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为服务不足人群进行结直肠癌筛查的挑战与可能的解决方案。

Challenges and possible solutions to colorectal cancer screening for the underserved.

机构信息

Affiliations of authors: Division of Gastroenterology, Department of Internal Medicine, University of California San Diego, Veterans Affairs San Diego Healthcare System, San Diego, CA (SG); University of California San Diego Moores Cancer Center, San Diego, CA (SG, MEM); Division of Gastroenterology, Department of Internal Medicine, University of Miami Miller School of Medicine, Miami, FL (DAS, ARD); Department of Family Medicine and Community Health at the Perelman School of Medicine, Center for Clinical Epidemiology and Biostatistics, Leonard Davis Institute for Health Economics, and the Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, PA (CAD); Southern California Kaiser Permanente Group, San Diego, CA (DAS); San Francisco General Hospital; University of California San Francisco, San Francisco, CA (LD, MS, JA); Division of Gastroenterology, University of Michigan Medical Center, Ann Arbor, MI (BJE); Division of Gastroenterology, Department of Medicine, Howard University, Washington, DC (AOL); MD Incorporated, Encinitas, CA (JM); Kaiser Northern California Division of Research, Oakland, CA (JA); Alameda County Medical Center, Oakland, CA (TB); University of Texas Southwestern Medical School, Dallas, TX (ZG); Group Health Research Institute, Seattle, WA (BBG); Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY (SHI); Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA (MEM).

出版信息

J Natl Cancer Inst. 2014 Apr;106(4):dju032. doi: 10.1093/jnci/dju032. Epub 2014 Mar 28.

Abstract

Colorectal cancer (CRC) is a leading cause of cancer mortality worldwide. CRC incidence and mortality can be reduced through screening. However, in the United States, screening participation remains suboptimal, particularly among underserved populations such as the uninsured, recent immigrants, and racial/ethnic minority groups. Increasing screening rates among underserved populations will reduce the US burden of CRC. In this commentary focusing on underserved populations, we highlight the public health impact of CRC screening, list key challenges to screening the underserved, and review promising approaches to boost screening rates. We identify four key policy and research priorities to increase screening among underserved populations: 1) actively promote the message, "the best test is the one that gets done"; 2) develop and implement methods to identify unscreened individuals within underserved population groups for screening interventions; 3) develop and implement approaches for organized screening delivery; and 4) fund and enhance programs and policies that provide access to screening, diagnostic follow-up, and CRC treatment for underserved populations. This commentary represents the consensus of a diverse group of experts in cancer control and prevention, epidemiology, gastroenterology, and primary care from across the country who formed the Coalition to Boost Screening among the Underserved in the United States. The group was organized and held its first annual working group meeting in conjunction with the World Endoscopy Organization's annual Colorectal Cancer Screening Committee meeting during Digestive Disease Week 2012 in San Diego, California.

摘要

结直肠癌(CRC)是全球癌症死亡的主要原因。通过筛查可以降低 CRC 的发病率和死亡率。然而,在美国,筛查参与率仍然不理想,尤其是在未参保人群、新移民和少数族裔等服务不足的人群中。提高服务不足人群的筛查率将降低美国 CRC 的负担。在这篇聚焦服务不足人群的评论中,我们强调了 CRC 筛查对公共卫生的影响,列出了为服务不足人群进行筛查的主要挑战,并回顾了提高筛查率的有希望的方法。我们确定了增加服务不足人群筛查的四个关键政策和研究重点:1)积极宣传“最好的检测是完成的检测”这一信息;2)开发并实施在服务不足人群中识别未接受筛查个体的方法,以便进行筛查干预;3)开发并实施有组织的筛查实施方法;4)为服务不足人群提供筛查、诊断随访和 CRC 治疗的机会,资助并加强相关项目和政策。本评论代表了来自全国各地的癌症控制和预防、流行病学、胃肠病学和初级保健领域的多元化专家小组的共识,该小组成立了“在美国提高服务不足人群筛查率联盟”。该组织成立并于 2012 年在加利福尼亚州圣地亚哥举行的世界内镜组织年度 CRC 筛查委员会会议期间召开了第一次年度工作组会议。

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