National Guidelines for Colorectal Cancer Screening in Saudi Arabia with strength of recommendations and quality of evidence
National Guidelines for Colorectal Cancer Screening in Saudi Arabia with strength of recommendations and quality of evidence
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DOI：
10.5144/0256-4947.2015.189
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发表时间：
2015-05-01
影响因子：
1.6
通讯作者：
Morgan, Rebecca L.
中科院分区：
文献类型：
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作者：
Alsanea, Nasser;Almadi, Majid A.;Morgan, Rebecca L.
背景：结直肠癌是沙特男性中最常见的癌症，在沙特女性中排名第三。鉴于沙特阿拉伯结直肠癌与其他癌症相比占主导地位，需要针对具体情况制定筛查指南。方法：来自沙特结肠和直肠外科学会、沙特胃肠病学会、沙特肿瘤学会、沙特肠造口治疗分会、家庭医学和沙特阿拉伯卫生部公共卫生司的专家以及一名患者倡导者由沙特阿拉伯卫生部下属的沙特循证医疗保健中心召集。该小组与加拿大麦克马斯特大学的一个方法学小组合作，制定了结肠直肠癌筛查的国家指南。在确定关键问题后，专家组对所有关于筛查效用、沙特阿拉伯结直肠癌筛查费用以及沙特患者的价值观和偏好的报告进行了系统审查。适当时，进行荟萃分析，以生成汇总效应估计值。使用GRADE方法，专家组使用证据到决策（EtD）框架来评估在确定建议的强度和方向方面重要的所有领域（益处和危害、价值和偏好、资源影响、公平性、可接受性和可行性）。如果未达成共识，则通过共识或投票解决与EtD域相关的判断。最终建议是在2015年3月于沙特阿拉伯利雅得举行的为期两天的会议上制定的。专家组成员之间的利益冲突是根据世界卫生组织的规则处理的。局限性：缺乏关于腺瘤性息肉发病率或发病率激增的年龄组的国家数据。有没有国家临床试验评估结直肠癌筛查的不同模式及其对mortality.CONCLUSION的影响的有效性：该小组建议在沙特阿拉伯的结直肠癌筛查无症状的沙特患者结直肠癌的平均风险。应该建立基础设施来实现这一目标。
BACKGROUND: Colorectal cancer is the most common cancer among Saudi men and the third commonest among Saudi women. Given the predominance of colorectal cancer compared with other cancers in Saudi Arabia, context-specific guidelines are needed for screening. METHODS: Experts from the Saudi Society of Colon and Rectal Surgery, Saudi Gastroenterology Association, Saudi Oncology Society, Saudi Chapter of Enterostomal Therapy, Family Medicine and Department of Public Health at the Saudi Arabian Ministry of Health and a patient advocate was assembled by the Saudi Centre for Evidence-Based Healthcare, a subsidiary of the Saudi Arabian Ministry of Health. The panel collaborated with a methodological team from McMaster University, Canada to develop national guidelines for colorectal cancer screening. After identifying key questions, the panel conducted a systematic review of all reports on the utility of screening, the cost of screening for colorectal cancer in Saudi Arabia and on the values and preferences of Saudi patients. Meta-analyses, when appropriate, were performed to generate pooled estimates of effect. Using the GRADE approach, the panel used the evidence-to-decision (EtD) framework to assess all domains important in determining the strength and direction of the recommendations (benefits and harms, values and preferences, resource implications, equity, acceptability, and feasibility). Judgments related to the EtD domains were resolved through consensus or voting, if consensus was not reached. The final recommendations were developed during a two-day meeting held in Riyadh, Saudi Arabia in March 2015. Conflicts of interests among the panel members were handled according to the World Health Organization rules.LIMITATIONS: There is lack of national data on the incidence of adenomatous polyps or the age groups in which the incidence surges. There were no national clinical trials assessing the effectiveness of the different modalities of screening for colorectal cancer and their impact on mortality.CONCLUSION: The panel recommends screening for colorectal cancer in Saudi Arabia in asymptomatic Saudi patients at average risk of colorectal cancer. An infrastructure should be built to achieve that goal.