Associate Professor and Attending Physician, University of Virginia School of Medicine, Charlottesville, VA.
Emeritus Professor, Louisiana State University School of Public Health, New Orleans, LA.
CA Cancer J Clin. 2018 Jul;68(4):250-281. doi: 10.3322/caac.21457. Epub 2018 May 30.
In the United States, colorectal cancer (CRC) is the fourth most common cancer diagnosed among adults and the second leading cause of death from cancer. For this guideline update, the American Cancer Society (ACS) used an existing systematic evidence review of the CRC screening literature and microsimulation modeling analyses, including a new evaluation of the age to begin screening by race and sex and additional modeling that incorporates changes in US CRC incidence. Screening with any one of multiple options is associated with a significant reduction in CRC incidence through the detection and removal of adenomatous polyps and other precancerous lesions and with a reduction in mortality through incidence reduction and early detection of CRC. Results from modeling analyses identified efficient and model-recommendable strategies that started screening at age 45 years. The ACS Guideline Development Group applied the Grades of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria in developing and rating the recommendations. The ACS recommends that adults aged 45 years and older with an average risk of CRC undergo regular screening with either a high-sensitivity stool-based test or a structural (visual) examination, depending on patient preference and test availability. As a part of the screening process, all positive results on noncolonoscopy screening tests should be followed up with timely colonoscopy. The recommendation to begin screening at age 45 years is a qualified recommendation. The recommendation for regular screening in adults aged 50 years and older is a strong recommendation. The ACS recommends (qualified recommendations) that: 1) average-risk adults in good health with a life expectancy of more than 10 years continue CRC screening through the age of 75 years; 2) clinicians individualize CRC screening decisions for individuals aged 76 through 85 years based on patient preferences, life expectancy, health status, and prior screening history; and 3) clinicians discourage individuals older than 85 years from continuing CRC screening. The options for CRC screening are: fecal immunochemical test annually; high-sensitivity, guaiac-based fecal occult blood test annually; multitarget stool DNA test every 3 years; colonoscopy every 10 years; computed tomography colonography every 5 years; and flexible sigmoidoscopy every 5 years. CA Cancer J Clin 2018;68:250-281. © 2018 American Cancer Society.
在美国，结直肠癌（CRC）是成年人中第四大常见癌症，也是癌症死亡的第二大主要原因。为了本次指南更新，美国癌症协会（ACS）使用了现有的 CRC 筛查文献系统证据审查和微观模拟分析，包括对按种族和性别开始筛查的年龄进行新的评估，以及纳入美国 CRC 发病率变化的额外建模。使用多种选择之一进行筛查与腺瘤性息肉和其他癌前病变的检测和去除相关，与 CRC 发病率降低和早期检测相关，从而显著降低 CRC 的发病率和死亡率。模型分析的结果确定了高效且符合模型建议的策略，即从 45 岁开始筛查。ACS 指南制定小组应用推荐分级的评估、制定与评价（GRADE）标准制定和评估建议。ACS 建议年龄在 45 岁及以上、CRC 平均风险的成年人根据患者偏好和检测可用性，选择定期进行高敏粪便检测或结构（视觉）检查。作为筛查过程的一部分，所有非结肠镜筛查检测的阳性结果都应及时进行结肠镜检查。建议从 45 岁开始筛查是一个有条件的建议。建议 50 岁及以上成年人定期筛查是一个强烈的建议。ACS 建议（有条件的建议）：1）预期寿命超过 10 年、身体健康的一般风险成年人继续进行 CRC 筛查，直至 75 岁；2）临床医生根据患者的偏好、预期寿命、健康状况和既往筛查史，对 76-85 岁之间的个体进行个体化 CRC 筛查决策；3）临床医生不鼓励 85 岁以上的个体继续进行 CRC 筛查。CRC 筛查的选择有：每年进行一次粪便免疫化学检测；每年进行一次高敏、愈创木脂粪便潜血检测；每 3 年进行一次多靶点粪便 DNA 检测；每 10 年进行一次结肠镜检查；每 5 年进行一次计算机断层结肠成像检查；每 5 年进行一次乙状结肠镜检查。CA Cancer J Clin 2018;68:250-281. © 2018 American Cancer Society.
