Department of Surgery, Crosshouse Hospital, Kilmarnock, UK.
Colorectal Dis. 2013 Jan;15(1):34-41. doi: 10.1111/j.1463-1318.2012.03100.x.
Bowel screening aims to reduce colorectal-cancer mortality by the detection and treatment of early-stage asymptomatic disease and the removal of precancerous adenomas. Bowel screening started in Ayrshire and Arran in September 2007. We report the impact of this screening on the diagnosis and stage of colorectal cancer and characterize screen-detected cancers in comparison with those diagnosed through other pathways.
Diagnoses were identified from an audit database. Referrals were grouped into screen detected, routine, urgent and emergency presentations.
Between January 2001 and December 2010, 2289 diagnoses of colorectal cancer were made. From 2001 to 2006, the mean (range) number of new colorectal-cancer diagnoses per year was 210 (198-220). Between 2007 and 2010, the mean (range) number of diagnoses per year was 256 (239-274), a significant (P = 0.008) increase. Since September 2007, 877 colorectal cancers have been diagnosed: 17% were screen detected; 11% were detected as a result of routine GP referral; 51% were detected after urgent GP referral; and 21% were emergency presentations. TNM stage increased with urgency of referral. Approximately two-thirds (66%) of screen-detected colorectal cancers were node negative vs 25% of emergency presentations (P < 0.001). Most screen-detected cancers were distal to the splenic flexure (75%). Screened cancers had favourable pathology; lower T and N stages (both P < 0.001), less venous invasion (P < 0.001) and better differentiation (P < 0.05). Similar results were seen after stratification for TNM stage. Screening has not yet resulted in a significant shift towards early-stage disease since 2007.
Screening has been associated with an increase in the numbers of both new and early-stage colorectal cancers. Screen-detected cancers are predominantly early-stage disease with favourable pathology. At present, it remains to be seen whether screening will ultimately translate into an overall reduction in advanced-stage disease.
结直肠癌筛查旨在通过检测和治疗早期无症状疾病以及切除癌前腺瘤来降低结直肠癌死亡率。结直肠癌筛查于 2007 年 9 月在艾尔郡和阿伦开始。我们报告了这种筛查对结直肠癌的诊断和分期的影响，并比较了筛查发现的癌症与通过其他途径诊断的癌症。
从审计数据库中确定诊断。转诊被分为筛查发现、常规、紧急和急诊。
2001 年 1 月至 2010 年 12 月，共诊断出 2289 例结直肠癌。2001 年至 2006 年，每年新诊断的结直肠癌平均（范围）数量为 210（198-220）。2007 年至 2010 年，每年的诊断平均（范围）数量为 256（239-274），显著增加（P=0.008）。自 2007 年 9 月以来，共诊断出 877 例结直肠癌：17%为筛查发现；11%为常规 GP 转诊发现；51%为紧急 GP 转诊发现；21%为急诊。TNM 分期随转诊的紧急程度而增加。大约三分之二（66%）的筛查发现结直肠癌无淋巴结转移，而 25%的急诊发现（P<0.001）。大多数筛查发现的癌症位于脾曲远端（75%）。筛查发现的癌症具有有利的病理；较低的 T 和 N 分期（均 P<0.001），较少的静脉侵犯（P<0.001）和更好的分化（P<0.05）。在按 TNM 分期分层后，也得到了类似的结果。自 2007 年以来，筛查尚未导致早期疾病数量的显著增加。
筛查与新的和早期结直肠癌数量的增加有关。筛查发现的癌症主要是早期疾病，具有有利的病理。目前，尚不清楚筛查是否最终会导致晚期疾病的总体减少。
