Department of Biochemistry and Molecular Biology, University of Santiago de Compostela, Santiago de Compostela 15782, Spain.
Centre for Research in Molecular Medicine and Chronic Diseases (CiMUS), University of Santiago de Compostela, Santiago de Compostela 15782, Galicia, Spain.
World J Gastroenterol. 2024 Jun 14;30(22):2849-2851. doi: 10.3748/wjg.v30.i22.2849.
In this editorial we comment on the article by Agatsuma published in the . They suggest policies for more effective colorectal screening. Screening is the main policy that has led to lower mortality rates in later years among the population that was eligible for screening. Colonoscopy is the gold standard tool for screening and has preventive effects by removing precancerous or early malignant polyps. However, colonoscopy is an invasive process, and fecal tests such as the current hemoglobin immunodetection were developed, followed by endoscopy, as the general tool for population screening, avoiding logistical and economic problems. Even so, participation and adherence rates are low. Different screening options are being developed with the idea that if people could choose between the ones that best suit them, participation in population-based screening programs would increase. Blood tests, such as a recent one that detects cell-free DNA shed by tumors called circulating tumor DNA, showed a similar accuracy rate to stool tests for cancer, but were less sensitive for advanced precancerous lesions. At the time when the crosstalk between the immune system and cancer was being established as a new hallmark of cancer, novel immune system-related biomarkers and information on patients' immune parameters, such as cell counts of different immune populations, were studied for the early detection of colorectal cancer, since they could be effective in asymptomatic people, appearing earlier in the adenoma-carcinoma development compared to the presence of fecal blood. sCD26, for example, detected 80.37% of advanced adenomas. To reach as many eligible people as possible, starting at an earlier age than current programs, the direction could be to apply tests based on blood, urine or salivary fluid to samples taken during routine visits to the primary health system.
在这篇社论中，我们对 Agatsuma 发表在 上的文章进行了评论。他们提出了更有效的结直肠癌筛查政策。筛查是主要政策，近年来使符合筛查条件的人群死亡率降低。结肠镜检查是筛查的金标准工具，通过切除癌前或早期恶性息肉具有预防作用。然而，结肠镜检查是一种有创的过程，因此开发了粪便检测等方法，如当前的血红蛋白免疫检测，然后是内窥镜检查，作为人群筛查的一般工具，避免了后勤和经济问题。即便如此，参与率和依从率仍然很低。正在开发不同的筛查选择，其理念是如果人们可以在最适合他们的选项之间进行选择，那么基于人群的筛查计划的参与度将会提高。血液检测，例如最近一种检测称为循环肿瘤 DNA 的肿瘤释放的无细胞 DNA 的检测，其对癌症的检测准确率与粪便检测相似，但对高级癌前病变的检测敏感性较低。当免疫系统与癌症之间的相互作用被确立为癌症的一个新标志时，新型免疫系统相关生物标志物和患者免疫参数信息，如不同免疫群体的细胞计数，被研究用于结直肠癌的早期检测，因为它们在无症状人群中可能有效，与粪便潜血相比，在腺瘤-癌发展过程中出现得更早。例如，sCD26 检测到 80.37%的高级腺瘤。为了尽可能多地覆盖到符合条件的人群，我们可以从比当前计划更早的年龄开始，将方向转向应用基于血液、尿液或唾液的测试，这些测试可以应用于在初级卫生系统的常规就诊时采集的样本。
