Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.
Population Health Sciences Institute, Newcastle University, Newcastle, UK.
Nat Rev Gastroenterol Hepatol. 2020 Dec;17(12):773-780. doi: 10.1038/s41575-020-00368-3. Epub 2020 Oct 16.
Population screening and endoscopic surveillance are used widely to prevent the development of and death from colorectal cancer (CRC). However, CRC remains a major cause of cancer mortality and the increasing burden of endoscopic investigations threatens to overwhelm some health services. This Perspective describes the rationale for and approach to improved risk stratification and decision-making for CRC prevention and diagnosis. Limitations of current approaches will be discussed using the UK as an example of the challenges faced by a particular health-care system, followed by discussion of novel risk biomarker utilization. We explore how risk stratification will be advantageous to current health-care providers and users, enabling more efficient use of limited colonoscopy resources. We discuss risk stratification in the setting of population screening as well as the surveillance of high-risk groups and investigation of symptomatic patients. We also address challenges in the development and validation of risk stratification tools and identify key research priorities.
人群筛查和内镜监测被广泛用于预防结直肠癌（CRC）的发生和死亡。然而，CRC 仍然是癌症死亡的主要原因，内镜检查负担的增加有可能使一些卫生服务不堪重负。本观点描述了用于改善 CRC 预防和诊断的风险分层和决策的基本原理和方法。将以英国为例，讨论当前方法的局限性，以及新型风险生物标志物的应用。我们探讨了风险分层如何使当前的医疗保健提供者和使用者受益，从而更有效地利用有限的结肠镜检查资源。我们讨论了人群筛查中的风险分层以及高危人群的监测和症状患者的检查。我们还解决了风险分层工具的开发和验证中的挑战，并确定了关键的研究重点。
