全球针对家族史高危人群的结直肠癌筛查指南推荐意见的系统综述

目的 对全球现有结直肠癌家族史高危人群筛查指南的更新进展及推荐意见进行系统总结和评价。方法 以“结直肠癌”“筛查”“指南”“共识”“推荐”“家族史”以及“colorectal cancer”“screening”“guideline”“recommendation”“family history”为关键词,并补充其自由词,系统检索中国知网、万方数据知识服务平台、PubMed、Embase、Cochrane Library、Web of Science,并且同时检索官网刊登的结直肠癌筛查指南/共识作为补充,语种限定为中文和英文。截至2022年5月24日,共20篇有效文献。对纳入文献的基本信息、针对家族史人群的推荐意见等进行摘录整理及汇总描述。结果 在20篇文献中,大多数国家/地区/机构根据结直肠癌家族史人群的亲属关系等级,对筛查起止年龄、筛查方式及筛查周期提出建议。多数指南针对有1例60岁前患结直肠癌一级亲属的人群,推荐筛查起始年龄为40岁或比患病亲属诊断年龄提前10年,推荐的筛查方式多为结肠镜。结论 目前全球多数结直肠癌家族史高危人群筛查指南主要针对一级亲属家族史、以结肠镜作为主要筛查方式。本文将为我国针对结直肠癌家族史高危人群筛查策略的更新提供参考依据,进而完善结直肠癌筛查与早诊早治实践。     

我国结直肠癌筛查循证指南关键问题清单的构建

目的 对现有结直肠癌筛查循证指南进行梳理,搭建和确立适用于我国结直肠癌筛查循证指南的关键问题清单,为我国结直肠癌筛查循证指南的制订提供理论基础和参考。方法 首先,根据WHO指南制订流程定义循证指南,对符合该定义的指南进行全面解读;其次,结合循证指南的制订流程,形成初步的结直肠癌筛查循证指南关键问题问卷;最后,邀请临床、循证医学及流行病学等多领域专家,通过Delphi法形成适用于我国的结直肠癌筛查循证指南关键问题清单。结果 Delphi专家论证共收回有效问卷34份,专家权威系数为0.81,权威程度较高;问卷各条目专家意见集中程度较高,满分比均 > 75%,变异系数 < 0.3。经论证形成的结直肠癌筛查循证指南关键问题清单分为流行病学问题、人群风险分类、筛查起止年龄、筛查方法、实施相关情况、专家组成员选择6个维度共计20个详细条目,基本涵盖了适用于我国结直肠癌筛查循证指南制订过程中需要考虑的问题。结论 本研究所形成的结直肠癌筛查循证指南关键问题清单可指导未来我国结直肠癌筛查循证指南的制订工作,同时,该框架也可为其他癌症筛查循证指南的制订提供参考。     

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...     

2008年《NCCN结直肠癌筛查指南》要点解读（一）

NCCN（national comprehensive cancer network）是21个世界顶级癌症中心组成的非营利性学术联盟，其制订的《NCCN肿瘤学临床实践指南》已成为全球肿瘤临床实践中应用最为广泛的指南。NCCN公布的2008年《NCCN结直肠癌筛查指南》是通过系统的研究而制定的既能帮助医生对人群结直肠癌的患病风险进行评估，也能帮助医生在特定的临床环境下做出合适的筛查、治疗及治疗后监测方案，从而最终达到降低结直肠癌的发病率和病死率的目的。现将2008年《NCCN结直肠癌筛查指南》中关于一般危险人群的筛查方案做一概要性解读。     

基于慢病管理的结直肠癌筛查模式初探

结直肠癌是当今最常见的恶性肿瘤之一,我国结直肠癌的发病率与死亡率飞速增长.结直肠癌筛查是早期发现、早期治疗结直肠癌及癌前病变的重要途径.相对于伺机性筛查,人群筛查是更理想的结直肠癌筛查模式,但在我国却面临着依从性低、财政负担过重的问题.基于慢病管理的结直肠癌筛查模式,作为人群筛查的一种,针对高危人群更多、依从性更好、成本更低且更易组织管理的特殊群体——慢病管理人群进行干预.这种新型筛查模式既保留了人群筛查的固有特性,又在一定程度上吸收了伺机性筛查的优势,有助于有限资源的效益最大化,也是更适合我国现阶段国情的结直肠癌筛查模式.     

