由2450例大肠癌临床资料探讨伺机性筛查策略

目的回顾性分析已知大肠癌临床资料,为伺机性筛查策略及方案制定提供依据。方法收集2001年10月至2011年9月间华北地区五家医院收治的、具有完整记录并经组织学检查确诊的2450例大肠癌患者资料,分析年龄、性别、肿瘤发生部位和组织学类型与大肠癌发病的相关性。结果大肠癌患者中男性1377例,女性1073例;男：女为1．28：1;50岁以下占所有大肠癌病例的18．14％,50岁以上呈明显上升趋势;直乙结肠癌占73．00％,其他部位占27．00％（降结肠、横结肠、升结肠癌分别为6．12％,6．98％和13．9％）;中分化腺癌占50．33％,高分化腺癌占40．35％,低分化腺癌占9．32％;分化程度与诊断年龄无明显相关性分化程度与诊断年龄、性别无明显相关性（P〉0．05）。结论50岁以下大肠癌所占比例上升,年轻化趋势,伺机性筛查不宜做年龄限制;推荐全结肠镜检查作为伺机性筛查精查手段;伺机性筛查不考虑性别差异。     

国外结直肠癌筛查指南更新进展及对我国人群筛查工作的启示

目的了解国外结直肠癌(colorectal cancer,CRC)筛查指南更新进展,为我国人群结直肠癌筛查工作提供借鉴。方法采用文献综述的方法分析国外CRC筛查指南更新进展。检索以下数据库:Pubmed、Ovid EBMR、EBSCO MEDLINE、Springe For Hospital&Health。检索词为"colorectal cancer""guideline""recommendations""consensus"。文献发表时间为2009年1月至2019年7月,语言为英语并可获得全文文献者。结果共纳入5个指南及共识:美国预防服务工作组CRC筛查建议(2016)、美国结直肠癌多学会工作组筛查指南(2017)、加拿大卫生保健预防工作组CRC筛查指南(2016)、欧盟CRC筛查指南工作组指南(2010)、亚太地区CRC筛查共识(2015)。多数指南推荐筛查人群的年龄为50～75岁,筛查方法为粪隐血试验(化学法和免疫法)、乙状结肠镜检查和结肠镜检查,但推荐的优选试验和间隔时间不同。结论对CRC普通风险人群应于50-75岁间进行CRC筛查,筛查方法可依据所在地区的CRC流行...     

结直肠癌早期筛查进展

目的 总结中美权威机构推荐的结直肠癌筛查手段。方法 在美国预防医学工作组（USPSTF）、美国纽约州卫生部、国家消化系统疾病临床医学研究中心等权威机构网站检索 “结直肠癌”、“筛查”等关键词。根据权威机构推荐的早期筛查方法,进一步在NCBI数据库中检索获得技术实施方法、优缺点等信息。结果 比较了结肠镜、结肠CT、钡灌肠造影、粪便隐血试验、粪便免疫化学试验、粪便DNA检测和液体活检的敏感性、特异性及优缺点。结论 内镜及影像技术不断完善。各种非侵入性、高敏感性、高特异性的生物标志物不断涌现,并需及早开展临床试验,以满足大规模人群筛查的需求。     

Demographic,social cognitive and social ecological predictors of intention and participation in screening for colorectal cancer

Background  

Previous research points to differences between predictors of intention to screen for colorectal cancer (CRC) and screening behavior, and suggests social ecological factors may influence screening behavior. The aim of this study was to compare the social cognitive and social ecological predictors of intention to screen with predictors of participation.     

Cost-effectiveness of colorectal cancer screening

Colorectal cancer is an important public health problem. Several screening methods have been shown to be effective in reducing colorectal cancer mortality. The objective of this review was to assess the cost-effectiveness of the different colorectal cancer screening methods and to determine the preferred method from a cost-effectiveness point of view. Five databases (MEDLINE, EMBASE, the Cost-Effectiveness Analysis Registry, the British National Health Service Economic Evaluation Database, and the lists of technology assessments of the Centers for Medicare and Medicaid Services) were searched for cost-effectiveness analyses published in English between January 1993 and December 2009. Fifty-five publications relating to 32 unique cost-effectiveness models were identified. All studies found that colorectal cancer screening was cost-effective or even cost-saving compared with no screening. However, the studies disagreed as to which screening method was most effective or had the best incremental cost-effectiveness ratio for a given willingness to pay per life-year gained. There was agreement among studies that the newly developed screening tests of stool DNA testing, computed tomographic colonography, and capsule endoscopy were not yet cost-effective compared with the established screening options.     

Cost-effective screening strategies for colorectal cancer.

