Wilkins Thad, Reynolds Peter L
Department of Family Medicine, Medical College of Georgia, Augusta, Georgia 30912, USA.
Am Fam Physician. 2008 Dec 15;78(12):1385-92.
Colorectal cancer causes significant morbidity and mortality in the United States. The incidence of colorectal cancer can be reduced with increasing efforts directed at mass screening of average-risk adults 50 years and older. Currently, fecal occult blood test and flexible sigmoidoscopy have the highest levels of evidence to support their use for colorectal cancer screening. Colonoscopy does not have a proven colorectal cancer mortality benefit, but it does have the greatest single-test accuracy, and it is the final test in the pathway to evaluate and treat patients with other abnormal screening tests. Double-contrast barium enema has sparse data of effectiveness. Computed tomographic colonography, fecal DNA testing, and Pillcam Colon are promising tests that need further study before they can be recommended for widespread screening. Routine screening should continue until 75 years of age. There is good evidence that fiber and antioxidants are not effective for primary prevention of colorectal cancer; they should not be recommended for chemoprevention. There is good evidence that aspirin, nonsteroidal antiinflammatory drugs, and cyclooxygenase-2 inhibitors are effective for decreasing the risk of colorectal cancer and adenomatous polyps, but increased risks, such as gastrointestinal bleeding, limit their usefulness. There is fair evidence that obesity is associated with colorectal cancer. Additional studies are needed on decreased fat intake and red meat consumption, and the use of calcium, vitamin D, and statins before these can be recommended for primary prevention of colorectal cancer.
在美国，结直肠癌导致了严重的发病率和死亡率。随着针对50岁及以上平均风险成年人进行大规模筛查的力度加大，结直肠癌的发病率可以降低。目前，粪便潜血试验和乙状结肠镜检查有最高水平的证据支持其用于结直肠癌筛查。结肠镜检查虽未被证实对降低结直肠癌死亡率有益，但它具有最高的单项检查准确性，并且是评估和治疗其他筛查试验异常患者流程中的最终检查。双重对比钡灌肠造影的有效性数据较少。计算机断层结肠成像、粪便DNA检测和结肠胶囊内镜是有前景的检查，但在被推荐用于广泛筛查之前还需要进一步研究。常规筛查应持续到75岁。有充分证据表明纤维和抗氧化剂对结直肠癌的一级预防无效；不建议将它们用于化学预防。有充分证据表明阿司匹林、非甾体抗炎药和环氧化酶-2抑制剂对降低结直肠癌和腺瘤性息肉的风险有效，但诸如胃肠道出血等增加的风险限制了它们的实用性。有合理证据表明肥胖与结直肠癌有关。在推荐减少脂肪摄入、减少红肉消费以及使用钙、维生素D和他汀类药物用于结直肠癌的一级预防之前，还需要进行更多研究。
