Centre for Research into Cancer Prevention and Screening, University of Dundee, Dundee, Scotland, UK.
Clin Chem Lab Med. 2022 Jul 13;60(10):1496-1505. doi: 10.1515/cclm-2022-0583. Print 2022 Sep 27.
Currently, women are disadvantaged compared to men in colorectal cancer (CRC) screening, particularly in programmes that use faecal immunochemical tests for haemoglobin (FIT) followed by colonoscopy. Although there is no single cause for all the known disadvantages, many can be attributed to the ubiquitous finding that women have lower faecal haemoglobin concentrations (f-Hb) than men; there are many plausible reasons for this. Generally, a single f-Hb threshold is used in CRC screening programmes, leading to lower positivity for women than men, which causes poorer outcomes for women, including lower CRC detection rate, higher interval cancer (IC) proportion, and higher CRC mortality. Many of the now widely advocated risk scoring strategies do include factors taking account of sex, but these have not been extensively piloted or introduced. Using different f-Hb thresholds for the sexes seems advantageous, but there are difficulties, including deciding which characteristic should be selected to achieve equivalency, for example, positivity, IC proportions, or specificity. Moreover, additional colonoscopy resources, often constrained, would be required. Governments and their agencies should be encouraged to prioritise the allocation of resources to put simple strategies into practice, such as different f-Hb thresholds to create equal positivity in both sexes.
目前，与男性相比，女性在结直肠癌（CRC）筛查中处于不利地位，尤其是在使用粪便免疫化学试验检测血红蛋白（FIT）后进行结肠镜检查的方案中。尽管造成所有已知劣势的原因并非单一，但许多原因可归因于一个普遍的发现，即女性的粪便血红蛋白浓度（f-Hb）低于男性；造成这种情况的原因有很多。一般来说，CRC 筛查方案中使用单一的 f-Hb 阈值，导致女性的阳性率低于男性，这给女性带来了更差的结果，包括 CRC 检出率较低、间隔期癌症（IC）比例较高和 CRC 死亡率较高。现在广泛提倡的许多风险评分策略确实包括考虑性别的因素，但这些策略尚未得到广泛试点或引入。为男女使用不同的 f-Hb 阈值似乎是有利的，但存在一些困难，包括确定应选择哪些特征来实现等效性，例如阳性率、IC 比例或特异性。此外，还需要更多的结肠镜检查资源，而这些资源往往是有限的。应鼓励政府及其机构优先分配资源，以实施简单的策略，例如使用不同的 f-Hb 阈值，使男女的阳性率相等。
