Walshe Margaret, Moran Robert, Boyle Marie, Cretu Ion, Galvin Zita, Swan Victoria, Trikovic Jason, Farrell Michael P, Foy Sinéad, O'Brien Loretta, Leyden Jan, Mulligan Niall, Fenlon Helen, Gallagher David J, MacMathúna Padraic
Gastrointestinal Unit, Mater Misericordiae University Hospital, University College Dublin, Eccles Street, Dublin 7, Ireland.
Gastrointestinal Unit, Mater Misericordiae University Hospital, University College Dublin, Eccles Street, Dublin 7, Ireland.
Cancer Epidemiol. 2017 Oct;50(Pt A):30-38. doi: 10.1016/j.canep.2017.07.002. Epub 2017 Aug 4.
We present the 15-year experience of a family colorectal cancer screening service in Ireland with emphasis on real life experience and outcomes.
Questionnaires were used to assess family cancer history and assign patients to risk categories; 'Moderate Risk', HNPCC, (suspected) genetic syndrome (non-HNPCC), 'Low Risk'. Screening was by full colonoscopy. We report neoplastic yield, examining effect of risk category, age, gender, and index colonoscopy findings.
Between 1998 and 2013, 2242 individuals were referred; 57.3% female, 42.7% male, median age 46 years (range9-85yrs). Median follow up time was 7.9yrs (range 0.5-15.3yrs). Follow up data after exclusion (non-compliance, known CRC) was available in 1496 (66.7%): 'Moderate risk' 785 (52.5%), HNPCC 256 (17.1%), (suspected) genetic syndrome (non-HNPCC) 85 (5.7%), 'Low Risk' 370 (24.7%). Screening was performed in 1025(68.5%) patients; colonoscopy data available for 993 (96.9%); total 1914 colonoscopies. At index colonoscopy, 178 (18.0%) patients had adenomas; 56 (5.5%) advanced adenoma. During the entire study period, 240 (24.2%) had an adenoma; 69 (7.0%) advanced adenoma. Cancers were diagnosed on screening in 2 patients. Older age and male gender were associated with higher adenoma detection rate; p<0.001, p=0.01, respectively. Risk category did not affect adenoma yield. Adenoma and advanced adenoma detection at index colonoscopy were associated with detection of same at follow up screening; p<0.001.
Male gender and age (>50) were the core identifiable risk factors for neoplasia at screening colonoscopy in this family screening setting. Our results would support less intensive surveillance in younger patients (<50), particularly where index colonoscopy is normal.
我们介绍了爱尔兰一项为期15年的家族性结直肠癌筛查服务经验，重点是实际经验和结果。
采用问卷调查评估家族癌症病史，并将患者分为风险类别；“中度风险”、遗传性非息肉病性结直肠癌（HNPCC）、（疑似）遗传综合征（非HNPCC）、“低风险”。筛查采用全结肠镜检查。我们报告肿瘤检出率，研究风险类别、年龄、性别和首次结肠镜检查结果的影响。
1998年至2013年期间，共转诊2242人；女性占57.3%，男性占42.7%，中位年龄46岁（范围9 - 85岁）。中位随访时间为7.9年（范围0.5 - 15.3年）。排除（不依从、已知结直肠癌）后的随访数据在1496人中可用（66.7%）：“中度风险”785人（52.5%），HNPCC 256人（17.1%），（疑似）遗传综合征（非HNPCC）85人（5.7%），“低风险”370人（24.7%）。1025名（68.5%）患者接受了筛查；993名（96.9%）患者有结肠镜检查数据；共进行了1914次结肠镜检查。在首次结肠镜检查时，178名（18.0%）患者发现腺瘤；56名（5.5%）为进展性腺瘤。在整个研究期间，240名（24.2%）患者发现腺瘤；69名（7.0%）为进展性腺瘤。筛查中诊断出2例癌症。年龄较大和男性与较高的腺瘤检出率相关；p<0.001，p = 0.01，风险类别不影响腺瘤检出率。首次结肠镜检查时腺瘤和进展性腺瘤的检出与随访筛查时的检出相关；p<0.001。
在这个家族筛查环境中，男性和年龄（>50岁）是筛查结肠镜检查时肿瘤形成的核心可识别风险因素。我们的结果支持对年轻患者（<50岁）进行强度较低的监测，特别是在首次结肠镜检查正常的情况下。
