一图读懂:大肠癌四种筛查方式的临床实践指南
创作:迟卉 审核:Lexi 2019年11月01日
  • 建议使用QCancer®等工具计算今后15年内个人患结直肠癌(CRC)的风险;
  • 对于50-79岁未筛查、无症状成人,15年CRC风险低于3%不建议筛查,高于3%建议筛查;
  • 推荐筛查方式:粪便免疫化学试验(FIT)/年、FIT/2年、乙状结肠镜和结肠镜检查;
  • FIT/2年对15年以上癌症发病率(CI)影响甚微,FIT/年、乙状结肠镜和结肠镜可降低CI;
  • 筛查相关的严重胃肠道和心血管不良事件罕见;
  • 获益大小取决于个人患癌风险,危害和负担与癌症风险无密切关系。
#一张图读懂系列文献#
主编推荐语
Lexi
近15年乙状结肠镜筛查试验的更新为结直肠癌筛查的有效性提供了新的证据。那么,对于50至79岁的人群,接受结直肠癌筛查对健康结果有重要影响吗?哪一种筛查方式是最优的?最新发表在British Medical Journal杂志的结直肠癌筛查临床实践指南回答了这些问题。该指南推荐了四种结直肠癌筛查方案,并根据已有证据总结了四种方案的特点,建议根据个人患结直肠癌的风险确定是否进行筛查,以及选择合适的筛查方式。同时,该指南就如何计算个体患结直肠癌的风险进行了指导,其风险可根据年龄、性别、种族、吸烟情况、病史、家族史等情况进行计算。考虑到不同的价值观和偏好,最佳的健康护理需要来自包括患者、医护人员等多个方面的共同决策。该指南还包括关联研究、筛查的危害和益处、实际问题的筛选决策辅助工具。我们特别译制了一图读懂,希望能助你涨知识。
关键字
延伸阅读本研究的原文信息和链接出处,以及相关解读和评论文章。欢迎读者朋友们推荐!

Colorectal cancer screening with faecal immunochemical testing, sigmoidoscopy or colonoscopy: a clinical practice guideline

用粪便免疫化学检测、乙状结肠镜或结肠镜筛查结直肠癌:临床实践指南

10.1136/bmj.l5515

2019-10-02, Article

Abstract & Authors:展开

Abstract:收起
CLINICAL QUESTION: Recent 15-year updates of sigmoidoscopy screening trials provide new evidence on the effectiveness of colorectal cancer screening. Prompted by the new evidence, we asked: "Does colorectal cancer screening make an important difference to health outcomes in individuals initiating screening at age 50 to 79? And which screening option is best?"
CURRENT PRACTICE: Numerous guidelines recommend screening, but vary on recommended test, age and screening frequency. This guideline looks at the evidence and makes recommendations on screening for four screening options: faecal immunochemical test (FIT) every year, FIT every two years, a single sigmoidoscopy, or a single colonoscopy.
RECOMMENDATIONS: These recommendations apply to adults aged 50-79 years with no prior screening, no symptoms of colorectal cancer, and a life expectancy of at least 15 years. For individuals with an estimated 15-year colorectal cancer risk below 3%, we suggest no screening (weak recommendation). For individuals with an estimated 15-year risk above 3%, we suggest screening with one of the four screening options: FIT every year, FIT every two years, a single sigmoidoscopy, or a single colonoscopy (weak recommendation). With our guidance we publish the linked research, a graphic of the absolute harms and benefits, a clear description of how we reached our value judgments, and linked decision aids.
HOW THIS GUIDELINE WAS CREATED: A guideline panel including patients, clinicians, content experts and methodologists produced these recommendations using GRADE and in adherence with standards for trustworthy guidelines. A linked systematic review of colorectal cancer screening trials and microsimulation modelling were performed to inform the panel of 15-year screening benefits and harms. The panel also reviewed each screening option's practical issues and burdens. Based on their own experience, the panel estimated the magnitude of benefit typical members of the population would value to opt for screening and used the benefit thresholds to inform their recommendations.
THE EVIDENCE: Overall there was substantial uncertainty (low certainty evidence) regarding the 15-year benefits, burdens and harms of screening. Best estimates suggested that all four screening options resulted in similar colorectal cancer mortality reductions. FIT every two years may have little or no effect on cancer incidence over 15 years, while FIT every year, sigmoidoscopy, and colonoscopy may reduce cancer incidence, although for FIT the incidence reduction is small compared with sigmoidoscopy and colonoscopy. Screening related serious gastrointestinal and cardiovascular adverse events are rare. The magnitude of the benefits is dependent on the individual risk, while harms and burdens are less strongly associated with cancer risk.
UNDERSTANDING THE RECOMMENDATION: Based on benefits, harms, and burdens of screening, the panel inferred that most informed individuals with a 15-year risk of colorectal cancer of 3% or higher are likely to choose screening, and most individuals with a risk of below 3% are likely to decline screening. Given varying values and preferences, optimal care will require shared decision making.

First Authors:
Lise M Helsingen

Correspondence Authors:
Lise M Helsingen

All Authors:
Lise M Helsingen,Per Olav Vandvik,Henriette C Jodal,Thomas Agoritsas,Lyubov Lytvyn,Joseph C Anderson,Reto Auer,Silje Bjerkelund Murphy,Majid Abdulrahman Almadi,Douglas A Corley,Casey Quinlan,Jonathan M Fuchs,Annette McKinnon,Amir Qaseem,Anja Fog Heen,Reed A C Siemieniuk,Mette Kalager,Juliet A Usher-Smith,Iris Lansdorp-Vogelaar,Michael Bretthauer,Gordon Guyatt

评论