Carroll Magdalen R R, Seaman Helen E, Halloran Stephen P
NHS Bowel Cancer Screening Programme Southern Hub, 20 Priestley Road, Surrey Research Park, Guildford, Surrey GU2 7YS, UK; Royal Surrey County Hospital Foundation Trust, Egerton Road, Guildford, Surrey, GU2 7XX, UK.
NHS Bowel Cancer Screening Programme Southern Hub, 20 Priestley Road, Surrey Research Park, Guildford, Surrey GU2 7YS, UK; Royal Surrey County Hospital Foundation Trust, Egerton Road, Guildford, Surrey, GU2 7XX, UK; University of Surrey, Guildford, GU2 7XH, UK.
Clin Biochem. 2014 Jul;47(10-11):921-39. doi: 10.1016/j.clinbiochem.2014.04.019. Epub 2014 Apr 24.
Worldwide, colorectal (CRC) is the third most common form of cancer, after lung and breast cancer, and the fourth most common cause of cancer death, although in developed countries CRC incidence is higher and it accounts for an even higher proportion of cancer deaths. Successful treatment of early-stage CRC confers substantial survival advantage, and there is now overwhelming evidence that screening average-risk individuals for CRC reduces the incidence and disease-specific mortality. In spite of considerable research for new biomarkers for CRC, the detection of blood in faeces remains the most effective screening tool. The best evidence to date for population-based CRC screening comes from randomised-controlled trials that used a guaiac-based faecal occult blood test (gFOBt) as the first-line screening modality, whereby test-positive individuals are referred for follow-up investigations, usually colonoscopy. A major innovation in the last ten years or so has been the development of other more analytically sensitive and specific screening techniques for blood in faeces. The faecal immunochemical test for haemoglobin (FIT) confers substantial benefits over gFOBt in terms of analytical sensitivity, specificity and practicality and FIT are now recommended for CRC screening by the European guidelines for quality assurance in colorectal cancer screening and diagnosis. The challenge internationally is to develop high quality CRC screening programmes for which uptake is high. This is especially important for developing countries witnessing an increase in the incidence of CRC as populations adopt more westernised lifestyles. This review describes the tests available for CRC screening and how they are being used worldwide. The reader will gain an understanding of developments in CRC screening and issues that arise in choosing the most appropriate screening test (or tests) for organised population-based screening internationally and optimising the performance of the chosen test (or tests). Whilst a wide range of literature has been cited, this is not a systematic review. The authors provide FOBT CRC screening for a population of 14.6 million in the south of England and the senior author (SPH) was the lead author of the European guidelines for quality assurance in colorectal cancer screening and diagnosis and leads the World Endoscopy Organization Colorectal Cancer Committee's Expert Working Group on 'FIT for Screening'.
在全球范围内，结直肠癌（CRC）是继肺癌和乳腺癌之后的第三大常见癌症形式，也是癌症死亡的第四大常见原因，不过在发达国家，结直肠癌的发病率更高，在癌症死亡中所占比例也更高。早期结直肠癌的成功治疗可带来显著的生存优势，目前有大量证据表明，对平均风险个体进行结直肠癌筛查可降低发病率和疾病特异性死亡率。尽管对结直肠癌的新生物标志物进行了大量研究，但粪便潜血检测仍然是最有效的筛查工具。迄今为止，基于人群的结直肠癌筛查的最佳证据来自随机对照试验，这些试验使用基于愈创木脂的粪便潜血试验（gFOBt）作为一线筛查方式，检测呈阳性的个体被转诊进行后续检查，通常是结肠镜检查。在过去十年左右的时间里，一项重大创新是开发了其他对粪便潜血检测分析更敏感、更特异的筛查技术。血红蛋白粪便免疫化学检测（FIT）在分析敏感性、特异性和实用性方面比gFOBt有很大优势，目前欧洲结直肠癌筛查和诊断质量保证指南推荐将FIT用于结直肠癌筛查。国际上面临的挑战是制定高质量且接受度高的结直肠癌筛查计划。这对发展中国家尤为重要，因为随着人们生活方式越来越西化，这些国家的结直肠癌发病率正在上升。本综述描述了可用于结直肠癌筛查的检测方法以及它们在全球的使用情况。读者将了解结直肠癌筛查的发展情况以及在为国际有组织的人群筛查选择最合适的筛查检测方法（一种或多种）并优化所选检测方法（一种或多种）的性能时出现的问题。虽然引用了大量文献，但这并非系统综述。作者为英格兰南部1460万人口提供粪便潜血试验结直肠癌筛查，资深作者（SPH）是欧洲结直肠癌筛查和诊断质量保证指南的主要作者，并领导世界内镜组织结直肠癌委员会“适合筛查的FIT”专家工作组。
