Bretthauer Michael, Hoff Geir
Medisinsk avdeling, Seksjon for fordøyelsessykdommer, Rikshospitalet-Radiumhospitalet, 0027 Oslo.
Tidsskr Nor Laegeforen. 2007 Oct 18;127(20):2688-91.
Colorectal cancer (CRC) is one of the most common cancers in Norway. An increasing incidence is observed. CRC develops from benign adenomas in the colon over a long time. This paper reviews the evidence for drug prevention and screening for CRC.
Medline was systematically searched using the MeSH terms "Colorectal neoplasm AND prevention and control", with a limitation on randomised trials in humans.
Acetylsalicylic-acid, non-steroidal anti-inflammatory drugs and COX-2 inhibitors are shown to reduce adenoma growth, but it remains uncertain whether these drugs reduce the incidence of CRC. The drugs are associated with serious side-effects. Drug-prevention of CRC can therefore not be recommended. Faecal occult blood testing (FOBT) is the only CRC screening method where randomised trials have shown to effectively reduce CRC mortality. FOBT has no effect on CRC incidence and reduced compliance and effect have been observed over time. Endoscopic screening has a potentially larger effect, and can theoretically prevent CRC, but high quality studies are needed. Data from randomised trials are awaited for sigmoidoscopy screening. Colonoscopy screening has not been subjected to randomised trials and can thus not be recommended for population-based screening.
结直肠癌（CRC）是挪威最常见的癌症之一，其发病率呈上升趋势。CRC是由结肠内的良性腺瘤长期发展而来。本文综述了CRC药物预防和筛查的相关证据。
使用医学主题词“结直肠肿瘤与预防和控制”对Medline进行系统检索，检索限于人类随机试验。
乙酰水杨酸、非甾体抗炎药和COX-2抑制剂可降低腺瘤生长，但这些药物是否能降低CRC发病率仍不确定。这些药物伴有严重副作用。因此不推荐使用药物预防CRC。粪便潜血试验（FOBT）是唯一经随机试验证明可有效降低CRC死亡率的CRC筛查方法。FOBT对CRC发病率无影响，且随着时间推移，其依从性和效果有所下降。内镜筛查可能有更大效果，理论上可预防CRC，但需要高质量研究。期待乙状结肠镜筛查的随机试验数据。结肠镜筛查尚未进行随机试验，因此不推荐用于人群筛查。
