Indiana University School of Medicine, Indianapolis, Indiana.
University of California San Diego, San Diego, California.
Gastroenterology. 2017 Jul;153(1):307-323. doi: 10.1053/j.gastro.2017.05.013. Epub 2017 Jun 9.
This document updates the colorectal cancer (CRC) screening recommendations of the U.S. Multi-Society Task Force of Colorectal Cancer (MSTF), which represents the American College of Gastroenterology, the American Gastroenterological Association, and The American Society for Gastrointestinal Endoscopy. CRC screening tests are ranked in 3 tiers based on performance features, costs, and practical considerations. The first-tier tests are colonoscopy every 10 years and annual fecal immunochemical test (FIT). Colonoscopy and FIT are recommended as the cornerstones of screening regardless of how screening is offered. Thus, in a sequential approach based on colonoscopy offered first, FIT should be offered to patients who decline colonoscopy. Colonoscopy and FIT are recommended as tests of choice when multiple options are presented as alternatives. A risk-stratified approach is also appropriate, with FIT screening in populations with an estimated low prevalence of advanced neoplasia and colonoscopy screening in high prevalence populations. The second-tier tests include CT colonography every 5 years, the FIT-fecal DNA test every 3 years, and flexible sigmoidoscopy every 5 to 10 years. These tests are appropriate screening tests, but each has disadvantages relative to the tier 1 tests. Because of limited evidence and current obstacles to use, capsule colonoscopy every 5 years is a third-tier test. We suggest that the Septin9 serum assay (Epigenomics, Seattle, Wash) not be used for screening. Screening should begin at age 50 years in average-risk persons, except in African Americans in whom limited evidence supports screening at 45 years. CRC incidence is rising in persons under age 50, and thorough diagnostic evaluation of young persons with suspected colorectal bleeding is recommended. Discontinuation of screening should be considered when persons up to date with screening, who have prior negative screening (particularly colonoscopy), reach age 75 or have <10 years of life expectancy. Persons without prior screening should be considered for screening up to age 85, depending on age and comorbidities. Persons with a family history of CRC or a documented advanced adenoma in a first-degree relative age <60 years or 2 first-degree relatives with these findings at any age are recommended to undergo screening by colonoscopy every 5 years, beginning 10 years before the age at diagnosis of the youngest affected relative or age 40, whichever is earlier. Persons with a single first-degree relative diagnosed at ≥60 years with CRC or an advanced adenoma can be offered average-risk screening options beginning at age 40 years.
本文件更新了美国多学会大肠癌筛查工作组（MSTF）的大肠癌（CRC）筛查建议，该工作组代表美国胃肠病学会、美国胃肠病协会和美国胃肠内镜学会。CRC 筛查试验根据性能特征、成本和实际考虑因素分为 3 个级别。第一级别的测试是每 10 年进行一次结肠镜检查和每年一次粪便免疫化学测试（FIT）。无论如何提供筛查，结肠镜检查和 FIT 都被推荐为筛查的基石。因此，在基于首先提供结肠镜检查的顺序方法中，对于拒绝结肠镜检查的患者，应提供 FIT。当提供多种替代方案作为选择时，结肠镜检查和 FIT 被推荐为首选测试。风险分层方法也是合适的，在估计高级肿瘤患病率较低的人群中进行 FIT 筛查，在高患病率人群中进行结肠镜筛查。第二级别的测试包括每 5 年进行一次 CT 结肠成像、每 3 年进行一次 FIT-粪便 DNA 测试和每 5 至 10 年进行一次柔性乙状结肠镜检查。这些测试是合适的筛查测试，但与第 1 级测试相比，每种测试都有缺点。由于证据有限且目前使用存在障碍，每 5 年进行一次胶囊结肠镜检查是第三级别的测试。我们建议不要使用 Septin9 血清检测（Epigenomics，西雅图，华盛顿州）进行筛查。在平均风险人群中，应从 50 岁开始进行 CRC 筛查，而在非洲裔美国人中，由于有限的证据支持在 45 岁时进行筛查，因此不在此范围内。50 岁以下人群的 CRC 发病率正在上升，建议对疑似结直肠出血的年轻人进行彻底的诊断评估。对于接受过筛查且之前的筛查结果为阴性（尤其是结肠镜检查）、年龄达到 75 岁或预期寿命不足 10 年的人群，应考虑停止筛查。对于没有接受过筛查的人群，应根据年龄和合并症考虑进行筛查，直至 85 岁。对于结直肠癌家族史或有记录的一级亲属在 60 岁以下患有晚期腺瘤或在任何年龄有 2 个一级亲属有这些发现的人群，建议每 5 年进行一次结肠镜检查筛查，从诊断出最年轻受影响亲属年龄或 40 岁（以较早者为准）前 10 年开始。有一个一级亲属在 60 岁以上被诊断患有 CRC 或晚期腺瘤的人群，可以从 40 岁开始选择平均风险的筛查方案。
