Tiankanon Kasenee, Aniwan Satimai, Rerknimitr Rungsun
Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Chulalongkorn University, Bangkok, Thailand.
Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross, Bangkok, Thailand.
Clin Endosc. 2021 Jul;54(4):499-504. doi: 10.5946/ce.2020.245-IDEN. Epub 2021 Mar 15.
Colorectal cancer (CRC) accounts for approximately 10.3% of new cancer cases in Thailand and is currently the 3rd most prevalent cancer found among the Thai population. Starting in 2017, the Thai government announced the national CRC screening program as a response to this important issue. Among the 70 million people currently residing in Thailand, 14 million require screening, while there are approximately a total of 1,000 endoscopists available to perform colonoscopy. Due to the limited resources and shortage of endoscopists in Thailand, applying a population-based one-step colonoscopy program as a primary screening method is not feasible. To reduce colonoscopy workload, with the help of others, including village health volunteers, institution-based health personnel, reimbursement coders, pathologists, and patients due for CRC screening, a two-step approach of one-time fecal immunochemical test (FIT), which prioritizes and filters out subjects for colonoscopy, is chosen. Moreover, additional adjustments to the optimal FIT cutoff value and the modified Asia-Pacific Colorectal Screening risk score, including body weight, were proposed to stratify the priority of colonoscopy schedule. This article aims to give an overview of the past and current policy developmental strategies and the current status of the Thailand CRC screening program.
在泰国，结直肠癌（CRC）约占新增癌症病例的10.3%，目前是泰国人群中第三大常见癌症。自2017年起，泰国政府宣布实施国家CRC筛查计划，以应对这一重要问题。在泰国目前居住的7000万人中，有1400万人需要进行筛查，而大约共有1000名内镜医师可进行结肠镜检查。由于泰国资源有限且内镜医师短缺，采用基于人群的一步式结肠镜检查计划作为主要筛查方法并不可行。为了减轻结肠镜检查的工作量，在包括乡村卫生志愿者、机构医护人员、报销编码员、病理学家以及应接受CRC筛查的患者等各方的帮助下，选择了一种两步法，即一次性粪便免疫化学检测（FIT），该方法对结肠镜检查对象进行优先级排序并筛选。此外，还提出了对最佳FIT临界值以及修改后的亚太结直肠癌筛查风险评分（包括体重）进行额外调整，以对结肠镜检查时间表的优先级进行分层。本文旨在概述泰国CRC筛查计划过去和当前的政策制定策略以及现状。
