Kronborg O
Department of Surgical Gastroenterology, Odense University Hospital, Denmark.
Ann Med. 1991 Oct;23(4):373-9. doi: 10.3109/07853899109148076.
The causes of colorectal cancer are complex and in most cases obscure, making primary prevention impossible at present. Secondary prevention by finding and treating early asymptomatic cancers may possibly reduce mortality from this very common cancer. Results from conventional treatment have changed little during recent decades and are unsatisfactory, with more than half of the patients dying from the disease. The incidence has increased during recent years in many countries, making it vital to evaluate possible benefits from screening. This review considers different methods of screening for colorectal cancer and includes an overview of continuing European controlled randomised trials with the faecal occult blood test, Haemoccult-II. No final evaluation is possible, but advantages and drawbacks of different strategies are discussed. Assuming that the goal of reducing mortality is achieved, several other problems remain unsolved: the organisation of screening, the training of doctors in endoscopy, cost benefit and cost effectiveness all of which will have to be solved before a population screening can be recommended. Present screening tools are not ideal and we have to continue the search for better markers of early colorectal cancers and even possible precursors like adenomas.
结直肠癌的病因复杂，在大多数情况下不明，这使得目前无法进行一级预防。通过发现和治疗早期无症状癌症进行二级预防可能会降低这种常见癌症的死亡率。近几十年来，传统治疗的结果变化不大且不尽人意，超过半数的患者死于该病。近年来，许多国家的发病率有所上升，因此评估筛查可能带来的益处至关重要。本综述探讨了结直肠癌的不同筛查方法，并概述了欧洲正在进行的使用隐血试验（Haemoccult-II）的对照随机试验。目前无法进行最终评估，但讨论了不同策略的优缺点。假设降低死亡率的目标得以实现，仍有其他几个问题有待解决：筛查的组织、内镜检查医生的培训、成本效益，在推荐进行人群筛查之前，所有这些问题都必须得到解决。目前的筛查工具并不理想，我们必须继续寻找更好的早期结直肠癌标志物，甚至可能包括腺瘤等癌前病变的标志物。
