Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Harvard Medical School, Boston.
Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston.
JAMA Oncol. 2021 Jul 1;7(7):985-992. doi: 10.1001/jamaoncol.2021.1364.
Evidence indicates that screening for colorectal cancer (CRC) beginning at 50 years of age can detect early-stage CRC and premalignant neoplasms (eg, adenomas) and thus prevent CRC-related mortality. At present, the US Preventive Services Task Force recommends continuing CRC screening until 75 years of age and individualized decision-making for adults older than 75 years, while accounting for a patient's overall health and screening history. However, scant data exist to support these recommendations.
To examine the association of lower gastrointestinal tract screening endoscopy with the risk of CRC incidence and CRC-related mortality in older US adults.
DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study of health care professionals in the US included data from the Nurses' Health Study (NHS) and Health Professionals Follow-up Study (HPFS) from January 1, 1988, through January 31, 2016, for the HPFS and June 30, 2016, for the NHS. Data were analyzed from May 8, 2019, to July 9, 2020.
History of screening sigmoidoscopy or colonoscopy (routine/average risk or positive family history) to 75 years of age and after 75 years of age, assessed every 2 years.
Incidence of CRC and CRC-related mortality confirmed by National Death Index, medical records, and pathology reports.
Among 56 374 participants who reached 75 years of age during follow-up (36.8% men and 63.2% women), 661 incident CRC cases and 323 CRC-related deaths were documented. Screening endoscopy after 75 years of age was associated with reduced risk of CRC incidence (multivariable hazard ratio [HR], 0.61; 95% CI, 0.51-0.74) and CRC-related mortality (HR, 0.60; 95% CI, 0.46-0.78), regardless of screening history. The HR comparing screening with nonscreening after 75 years of age was 0.67 (95% CI, 0.50-0.89) for CRC incidence and 0.58 (95% CI, 0.38-0.87) for CRC-related mortality among participants who underwent screening endoscopy before 75 years of age, and 0.51 (95% CI, 0.37-0.70) for CRC incidence and 0.63 (95% CI, 0.43-0.93) for CRC-related mortality among participants without a screening history. However, screening endoscopy after 75 years of age was not associated with risk reduction in CRC death among participants with cardiovascular disease (HR, 1.18; 95% CI, 0.59-2.35) or significant comorbidities (HR, 1.17; 95% CI, 0.57-2.43).
In this cohort study, endoscopy among individuals older than 75 years was associated with lower risk of CRC incidence and CRC-related mortality. These data support continuation of screening after 75 years of age among individuals without significant comorbidities.
有证据表明，从 50 岁开始对结直肠癌（CRC）进行筛查，可以发现早期 CRC 和癌前病变（如腺瘤），从而预防与 CRC 相关的死亡率。目前，美国预防服务工作组建议继续进行 CRC 筛查，直至 75 岁，并根据患者的整体健康状况和筛查史，为 75 岁以上的成年人进行个体化决策。然而，目前尚缺乏支持这些建议的数据。
研究下消化道筛查内镜检查与美国老年成年人 CRC 发病率和 CRC 相关死亡率的关系。
设计、地点和参与者：这是一项在美国医疗保健专业人员中进行的前瞻性队列研究，数据来自 NHS 和 HPFS，时间范围为 1988 年 1 月 1 日至 2016 年 1 月 31 日（HPFS）和 2016 年 6 月 30 日（NHS）。数据分析时间为 2019 年 5 月 8 日至 2020 年 7 月 9 日。
在 75 岁之前和之后进行过乙状结肠镜检查或结肠镜检查（常规/平均风险或有阳性家族史）的历史，每 2 年评估一次。
通过国家死亡索引、病历和病理报告确认 CRC 的发病和 CRC 相关的死亡。
在随访期间达到 75 岁的 56374 名参与者中（36.8%为男性，63.2%为女性），记录了 661 例 CRC 病例和 323 例 CRC 相关死亡。无论筛查史如何，75 岁以后进行内镜筛查与 CRC 发病率（多变量 HR，0.61；95%CI，0.51-0.74）和 CRC 相关死亡率（HR，0.60；95%CI，0.46-0.78）降低相关。在 75 岁之前接受过内镜筛查的参与者中，与 75 岁以后不筛查相比，75 岁以后筛查的 CRC 发病率 HR 为 0.67（95%CI，0.50-0.89），CRC 相关死亡率 HR 为 0.58（95%CI，0.38-0.87），而在没有筛查史的参与者中，CRC 发病率 HR 为 0.51（95%CI，0.37-0.70），CRC 相关死亡率 HR 为 0.63（95%CI，0.43-0.93）。然而，在患有心血管疾病（HR，1.18；95%CI，0.59-2.35）或有重大合并症（HR，1.17；95%CI，0.57-2.43）的参与者中，75 岁以后进行内镜筛查与 CRC 死亡风险降低无关。
在这项队列研究中，75 岁以上人群的内镜检查与 CRC 发病率和 CRC 相关死亡率降低相关。这些数据支持在没有重大合并症的情况下，继续进行 75 岁以后的筛查。
