Commentaries, Views, and Developments in Hta
Colorectal cancer screening policy in Europe doi:10.1017/S026646230909103X
Letter to the Editor: We agreed with Gul´acsi et al. on their perception about our article that did not include those eastern European countries that have recently joined the European Union. It does not mean that we tried to provide partial information or that we wanted to diminish the information with other purposes. In fact, the title of our article when it was sent to be published was: “Screening for colon-rectal cancer in the Europe of fifteen, Norway and Switzerland. So equal, so different. Is it time for a common approach?” and so was the title of the oral communication presented in the Annual Meeting of HTAi held in Montreal last summer (7). Even when we believed that this title was more accurate to the data provided in the article, we finally followed the suggestions of the reviewers to make the title short and comprehensive. We also agreed with Gul´acsi et al. on the importance of highlighting the characteristics of any other colorectal cancer screening programs in our continent and with the importance of establishing them, just in case they came from a profound analysis of the context to be implemented in, as it seems to be the case of Hungary (2;3;5). Nevertheless, our study did not want to describe the differences between all the programs in Europe, but that those differences were not based on real biological, epidemiological, or social dissimilarities among countries that affected colorectal cancer distribution (1). Moreover, we highlighted that the differences found in the screening strategies (age-range, techniques, risk factors considered, and follow-up periods) were not justified in results obtained from research studies or regional-national cancer registries. Our group (Osteba, Basque Office for HTA) has taken part in a recently published document on the situation of population screening programs in Spain (4). In the case of colorectal cancer, it was observed that the problem was the low response or participation rates (less than 50 percent in all the local experiences described) when comparing with other population screening programs such as breast cancer screening (response rate of more than 80 percent in all cases). These described low response rates were similar in other experiences all around the world and were against supporting widespread screening policies, at least in certain pathologies. In any case, we should take into account those data and the new available technologies to know the prognosis and the risk to develop certain pathologies. For sure, those new technologies will play a crucial role in the future screening programs for cancer. Those new developments will carry on new practices and new problems especially those related with the management of information and the role that
the patient should play in the final decision on a treatment (8). Finally, in our opinion, we should support common strategies and joint projects among Health Technology Assessment Agencies and networks to promote on time and comprehensive information on decisions of this kind. This would help decision makers to produce the right decision at their context and would avoid certain unjustified dissimilarities as those described in our study (6).
REFERENCES
1. Berrino F, De Angelis R, Sant M, et al. EUROCARE Working group. Survival for eight major cancers and all cancers combined for European adults diagnosed in 1995-99: Results of the EUROCARE-4 study. Lancet Oncol. 2007;8:773783. 2. Boncz I, Sebesty´en A, D´ozsa C, et al. Health economics analysis of colorectal screening. [In Hungarian: A colorectalis szu" r´esek eg´eszs´eg-gazdas´agtani elemz´ese] Magy Onkol. 2004;48:111115. 3. Boncz I, Sebestyen A, Pinter I, et al. Age-group specific gap between treatment cost of and mortality due to breast and colorectal cancer. J Clin Oncol. 2007;25:45014502. 4. Castells X, Sala M, Ascunce N, et al. coordinadores. Descripci´on del cribado del c´ancer en Espa˜na. Proyecto DESCRIC. Madrid: Plan de Calidad para el Sistema Nacional de Salud. Ministerio de Sanidad y Consumo. Ag`encia d’Avaluaci´o de Tecnologia i Recerca M`ediques de Catalu˜na; 2007. Informes de Evaluaci´on de Tecnolog´ıas Sanitarias, AATRM n´um. 2006/01. http://www.gencat.net/salut/depsan/units/aatrm/ pdf/in0601es.pdf. 5. Csonka C, Moln´ar C, N´emeth M, Ott´o S. Results of and experiences with colorectal screening in town Ajka. [In Hungarian: Az ajkai vastagb´elszu" r´es eredm´enyei e´ s tapasztalatai] Magy Onkol. 2004;48:29. 6. Guti´errez-Ibarluzea I, Asua J, Latorre K. Policies of screening for colorectal cancer in European countries. Int J Technol Assess Health Care. 2008;24:270-276. 7. Guti´errez-Ibarluzea I, Asua J, Latorre K. Screening for colonrectal cancer in the Europe of fifteen, Norway and Switzerland. So equal, so different. Is it time for a common approach? Montreal: HTAi; 2008. http://www.htai2008.org/filearchive/ 7b9bfdfa3c90233bd28cd84fdd555c59.pdf. 8. Tejada MI, Rueda JR, Nicol´as P, et al. Consejo gen´etico en el c´ancer de mama y en el c´ancer de colon. Investigaci´on Comisionada. Vitoria-Gasteiz. Departamento de Sanidad, Gobierno Vasco; 2007. Informe no : Osteba D-07-06.
I˜naki Guti´errez-Ibarluzea, MS, PhD (
[email protected]) Associate Professor Department of Biochemistry Nursing University School Vitoria-Gasteiz Jos´e Atxotegi z.g
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Commentaries, Views, and Developments in Hta
01009 Vitoria-Gasteiz (Basque Country) Spain Health Technology Assessment Technician Osteba-Basque Office for HTA Department of Health–Basque Country Donostia-San Sebastian, 1 01010 Vitoria-Gasteiz (Basque Country) Spain
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Jos´e Asua, MD, PhD (
[email protected]) Head Osteba-Basque Office for HTA Department of Health–Basque Country Donostia-San Sebastian, 1 01010 Vitoria-Gasteiz (Basque Country) Spain
INTL. J. OF TECHNOLOGY ASSESSMENT IN HEALTH CARE 25:1, 2009