This paper models a range of feasible strategies for mass population screening for colorectal cancer. It uses both clinical and economic data derived from the major colorectal cancer screening trial currently under way in Nottingham, supplemented by data from concurrent Scandinavian trials. Costs and yields for 12 strategies are modelled, and optima are identified according to a number of evaluation criteria. The cost-effectiveness condition for the desirability of introducing a programme of colorectal screening is also established.     

The cost of screening for colorectal cancer.

STUDY OBJECTIVE--The aim was to make projections of the likely costs and yield resulting from the implementation of a faecal occult blood screening programme for colorectal cancer. DESIGN--Cost and clinical data were derived from the MRC colorectal screening trial currently in progress in Nottingham, UK. SETTING--The above data were used as the basis for modelling the likely implications were the trial to be reproduced as a screening programme within a "typical" family practitioner committee area. MAIN RESULTS--For an average family practitioner committee area with a target population of 75,000 subjects aged 50-74 years, the initial screening round might be expected to detect 85 cancers at a total cost of approximately 250,000 pounds. This represents a cost per cancer detected of 2700 pounds and a cost per person screened of approximately 5 pounds. For subsequent screening rounds, total costs might be expected to fall although average costs are likely to remain approximately constant. CONCLUSIONS--The model is successful in generating "order of magnitude" estimates for the costs of implementation of a screening programme for colorectal cancer. As benefit estimates are not yet available, however, no cost-effectiveness analysis can be undertaken at this stage. In general, sensitivity analyses reveal that programme costs are more sensitive to changes in clinical variables, especially detection and compliance rates, than they are to variations in the costs of resource inputs. A screening programme with a more elaborate protocol than that currently employed in the Nottingham trial will entail considerable cost increases.     

Mass screening for colorectal cancer in Hungary.

Haemoccult screening for colorectal tumours was carried out in Hungary in small cities and villages around Budapest. Haemoccult slides were supplied to 17,662 individuals over 40 years of age, and 15,431 (87%) were returned. Of these, 346 (2.2%) were positive and 18 colorectal carcinomas were detected. Additionally, 24 patients with one or more polyps greater than 1 cm diameter were found. Of the screened cases of cancer 39% were in Dukes' stage A and B, a rate twice as good as when screening was not done. The cost per tumour detected amounted to about three times more than one monthly income, indicating that the costs of screening for colorectal cancer are relatively much higher in Hungary than in Western countries. All expenses were met from state funds.     

Patient-physician colorectal cancer screening discussions and screening use

BACKGROUND: Little is known about patient-physician colorectal cancer (CRC) screening discussions or how discussion content affects screening use. Analyses conducted in 2004-2005 of patient-physician CRC screening discussion content and its association with screening use are described. METHODS: A mailed survey and retrospective claims data were used to compile information on insured, primary care patients aged 50 to 70 years (n = 4966). The survey collected information on patient-physician CRC screening discussion content (including the 5A's: assess, advise, agree, assist, and arrange). Survey responses were linked with 5-year retrospective claims data (ending December 31, 2003) on CRC screening use. Among patients reporting screening discussions, generalized estimating equation approaches were used to estimate the association of discussion content with screening use. RESULTS: Among those reporting discussion information (n = 2463), 80% reported discussing CRC screening with their physician. The content of these discussions varied, and only 54% used CRC screening. Multivariable model results indicated that the likelihood of screening was greater among patients reporting help scheduling an appointment (assist) (odds ratio [OR] = 2.69, 95% confidence interval [CI] = 1.95-3.72) and those reporting a discussion of results or follow-up (arrange) (OR = 1.63, 95% CI = 1.18-2.24), and lower among patients offered a choice among screening modalities (agree) (OR = 0.57, 95% CI = 0.37-0.86) as well as among those who wanted more screening information (OR = 0.65, 95% CI = 0.43-0.97). CONCLUSIONS: Not all patient-physician CRC screening discussions result in CRC screening use. It is important to understand which aspects of shared decision making and discussion content are likely to increase informed and value-concordant decisions to participate in recommended evidence-based CRC screening.     

Predictors of stage of adoption for colorectal cancer screening

BACKGROUND: Although colorectal cancer is the third most common cancer in women, little is known about predictors of adherence to screening. METHODS: A randomly selected sample of 202 predominantly low-income and African-American women were interviewed. Knowledge of, attitudes and beliefs about, and practices related to flexible sigmoidoscopy (FS) screening were assessed. RESULTS: The majority of participants were in the precontemplation stage of adoption (56%). There were significant differences by stage of adoption for FS beliefs, FS barriers, risk of developing colorectal cancer, worry about getting colorectal cancer, and physician recommendation to get a FS. Predictors of adherence to FS guidelines were perceiving fewer barriers to getting a FS and having a physician recommend a FS. CONCLUSION: Seventy-two percent of the women in this study were nonadherent to FS screening guidelines. Psychosocial factors play an important role in screening for colorectal cancer. Ways of reducing barriers and increasing physician recommendations should be explored.     

