Armitage N C, Hardcastle J D
Department of Surgery, University Hospital, Nottingham, United Kingdom.
Ann Acad Med Singap. 1987 Jul;16(3):432-6.
The advanced stage of most colorectal cancers at the time of presentation is largely responsible for the poor prognosis of the majority of patients with this tumour. Symptoms attributable to colorectal cancer are nonspecific and there is often considerable delay between their onset and diagnosis. By offering faecal occult blood (FOB) tests to patients presenting to their family doctors with abdominal symptoms the delay in diagnosis was significantly reduced but the pathological stage of the cancers was similar to that of a control group managed by their family doctors in their standard manner. In order to detect cancers at an earlier, asymptomatic stage a randomised control trial of FOB testing was instituted. A total of 26,975 individuals from the general population between the ages of 45 and 75 years were randomised to receive FOB tests or to be controls. 4,917 (36%) completed the tests and a total of 18 cancers were detected of which 13 (72%) were confined to the bowel wall. At rescreen a further six cancers (3 stage A) were detected by FOB tests. In the control group 20 cancers were diagnosed at two years of which only one (5%) was stage A. Asymptomatic screening showed a significant increase in the proportion of early stage tumours but the effect on mortality will await long term follow up.
大多数结直肠癌患者就诊时已处于晚期，这在很大程度上导致了该肿瘤大多数患者预后不良。结直肠癌的症状缺乏特异性，从症状出现到诊断往往有相当长的延迟。通过为有腹部症状前来家庭医生处就诊的患者提供粪便潜血（FOB）检测，诊断延迟显著缩短，但癌症的病理分期与由家庭医生以标准方式管理的对照组相似。为了在更早的无症状阶段检测癌症，开展了一项FOB检测的随机对照试验。共有26975名年龄在45至75岁之间的普通人群被随机分为接受FOB检测组或对照组。4917人（36%）完成了检测，共检测出18例癌症，其中13例（72%）局限于肠壁。在复查时，FOB检测又发现了另外6例癌症（3例A期）。在对照组中，两年内诊断出20例癌症，其中只有1例（5%）为A期。无症状筛查显示早期肿瘤的比例显著增加，但对死亡率的影响有待长期随访。
