Murphy Caitlin C
Division of Epidemiology, Departments of Clinical Sciences and Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA.
Curr Gastroenterol Rep. 2019 May 16;21(7):28. doi: 10.1007/s11894-019-0695-4.
Colorectal cancer (CRC) screening is recommended to reduce CRC mortality. This review outlines key factors to consider when recommending screening, including disease burden, screening benefits and harms, and remaining knowledge gaps.
In response to increasing rates of CRC incidence among younger (age < 50 years) adults, the American Cancer Society published guidelines in May 2018 recommending average-risk CRC screening beginning at age 45 (vs. 50) years. Rates of young-onset CRC have increased in the USA since the early 1990s. However, there is very little empirical evidence of screening effectiveness in younger adults, and few studies have reported harms of routine screening in this age group. Further, we know little about the natural history of CRC in younger adults. Uncertainty surrounding the efficacy of CRC screening in younger adults suggests the benefits may be small. Precision cancer screening-or modified screening regimens based on risk-may improve the balance of screening benefits and harms beyond conventional age-based strategies.
推荐进行结直肠癌（CRC）筛查以降低CRC死亡率。本综述概述了推荐筛查时需考虑的关键因素，包括疾病负担、筛查的益处和危害，以及尚存的知识空白。
鉴于年轻（年龄<50岁）成年人中CRC发病率不断上升，美国癌症协会于2018年5月发布指南，建议平均风险的CRC筛查从45岁（而非50岁）开始。自20世纪90年代初以来，美国早发性CRC的发病率有所上升。然而，几乎没有关于年轻人筛查有效性的实证证据，很少有研究报告该年龄组常规筛查的危害。此外，我们对年轻成年人CRC的自然史了解甚少。围绕年轻人CRC筛查疗效的不确定性表明其益处可能很小。精准癌症筛查——或基于风险的改良筛查方案——可能比传统的基于年龄的策略更能改善筛查益处与危害之间的平衡。