Policies of screening for colorectal cancer in European countries

OBJECTIVES: The aim of this study was to analyze the current status of population screening for colon/rectum cancer in Europe to compare the different strategies, the coverage, the existence of pilot experiences, regional coverages, and the risk factors considered in each strategy. METHODS: A comprehensive, systematic search was performed in the literature for documents addressing population screening for colon/rectum cancer in Europe. An ad hoc questionnaire was prepared including questions considered relevant. The questionnaire was reviewed by experts in the area. To identify key informants, colleague members of the International Network of Agencies for Health Technology Assessment (INAHTA), participants in the EUnetHTA project, or representatives of the ministries of health of the different European countries were contacted. The information provided by key informants was checked with information directly obtained from the ministries of health, gray literature, and research documents. RESULTS: An 88 percent response rate was obtained. In countries for which no questionnaire data were collected, information was directly retrieved from the Web sites of the corresponding ministries. Four countries were found to perform population screenings: Austria, France, Germany, and the United Kingdom. However, they used different strategies. Five countries had begun regional or local strategies: Denmark, Finland, Italy, Spain, and Switzerland, and two additional countries (the Netherlands and Norway) reported ongoing research studies intended to determine the best strategy to implement a population-based screening program. Differences were found in age range, procedure chosen, and follow-up period. CONCLUSIONS: Even though the European Council recommended a wider implementation of population screening for colon/rectum cancer, our results suggest that this recommendation continues to be valid. The differences found in screening strategies (in terms of age range, procedures, risk factors considered, and follow-up periods) are not warranted by the results obtained in research studies or regional-national cancer registries.     

Pecuniary compensation increases participation in screening for colorectal cancer

The participation rate in medical screening programmes is typically below 100%, which means that not all potential health benefits are fully exploited. In this paper, the prospect of pecuniary compensation is tested as a method of increasing the participation rate. We propose a model explaining the individual's probability of participating in screening for colorectal cancer when he is offered pecuniary compensation, given that he did not participate when first invited. The participant's decision is based on both known and uncertain factors. The estimation is conducted in two steps, where a binary probit model is used in each. We find that pecuniary compensation increases the probability of participation, and that an individual's participation probability systematically varies with variables such as travel expenses, income, age, education level, expected benefit from the screening, use of health-care services, genetic predisposition and subjective health status. Using the results from the estimation, we predict changes in the participation rate for different levels of compensation and estimate the cost per additional individual screened. The cost per additional individual screened is 808, including 25 in compensation; this cost increases with the level of compensation.     

Participation in faecal occult blood screening for colorectal cancer

Chemical faecal occult blood testing has been proposed as a means of screening for colorectal cancer (C.C.) in populations or in identified high-risk groups. The level of public participation is a critical factor in the effectiveness of screening programmes. This study was conducted as a methodological pretest for an intended investigation of factors influencing screening participation. Faecal occult blood screening was offered to 728 employees of a teaching hospital in Sydney, New South Wales and 41% participation was obtained. Both participants and non-participants were questioned on demographic and social background factors, on their experience of C.C. in others, and on their reasons for participating or not participating. Major reasons for participation were: a general feeling of the importance of health checks and screening tests; a belief that it is important to diagnose C.C. early; and the fact that the test was simple and easy to do. Prominent self-acknowledged reasons for non-participation were indifference, procrastination, absence of previous bowel complaints, preference for one's own doctor to do such tests and inconvenience or lack of time. Those more likely to participate were: females; those of Australian or British origin; single, separated or divorced persons; those having two or more dependents and those with personal knowledge of a C.C. patient.     

Comparative educational approaches to screening for colorectal cancer.

The purpose of the study was to evaluate the public's willingness to perform the do-it-yourself Hemoccult Test for colon-rectum cancer and to assess the relative effectiveness of alternative means of persuading people to do the test. American Cancer Society volunteers in four different part of the country contacted a total of 11,115 members of the American Association of Retired Persons, using five methods that differed in the extent of personal and impersonal contact involved. Other variables such as inclusion of postage and dietary restrictions were studied and cost efficiencies were estimated. The Group Meeting Method was the most effective personal distribution method. The Selective Mail-Out Method was the most effective impersonal method. The return rate was higher when postage was provided. Dietary restrictions did not markedly reduce participation. Including digital examinations did not affect the return rate. The findings suggest that the Hemoccult Test has the potential of reaching a significant proportion of the nation's older population.