Screening for colorectal cancer in adults at average risk: A summary of the evidence for the US Preventive Services Task Force
Screening for colorectal cancer in adults at average risk: A summary of the evidence for the US Preventive Services Task Force
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DOI：
10.7326/0003-4819-137-2-200207160-00015
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发表时间：
2002-07-16
影响因子：
39.2
通讯作者：
Lohr, KN
中科院分区：
文献类型：
--
作者：
Pignone, M;Rich, M;Lohr, KN
目的：评估不同的结直肠癌筛查试验对平均风险成人的有效性。资料来源：最近的系统性综述；临床预防服务指南，第二版；以及1966年至2001年9月期间MEDLINE的重点检索。作者还进行了手工搜索、书目审查和咨询上下文专家以确保完整性。研究选择：当可用时，使用最新的高质量系统综述来确定相关文章。数据提炼：一位评价者将最后一组研究中的信息提取到证据表中，另一位评价者检查这些评价表的准确性。数据综合：对于50岁以上的中等风险成年人，来自多个进行良好的随机试验的证据支持，与没有筛查的人相比，粪便潜血检测在降低结直肠癌发病率和死亡率方面的有效性。来自进行良好的病例对照研究的数据支持乙状结肠镜检查和结肠镜检查在降低结肠癌发病率和死亡率方面的有效性。一项检测结直肠癌死亡率的非随机对照试验和检测诊断效率的随机试验支持使用粪便潜血检测和乙状结肠镜检查。钡灌肠的效果尚不清楚。数据不足以确定最有效的筛查策略。结论：结直肠癌筛查可降低结直肠癌的死亡率，并可通过切除腺瘤性息肉来降低发病率。几种可用的筛查方法似乎有效，但由于数据不足，无法确定单一的最佳筛查方法。
Purpose: To assess the effectiveness of different colorectal cancer screening tests for adults at average risk.Data Sources: Recent systematic reviews; Guide to Clinical Preventive Services, 2nd edition; and focused searches of MEDLINE from 1966 through September 2001. The authors also conducted hand searches, reviewed bibliographies, and consulted context experts to ensure completeness.Study Selection: When available, the most recent high-quality systematic review was used to identify relevant articles. This review was then supplemented with a MEDLINE search for more recent articles.Data Extraction: One reviewer abstracted information from the final set of studies into evidence tables, and a second reviewer checked the tables for accuracy. Discrepancies were resolved by consensus.Data Synthesis: For average-risk adults older than 50 years of age, evidence from multiple well-conducted randomized trials supported the effectiveness of fecal occult blood testing in reducing colorectal cancer incidence and mortality rates compared with no screening. Data from well-conducted case-control studies supported the effectiveness of sigmoidoscopy and possibly colonoscopy in reducing colon cancer incidence and mortality rates. A nonrandomized, controlled trial examining colorectal cancer mortality rates and randomized trials examining diagnostic yield supported the use of fecal occult blood testing plus sigmoidoscopy. The effectiveness of barium enema is unclear. Data are insufficient to support a definitive determination of the most effective screening strategy.Conclusions: Colorectal cancer screening reduces death from colorectal cancer and can decrease the incidence of disease through removal of adenomatous polyps. Several available screening options seem to be effective, but the single best screening approach cannot be determined because data are insufficient.