结直肠癌筛查：日本的现状

Screening for colorectal cancer: current status in Japan.

作者信息

Saito H

机构信息

First Department of Internal Medicine, Hirosaki University School of Medicine, Japan.

出版信息

Dis Colon Rectum. 2000 Oct;43(10 Suppl):S78-84. doi: 10.1007/BF02237230.

DOI:10.1007/BF02237230

PMID:11052482

Abstract

PURPOSE

Screening for colorectal cancer using a guaiac-based fecal occult blood, or Hemoccult, test has been demonstrated to reduce colorectal cancer mortality. However, the magnitude of effectiveness is relatively low because of poor sensitivity of the Hemoccult test. The immunochemical fecal occult blood test has been shown to be much more sensitive than the Hemoccult test in detecting preclinical colorectal cancer in an asymptomatic population. The purpose of this article is to discuss the validity of the immunochemical fecal occult blood test and the efficacy of a population-based screening program using the test.

METHODS

Relevant articles were primarily identified through MEDLINE search. Review was focused on the studies of population screening programs with the immunochemical fecal occult blood test.

RESULTS

Sensitivities for colorectal cancer calculated in the same population were reported to be 67 to 89 percent and only 33 to 37 percent for the immunochemical test and Hemoccult test, respectively. Case-control studies and other observational studies showed that screening programs using the immunochemical fecal occult blood test by hemagglutination reaction would reduce the risk of dying of colorectal cancer by 60 percent or more for those screened annually compared with those unscreened. It was also shown that a screening strategy using the immunochemical fecal occult blood test had the best cost-effectiveness ratio among the methods available. Nearly 5 million persons are currently screened per year in Japan, yielding 0.15 to 0.2 percent colorectal cancer cases among persons with positive fecal occult blood test results.

CONCLUSIONS

These results strongly suggest that a screening program with immunochemical fecal occult blood test has promising advantages in terms of effectiveness over programs with the Hemoccult test. More stress is warranted on introduction of immunochemical fecal occult blood testing as a screening test in place of the guaiac fecal occult blood test.

摘要

目的

已证实使用愈创木脂法粪便潜血试验（Hemoccult试验）筛查结直肠癌可降低结直肠癌死亡率。然而，由于Hemoccult试验敏感性较差，其有效性程度相对较低。免疫化学粪便潜血试验在无症状人群中检测临床前结直肠癌方面已显示出比Hemoccult试验敏感得多。本文的目的是讨论免疫化学粪便潜血试验的有效性以及使用该试验的基于人群的筛查计划的效果。

方法

主要通过MEDLINE检索确定相关文章。综述重点关注免疫化学粪便潜血试验的人群筛查计划研究。

结果

据报道，在同一人群中计算出的免疫化学试验和Hemoccult试验对结直肠癌的敏感性分别为67%至89%和仅33%至37%。病例对照研究和其他观察性研究表明，与未筛查者相比，每年接受免疫化学粪便潜血试验（通过血凝反应）筛查的人群死于结直肠癌的风险降低60%或更多。还表明，在现有方法中，使用免疫化学粪便潜血试验的筛查策略具有最佳的成本效益比。目前日本每年有近500万人接受筛查，粪便潜血试验结果呈阳性的人群中结直肠癌病例占0.15%至0.2%。