基于筛查干预角度的中国人群结直肠癌所致伤残调整寿命年负担分析

目的 基于筛查干预视角,分析中国人群结直肠癌所致伤残调整寿命年（DALY）负担的现况、既往与未来,并行国际比较,为中国人群结直肠癌疾病负担及其筛查干预提供参考。方法 基于全球疾病负担研究（GBD）平台摘录数据,描述中国2019年结直肠癌所致DALY数、世标率及不同亚组值;通过Joinpoint回归模型,分析1990-2019年变化趋势,结合人群筛查情况行国际比较。进一步预测中国结直肠癌所致DALY负担未来变化趋势。结果 中国2019年结直肠癌所致DALY总数为639.5万人年,占全球结直肠癌负担的26.3%,占中国全部癌种负担的9.5%;其中男性DALY数占65.2%,≥65岁者占44.8%,与本土结直肠癌筛查指南推荐接近的年龄段（40~74岁）人群占73.7%,伤残损失寿命年（YLD）数占4.8%。相比1990年,2019年中国结直肠癌所致DALY总数增长了181.5%,有明确归因占比上升幅度最大的因素是高BMI、红肉摄入过量和加工肉制品摄入过量等（增幅依次为151.1%、86.4%和78.8%）。就结直肠癌所致DALY率,中国1990年为245.6/10万,2019年为320.6/10万,增幅达30.5%;作为参照,已开展全人群结直肠癌筛查的澳大利亚（2006年启动）、英国（2006年）和日本（1992年）,DALY率降幅分别为36.0%、28.6%和17.8%。预测提示,若无继续扩大范围的人群筛查,2030年中国结直肠癌所致DALY总数将达766.6万人年~906.6万人年,较2019年将增加19.9%~41.8%。结论 中国结直肠癌所致DALY负担近30年持续增加,人口老龄化及伴随失能会使负担更重。目前本土推荐筛查年龄可覆盖七成DALY负担来源人群,但人群的实际筛查覆盖有限。其他国家结直肠癌所致DALY负担的下降与筛查开展密不可分,提示尽快扩大本土结直肠癌有效筛查覆盖率的重要性。     

APCS评分系统与问卷调查在体检人群结直肠癌机会性筛查中效果的比较

目的评估亚太结直肠癌筛查评分系统(APCS)和结直肠肿瘤高危因素问卷调查(HRFQ)在体检人群结直肠癌机会性筛查中的效果。方法选取2017年6月~2018年2月在中国航天科工集团七三一医院体检中心进行健康体检并接受结肠镜检查的人群294例,年龄57.28±9.85岁。采用APCS评分与HRFQ进行筛查;进行结肠镜检查一并记录结肠镜检查及病理结果。通过对比两种初筛工具筛查结直肠肿瘤的阳性预测值以及阴性预测值,评估两种初筛工具在体检人群结直肠癌机会性筛查中的效果。结果结肠镜检查共检出结直肠肿瘤50例。两种不同筛查方法 APCS评分(高危+中危)对结直肠肿瘤的阳性预测值(20.35%vs 15.07%)及阴性预测值(95.24%vs 82.35%),均明显高于HRFQ,差异有统计学意义(P0.05)。结论在体检人群结直肠癌机会性筛查中,作为初筛工具,APCS评分与HRFQ相比,能提高结直肠肿瘤的阳性预测值与阴性预测值,适合大范围推广。     

