess gastroenterologists' activities in any form of medical practice. In France, the patient was taken as the unit of economic activity in the survey, whereas in a similar study in the United Kingdom it was the endoscopy center that was used. The estimated annual figures for various types of activity show that a large number of total colonoscopies are conducted under general anesthesia, with polypectomy being carried out in 25 % of cases. The British inquiry showed a low rate of activity at endoscopy centers, due to shortages of staff and technical equipment. In France, the parameters chosen for the inquiry make it possible to appreciate the potential effects of government restrictions on the development of endoscopy. The inquiry's results are therefore of the greatest importance. In France, the results of a consensus conference held in 1997 on colorectal cancer and its prevention [2], along with the recommendations of the SFED (French Society of Digestive Endoscopy), are regarded as the guidelines for good practice in colonoscopy and polypectomy. It is as yet difficult to assess what the impact of the new financial arrangements being set in place by the French Government will be.

References

• 1 Canard J M, Carayon P, Dumas R, et al. La coloscopie en France en 1998: résultat d'une enquête prospective nationale de la Société Française d'Endoscopie Digestive: Journées Francophones de Pathologie Digestive, 20 - 24 Mars 1999, Nantes, France (conférence report).  Paris:; Société Française d'Endoscopie Digestive, 1999
• 2 (Anon). Conférence de consensus: prévention, dépistage et prise en charge des cancers du côlon, Paris, 29 et 30 janvier 1998 (Consensus conference: prevention, screening, and management of colonic cancers, Paris, France, January 29 - 30, 1998 - proceedings).  Gastroenterol Clin Biol. 1998;  22 (Suppl.) S1-295