Colorectal cancer screening: Recommendations for physicians and patients from the US Multi-Society Task Force on Colorectal Cancer
Colorectal cancer screening: Recommendations for physicians and patients from the US Multi-Society Task Force on Colorectal Cancer
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DOI：
10.1016/j.gie.2017.04.003
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发表时间：
2017-07-01
影响因子：
7.7
通讯作者：
Robertson, Douglas J.
中科院分区：
文献类型：
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作者：
Rex, Douglas K.;Boland, C. Richard;Robertson, Douglas J.
本文件更新了美国结直肠癌多学会工作组（MSTF）的结直肠癌（CRC）筛查建议，该工作组代表美国胃肠病学会，美国胃肠病协会和美国胃肠内镜学会。CRC筛查测试根据性能特征、成本和实际考虑因素分为3层。第一层测试是每10年一次的结肠镜检查和每年一次的粪便免疫化学测试（FIT）。结肠镜检查和FIT被推荐为筛查的基石，无论筛查是如何提供的。因此，在基于首先提供结肠镜检查的序贯方法中，应向拒绝结肠镜检查的患者提供FIT。结肠镜检查和FIT被推荐为多个选项作为替代时的选择测试。风险分层方法也是适当的，在估计晚期肿瘤患病率较低的人群中进行FIT筛查，在患病率较高的人群中进行结肠镜筛查。第二层测试包括每5年进行一次CT结肠镜检查、每3年进行一次FIT粪便DNA测试以及每5至10年进行一次柔性乙状结肠镜检查。这些测试都是适当的筛选测试，但每一个相对于1级测试的缺点。由于证据有限和目前的使用障碍，每5年一次的胶囊结肠镜检查是第三级检查。我们建议不要使用Septin 9血清测定（表观基因组学，华盛顿州西雅图）进行筛查。筛查应开始年龄在50岁的平均风险的人，除了在非洲裔美国人中，有限的证据支持筛查在45岁。CRC发病率在50岁以下的人群中正在上升，建议对疑似结直肠出血的年轻人进行全面的诊断评估。当筛查结束后，既往筛查（特别是结肠镜检查）阴性的人达到75岁或预期寿命<10岁时，应考虑停止筛查。根据年龄和合并症，应考虑对85岁以下未接受过筛查的患者进行筛查。对于有CRC家族史或一级亲属年龄<60岁或2名一级亲属在任何年龄有这些发现的晚期腺瘤患者，建议每5年进行一次结肠镜筛查，从最年轻受累亲属诊断年龄前10年或40岁开始，以较早者为准。有一个一级亲属在≥60岁时诊断为CRC或晚期腺瘤的人可以从40岁开始进行平均风险筛查。
This document updates the colorectal cancer (CRC) screening recommendations of the U.S. Multi-Society Task Force of Colorectal Cancer (MSTF), which represents the American College of Gastroenterology, the American Gastroenterological Association, and The American Society for Gastrointestinal Endoscopy. CRC screening tests are ranked in 3 tiers based on performance features, costs, and practical considerations. The first-tier tests are colonoscopy every 10 years and annual fecal immunochemical test (FIT). Colonoscopy and FIT are recommended as the cornerstones of screening regardless of how screening is offered. Thus, in a sequential approach based on colonoscopy offered first, FIT should be offered to patients who decline colonoscopy. Colonoscopy and FIT are recommended as tests of choice when multiple options are presented as alternatives. A risk-stratified approach is also appropriate, with FIT screening in populations with an estimated low prevalence of advanced neoplasia and colonoscopy screening in high prevalence populations. The second-tier tests include CT colonography every 5 years, the FIT–fecal DNA test every 3 years, and flexible sigmoidoscopy every 5 to 10 years. These tests are appropriate screening tests, but each has disadvantages relative to the tier 1 tests. Because of limited evidence and current obstacles to use, capsule colonoscopy every 5 years is a third-tier test. We suggest that the Septin9 serum assay (Epigenomics, Seattle, Wash) not be used for screening. Screening should begin at age 50 years in average-risk persons, except in African Americans in whom limited evidence supports screening at 45 years. CRC incidence is rising in persons under age 50, and thorough diagnostic evaluation of young persons with suspected colorectal bleeding is recommended. Discontinuation of screening should be considered when persons up to date with screening, who have prior negative screening (particularly colonoscopy), reach age 75 or have <10 years of life expectancy. Persons without prior screening should be considered for screening up to age 85, depending on age and comorbidities. Persons with a family history of CRC or a documented advanced adenoma in a first-degree relative age <60 years or 2 first-degree relatives with these findings at any age are recommended to undergo screening by colonoscopy every 5 years, beginning 10 years before the age at diagnosis of the youngest affected relative or age 40, whichever is earlier. Persons with a single first-degree relative diagnosed at ≥60 years with CRC or an advanced adenoma can be offered average-risk screening options beginning at age 40 years.