Colorectal cancer: risk factors and recommendations for early detection.
Colorectal cancer: risk factors and recommendations for early detection.
复制标题
结直肠癌：危险因素和早期检测建议。
作者：
T. Read;I. Kodner
越来越多的证据表明，早期结直肠癌和腺瘤性息肉的发现和治疗可以降低死亡率，在此推动下，联邦医疗保险和其他一些支付者最近批准对患有这种恶性肿瘤的中等风险人群进行结直肠癌筛查的补偿。美国卫生保健政策和研究机构召集的一个合作专家小组建议使用以下技术之一对50岁以上的中等风险人群进行筛查：每年粪便潜血检测、每五年柔性乙状结肠镜检查、每年粪便潜血检测与每五年柔性乙状结肠镜检查、每五年双对比钡灌肠或每10年结肠镜检查。应根据结直肠癌或息肉的家族病史，在较早的年龄开始筛查有危险因素的人。这些建议补充了美国家庭医生学会的结直肠癌筛查指南。基因研究的最新进展使鉴定患有结直肠癌的高危人群成为可能，因为他们具有罹患结直肠癌的遗传倾向。这些患者需要积极的筛查，通常是在早期进行低位内窥镜检查。在一些患者中，基因检测可以指导筛查，而且可能具有成本效益。
Spurred by mounting evidence that the detection and treatment of early-stage colorectal cancers and adenomatous polyps can reduce mortality, Medicare and some other payors recently authorized reimbursement for colorectal cancer screening in persons at average risk for this malignancy. A collaborative group of experts convened by the U.S. Agency for Health Care Policy and Research has recommended screening for average-risk persons over the age of 50 years using one of the following techniques: fecal occult blood testing each year, flexible sigmoidoscopy every five years, fecal occult blood testing every year combined with flexible sigmoidoscopy every five years, double-contrast barium enema every five to 10 years or colonoscopy every 10 years. Screening of persons with risk factors should begin at an earlier age, depending on the family history of colorectal cancer or polyps. These recommendations augment the colorectal cancer screening guidelines of the American Academy of Family physicians. Recent advances in genetic research have made it possible to identify persons at high risk for colorectal cancer because of an inherited predisposition to develop this malignancy. These patients require aggressive screening, usually by lower endoscopy performed at an early age. In some patients, genetic testing can guide screening and may be cost-effective.