Colorectal Cancer Screening for Average-Risk Adults: 2018 Guideline Update From the American Cancer Society
Colorectal Cancer Screening for Average-Risk Adults: 2018 Guideline Update From the American Cancer Society
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DOI：
10.3322/caac.21457
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发表时间：
2018-07-01
影响因子：
254.7
通讯作者：
Smith, Robert A.
中科院分区：
文献类型：
--
作者：
Wolf, Andrew M. D.;Fontham, Elizabeth T. H.;Smith, Robert A.
在美国，结直肠癌（CRC）是成人中诊断的第四大常见癌症，也是癌症死亡的第二大原因。对于该指南更新，美国癌症协会（ACS）使用了CRC筛查文献的现有系统证据综述和微观模拟建模分析，包括按种族和性别对开始筛查年龄的新评估，以及纳入美国CRC发病率变化的额外建模。多项选择中的任何一项筛查都可通过检测和切除腺瘤性息肉和其他癌前病变显著降低CRC发病率，并通过降低发病率和早期发现CRC降低死亡率。建模分析的结果确定了在45岁时开始筛查的有效和模型可验证的策略。ACS指南制定小组在制定和评级建议时采用了建议、评估、制定和评价等级（GRADE）标准。ACS建议年龄在45岁及以上的平均CRC风险的成年人进行定期筛查，根据患者的偏好和测试可用性进行高灵敏度粪便测试或结构（视觉）检查。作为筛查过程的一部分，所有非结肠镜筛查试验的阳性结果都应及时进行结肠镜检查。在45岁时开始筛查的建议是合格的建议。强烈建议50岁及以上的成年人定期筛查。ACS建议（合格的建议）：1）健康状况良好、预期寿命超过10年的平均风险成年人继续进行CRC筛查，直至75岁; 2）临床医生根据患者偏好、预期寿命、健康状况和既往筛查史，为76至85岁的个体制定个性化的CRC筛查决定;和3）临床医生不鼓励85岁以上的个体继续进行CRC筛查。CRC筛查的选择是：每年进行一次粪便免疫化学检测;每年进行一次高灵敏度、基于愈创木脂的粪便潜血检测;每3年进行一次多靶粪便DNA检测;每10年进行一次结肠镜检查;每5年进行一次计算机断层扫描结肠造影;每5年进行一次乙状结肠镜检查。(C)2018美国癌症协会
In the United States, colorectal cancer (CRC) is the fourth most common cancer diagnosed among adults and the second leading cause of death from cancer. For this guideline update, the American Cancer Society (ACS) used an existing systematic evidence review of the CRC screening literature and microsimulation modeling analyses, including a new evaluation of the age to begin screening by race and sex and additional modeling that incorporates changes in US CRC incidence. Screening with any one of multiple options is associated with a significant reduction in CRC incidence through the detection and removal of adenomatous polyps and other precancerous lesions and with a reduction in mortality through incidence reduction and early detection of CRC. Results from modeling analyses identified efficient and model-recommendable strategies that started screening at age 45 years. The ACS Guideline Development Group applied the Grades of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria in developing and rating the recommendations. The ACS recommends that adults aged 45 years and older with an average risk of CRC undergo regular screening with either a high-sensitivity stool-based test or a structural (visual) examination, depending on patient preference and test availability. As a part of the screening process, all positive results on noncolonoscopy screening tests should be followed up with timely colonoscopy. The recommendation to begin screening at age 45 years is a qualified recommendation. The recommendation for regular screening in adults aged 50 years and older is a strong recommendation. The ACS recommends (qualified recommendations) that: 1) average-risk adults in good health with a life expectancy of more than 10 years continue CRC screening through the age of 75 years; 2) clinicians individualize CRC screening decisions for individuals aged 76 through 85 years based on patient preferences, life expectancy, health status, and prior screening history; and 3) clinicians discourage individuals older than 85 years from continuing CRC screening. The options for CRC screening are: fecal immunochemical test annually; high-sensitivity, guaiac-based fecal occult blood test annually; multitarget stool DNA test every 3 years; colonoscopy every 10 years; computed tomography colonography every 5 years; and flexible sigmoidoscopy every 5 years. (C) 2018 American Cancer Society.