Cripps N P, Heald R J
Colorectal Research Unit, North Hampshire Hospitals NHS Trust, Basingstoke, Hampshire.
Gut. 1996 Mar;38(3):421-5. doi: 10.1136/gut.38.3.421.
Colorectal cancer (CRC) screening using family history to define a group at increased risk is gaining support. Three hundred and ninety six subjects aged over 25 with at least one first degree affected relative have been screened using a single slide, immunological faecal occult blood test (FOBT), and family history data to select the highest risk group. Compliance was 64.9% but was significantly better if contact was made within one year of diagnosis of the index relative (75% v 62.1%, chi 2 = 5.7, p < 0.05). Twelve subjects (13.2%) of those who had a colonoscopy) bearing adenomas have been detected, three of which were at high risk of malignant transformation. No cancers have been diagnosed. Most subjects undergoing screening were less than 55 years of age (67.8%). These accounted for most colonoscopies (68.1%) but only one large adenoma was diagnosed in this group. The FOBT was particularly useful, enabling the detection of five large adenomas. Family based CRC screening is practical in a district hospital setting. Although labour intensive, it meets a population demand and can detect significant numbers of adenomas. Screening, even in those at moderately increased risk, could be focused on the older age groups, probably those aged over 40.
利用家族病史来界定患癌风险增加的人群并进行结直肠癌（CRC）筛查正获得越来越多的支持。对396名年龄超过25岁且至少有一位一级亲属患癌的受试者进行了筛查，采用单张载玻片免疫学法粪便潜血试验（FOBT），并依据家族病史数据挑选出风险最高的人群。筛查的依从率为64.9%，但如果在索引亲属确诊后一年内进行联系，依从率会显著更高（75%对62.1%，卡方检验=5.7，p<0.05）。在接受结肠镜检查的受试者中，已检测出12名（13.2%）患有腺瘤，其中3名有恶性转化的高风险。尚未诊断出癌症。大多数接受筛查的受试者年龄小于55岁（67.8%）。这些人占了大多数结肠镜检查病例（68.1%），但该组仅诊断出1例大腺瘤。FOBT特别有用，能够检测出5例大腺瘤。基于家族的CRC筛查在地区医院环境中是可行的。虽然需要大量人力，但它满足了人群需求，并且能够检测出大量腺瘤。即使是对风险适度增加的人群进行筛查，也可将重点放在年龄较大的组，可能是40岁以上的人群。
