West N J, Poullis A P, Leicester R J
Department of Endoscopy, St George's Hospital, London, UK.
Colorectal Dis. 2008 Sep;10(7):708-14. doi: 10.1111/j.1463-1318.2007.01396.x. Epub 2007 Oct 23.
Colorectal cancer (CRC) is the third most common cancer and the second most common cause of cancer death in the UK with 36 100 new cases diagnosed each year in England and Wales and 55% of all patients presenting with lymph node metastases at the time of diagnosis. Early detection, before the development of symptoms, may be an effective way of reducing mortality and it is this which a screening programme seeks to address. The NHS Bowel Cancer Screening Programme (NHS BCSP) commenced in April 2006 and invites men and women aged 60-69 to participate via submission of a faecal occult blood test every 2 years; those with a positive result will be offered colonoscopy as the next investigation of choice. This article will explore the background to the programme, including the financial considerations behind it and the implication that this has had on colonoscopy standards and training in the UK. The chosen programme is not the most effective neither in terms of survival benefit nor cost effectiveness but is a compromise within a financially strained health care system. Endoscopy standards because of its introduction have, however, considerably improved in terms of patient experience, safety and improved practice.
结直肠癌（CRC）是英国第三大常见癌症，也是癌症死亡的第二大常见原因，在英格兰和威尔士每年有36100例新病例被诊断出来，55%的患者在诊断时出现淋巴结转移。在症状出现之前进行早期检测，可能是降低死亡率的有效方法，而这正是筛查计划旨在解决的问题。英国国民健康服务体系结直肠癌筛查计划（NHS BCSP）于2006年4月启动，邀请60至69岁的男性和女性每两年通过提交粪便潜血试验参与；检测结果呈阳性的人将被安排进行结肠镜检查作为下一步的首选检查。本文将探讨该计划的背景，包括其背后的财务考量以及这对英国结肠镜检查标准和培训的影响。所选的计划在生存获益和成本效益方面都不是最有效的，但却是在财政紧张的医疗保健系统中的一种折衷方案。然而，由于该计划的引入，内镜检查标准在患者体验、安全性和实践改进方面有了显著提高。
