Young Graeme P
Flinders University Centre for Cancer Prevention and Control, Adelaide, South Australia, Australia.
J Gastroenterol Hepatol. 2009 Oct;24 Suppl 3:S33-42. doi: 10.1111/j.1440-1746.2009.06069.x.
Australia is one of the first countries in the world to implement an organized whole-of-population screening program for colorectal cancer (CRC). Australians have made broad contributions to CRC in general ranging from primary prevention through genetics, secondary prevention and treatment, to palliation. This overview focuses on some of the contributions of direct relevance to population-based screening, stretching from technology development to population-based controlled studies and health services research. In terms of simple screening tests in a two-step screening strategy, the evidence is overwhelming that fecal immunochemical tests for hemoglobin (FITs) improve detection and are more acceptable. FIT-based screening is clearly acceptable to Australians and it has been demonstrated that a national organized screening program is feasible. In terms of benefit for Australians, with full roll out and high uptake by the population we could see the number of cases dying from CRC halved by this strategy. To this will be added the extra-screening benefits of improved diagnosis, improved treatment and improved public awareness, all benefits of other screening programs. CRC screening has progressed from a matter of irrelevance and distaste, to commonwealth government policy in the context of an organized program for all Australians.
澳大利亚是世界上最早实施针对结直肠癌（CRC）的有组织的全民筛查计划的国家之一。澳大利亚人在CRC的各个方面都做出了广泛贡献，从通过遗传学进行一级预防、二级预防和治疗，到缓解治疗。本综述重点关注与基于人群的筛查直接相关的一些贡献，涵盖从技术开发到基于人群的对照研究以及卫生服务研究。在两步筛查策略中的简单筛查测试方面，有压倒性的证据表明，粪便血红蛋白免疫化学检测（FITs）可提高检测率且更易被接受。基于FIT的筛查显然为澳大利亚人所接受，并且已经证明全国性的有组织筛查计划是可行的。就对澳大利亚人的益处而言，随着该策略的全面推行和民众的高参与度，我们可以看到因CRC死亡的病例数量通过此策略减半。此外，还将增加改善诊断、改善治疗和提高公众意识等额外的筛查益处，这些都是其他筛查计划的好处。CRC筛查已从无关紧要且令人厌恶的事情，发展成为澳大利亚联邦政府在面向全体澳大利亚人的有组织计划背景下的政策。
