Hull York Medical School, University of Hull, Cottingham Road, Hull, HU6 7HR, UK.
Centre for Population Health Sciences, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK.
Cancer Causes Control. 2022 May;33(5):653-685. doi: 10.1007/s10552-022-01568-9. Epub 2022 Mar 20.
In this scoping review, we examined the international literature on risk-stratified bowel screening to develop recommendations for future research, practice and policy.
Six electronic databases were searched from inception to 18 October 2021: Medline, Embase, PsycINFO, CINAHL, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials. Forward and backwards citation searches were also undertaken. All relevant literature were included.
After de-deduplication, 3,629 records remained. 3,416 were excluded at the title/abstract screening stage. A further 111 were excluded at full-text screening stage. In total, 102 unique studies were included. Results showed that risk-stratified bowel screening programmes can potentially improve diagnostic performance, but there is a lack of information on longer-term outcomes. Risk models do appear to show promise in refining existing risk stratification guidelines but most were not externally validated and less than half achieved good discriminatory power. Risk assessment tools in primary care have the potential for high levels of acceptability and uptake, and therefore, could form an important component of future risk-stratified bowel screening programmes, but sometimes the screening recommendations were not adhered to by the patient or healthcare provider. The review identified important knowledge gaps, most notably in the area of organisation of screening services due to few pilots, and what risk stratification might mean for inequalities.
We recommend that future research focuses on what organisational challenges risk-stratified bowel screening may face and a consideration of inequalities in any changes to organised bowel screening programmes.
在本次范围综述中，我们对国际风险分层肠道筛查文献进行了研究，旨在为未来的研究、实践和政策制定提供建议。
从建库至 2021 年 10 月 18 日，我们检索了 6 个电子数据库：Medline、Embase、PsycINFO、CINAHL、Cochrane 系统评价数据库和 Cochrane 对照试验中心注册库。此外，我们还进行了正向和反向引文搜索。所有相关文献均被纳入。
去重后，共保留 3629 条记录。在标题/摘要筛选阶段，有 3416 条记录被排除。在全文筛选阶段，又有 111 条记录被排除。最终，共有 102 项独特的研究被纳入。结果表明，风险分层肠道筛查方案可能有助于提高诊断性能，但缺乏关于长期结局的信息。风险模型似乎确实有望改进现有的风险分层指南，但大多数模型都没有经过外部验证，只有不到一半的模型具有良好的区分能力。初级保健中的风险评估工具具有较高的可接受性和接受度，因此可能成为未来风险分层肠道筛查计划的重要组成部分，但有时患者或医疗保健提供者并未遵循筛查建议。本综述确定了一些重要的知识空白，尤其是在由于试点较少而导致的筛查服务组织方面，以及风险分层对不平等现象可能意味着什么。
我们建议未来的研究重点关注风险分层肠道筛查可能面临的组织挑战，以及对有组织的肠道筛查计划进行任何改变时，如何考虑不平等问题。
