Department of Gastroenterological Oncology, the Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland; Department of Gastroenterology, Hepatology and Oncology, Medical Center for Postgraduate Education, Warsaw, Poland; Institute of Health and Society, University of Oslo, Oslo, Norway.
Department of Veterans Affairs Medical Center, White River Junction, Vermont; The Geisel School of Medicine at Dartmouth and The Dartmouth Institute, Hanover, New Hampshire.
Gastroenterology. 2020 Jan;158(2):404-417. doi: 10.1053/j.gastro.2019.11.026. Epub 2019 Nov 20.
Screening, followed by colonoscopic polypectomy (or surgery for malignant lesions), prevents incident colorectal cancer and mortality. However, there are variations in effective application of nearly every aspect of the screening process. Screening is a multistep process, and failure in any single step could result in unnecessary morbidity and mortality. Awareness of variations in operator- and system-dependent performance has led to detailed, comprehensive recommendations in the United States and Europe on how colonoscopy screening should be performed and measured. Likewise, guidance has been provided on quality assurance for nonprimary colonoscopy-based screening programs, including strategies to maximize adherence. Quality improvement is now a validated science, and there is clear evidence that higher quality prevents incident cancer and cancer death. Quality must be addressed at the levels of the system, provider, and individuals, to maximize the benefits of screening for any population. We review the important aspects of measuring and improving the quality of colorectal cancer screening.
筛查后行结肠镜下息肉切除术（或恶性病变手术）可预防结直肠癌的发生和死亡。然而，在筛查过程的几乎每一个方面的有效应用都存在差异。筛查是一个多步骤的过程，任何一个步骤的失败都可能导致不必要的发病率和死亡率。对操作人员和系统相关性能差异的认识，促使美国和欧洲制定了详细、全面的建议，规定了结肠镜筛查应如何进行和测量。同样，也为非基于结肠镜的初级筛查计划提供了质量保证指导，包括最大限度提高依从性的策略。质量改进现在是一门已被证实的科学，有明确的证据表明更高的质量可预防癌症的发生和癌症死亡。为了最大限度地提高任何人群的筛查获益，质量必须在系统、提供者和个人层面上得到解决。我们回顾了衡量和提高结直肠癌筛查质量的重要方面。
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