Department of Gastroenterology, Tel Aviv Medical Center, Israel.
Eur J Gastroenterol Hepatol. 2011 May;23(5):431-7. doi: 10.1097/MEG.0b013e328345bc38.
Most colorectal cancer (CRC) screening guidelines recommend average-risk screening up to the age of 75 years. However, increasing life span and incidence of proximal CRC could require changes to the age guidelines and adapting screening methodology for the elderly persons. Therefore, we reviewed our CRC epidemiology, international screening age-guidelines, and screening tests for the elderly persons and presented our long-term results of colonoscopy and semi-quantitated immunochemical fecal occult blood tests (I-FOBTs) in individuals that are 75 years or more.
We examined the Israel National Cancer Registry (INCR) data to assess the risk of CRC in individuals aged 75 years or more. We re-examined files of patients aged 75 years or more, who underwent both colonoscopy and three I-FOBTs, and followed them through the INCR to identify new cases of CRC.
Nationwide, during 2005 and 2007, 41.3% of all CRCs occurred in individuals aged 75 years or more. Both I-FOBT and colonoscopy were performed on 271 individuals (mean age: 78.5 years, standard deviation: 3.1). Both initial colonoscopy and I-FOBT of at least 50 ngHb/ml buffer in either of the first two tests identified six patients with CRC; INCR registered another stage 1 rectal CRC within 1 year. Therefore, the initial sensitivity to CRC of either test was 85.7% (95% confidence interval: 59.8 and 112), valid during a mean of 44.3 months and a standard deviation of 13.4 at INCR follow-up; 14 of 27 advanced adenomatous polyps were identified by I-FOBT, giving a sensitivity of 58.8% (95% confidence interval: 42.3 and 75.4) for CRC or advanced adenomatous polyps.
Recently, 41.3% of our CRCs occurred in individuals aged 75 years or more, diagnosed clinically and not by screening. I-FOBT and initial colonoscopic CRC sensitivity were similar, both having false-negative results. Screening age guidelines need reconsideration; our initial results show that semi-quantitated I-FOBT screening is feasible but needs large-scale evaluation in 'healthy' elderly persons.
大多数结直肠癌（CRC）筛查指南建议对平均风险人群进行筛查，直至 75 岁。然而，随着预期寿命的延长和近端 CRC 的发病率增加，可能需要修改年龄指南，并为老年人调整筛查方法。因此，我们回顾了 CRC 的流行病学、国际筛查年龄指南以及老年人的筛查试验，并介绍了我们对 75 岁及以上人群进行结肠镜检查和半定量免疫化学粪便潜血试验（I-FOBT）的长期结果。
我们检查了以色列国家癌症登记处（INCR）的数据，以评估 75 岁及以上人群患 CRC 的风险。我们重新检查了年龄在 75 岁及以上、接受过结肠镜检查和三次 I-FOBT 的患者的档案，并通过 INCR 对其进行随访，以确定新的 CRC 病例。
在全国范围内，2005 年和 2007 年，所有 CRC 中有 41.3%发生在 75 岁及以上人群中。271 名患者同时进行了 I-FOBT 和结肠镜检查（平均年龄：78.5 岁，标准差：3.1）。初次结肠镜检查和前两次检测中至少有一次缓冲液 50ngHb/ml 的 I-FOBT 共发现 6 例 CRC；INCR 在 1 年内又登记了 1 例 1 期直肠 CRC。因此，两种检测方法对 CRC 的初始敏感性均为 85.7%（95%置信区间：59.8%至 112%），在 INCR 随访的平均 44.3 个月和标准差 13.4 内有效；14 个高级腺瘤性息肉通过 I-FOBT 检出，CRC 或高级腺瘤性息肉的敏感性为 58.8%（95%置信区间：42.3%至 75.4%）。
最近，我们有 41.3%的 CRC 发生在 75 岁及以上的人群中，这些患者是通过临床诊断而不是筛查发现的。I-FOBT 和初次结肠镜检查对 CRC 的敏感性相似，均存在假阴性结果。筛查年龄指南需要重新考虑；我们的初步结果表明，半定量 I-FOBT 筛查是可行的，但需要在“健康”老年人中进行大规模评估。