慢病管理人群与自然人群结直肠癌筛查知信行现状及影响因素研究

目的了解慢病管理人群对结直肠癌筛查的知识、信念、行为现状及影响因素,并与自然人群相比较,为探索基于慢病管理的结直肠癌筛查模式提供参考依据。方法 2014年3月,对北京市右安门社区卫生服务中心前来就诊的慢病管理人群(慢病组)和自然人群(对照组)进行结直肠癌筛查问卷调查,有效问卷381份,其中慢病组193份,对照组188份。结果慢病组与对照组结直肠癌及结直肠癌筛查知识部分中位数分别为10分和8分,差异有统计学意义(Z=-1.98,P0.05);信念部分平均分分别为(49.17±7.33)分和(44.47±6.45)分,差异有统计学意义(t=6.64,P0.05)。两组分别仅有7.77%和5.85%的居民参加过结直肠癌筛查,差异无统计学意义(P0.05);80.31%和67.55%的居民有筛查意愿,差异有统计学意义(χ~2=0.06,P0.05)。两组人群中不愿意参加筛查的前三位原因均是身体健康没必要、没时间、结肠镜检查痛苦。但筛查过程麻烦无法坚持、筛查有商业目的以及不相信社区卫生服务中心的筛查技术等原因两组人群差异较大。logistic回归分析显示,组别、婚姻状况是居民结直肠癌筛查参与意愿的影响因素。结论慢病管理人群及自然人群的结直肠癌及结直肠癌筛查知识均不足、筛查行为均较差,但慢病管理人群筛查信念及意愿均高于自然人群。     

北京市结直肠癌高危人群内镜筛查依从性分析及对策探讨

目的 分析北京市城市地区结直肠癌高危人群内镜筛查依从性及相关影响因素,为优化城市结直肠癌筛查项目管理提供数据支持和对策建议.方法 选取2016-2019年北京市城市癌症早诊早治结直肠癌项目参与人群,采用多因素logistic回归模型分析影响结直肠癌高危人群内镜筛查依从性的相关因素.结果 73240名北京市40～69岁健...     

结直肠癌筛查的现状与新策略

结直肠癌是最常见的恶性肿瘤之一,在世界范围内,其发病率居恶性肿瘤的第4位。2002年全球共发生约100万例结直肠癌,53万例死于结直肠癌。我国结直肠癌发病率有上升趋势,据2000年调查结果显示,在我国北京和上海等大城市结直肠癌的发病率已上升至第2位或第3位,我国农村也上升较快,目前已居第5位。因此,对人群进行筛查是预防或早期发现结直肠癌的最有效方法。目前认为,年龄>50岁的人均应该接受结直肠癌的筛查。一、结直肠癌筛查现状结直肠癌筛查的方法很多,主要有粪便潜血试验(FOBT)和结肠镜检查,其他尚有基因学检查,血清学检查等。欧盟癌症预…     

Are U.S. cancer screening test patterns consistent with guideline recommendations with respect to the age of screening initiation?

Background  

U.S. cancer screening guidelines communicate important information regarding the ages for which screening tests are appropriate. Little attention has been given to whether breast, colorectal and prostate cancer screening test use is responsive to guideline age information regarding the age of screening initiation.     

Variation in Recommendations for Cancer Screening among Primary Care Physicians in New Mexico

The acceptance of age-appropriate cancer screening as an integral part of primary care has grown among physicians over the past decade. We conducted a mailed survey of all primary care physicians in New Mexico in order to better understand their current cancer screening practices. We found a high rate of self-reported screening, particularly for prostate and colorectal cancer. The screening rates were influenced only slightly by the introduction of evidence-based guidelines, with younger physicians and those with university affiliations more likely to follow recommendations. Female physicians and obstetrician-gynecologists endorsed breast and cervical cancer screening among all age groups and were less likely to follow recommendations for less frequent screening in women as they age. Since a physician's practice beliefs influence his/her attitude toward testing, tailoring education by physician specialty may be more effective than using generic messages in encouraging compliance with the most recent evidence-based guidelines.     

Physician financial incentives and feedback: failure to increase cancer screening in Medicaid managed care.

OBJECTIVES: A randomized controlled trial evaluated the impact of feedback and financial incentives on physician compliance with cancer screening guidelines for women 50 years of age and older in a Medicaid health maintenance organization (HMO). METHODS: Half of 52 primary care sites received the intervention, which included written feedback and a financial bonus. Mammography, breast exam, colorectal screening, and Pap testing compliance rates were evaluated. RESULTS: From 1993 to 1995, screening rates doubled overall (from 24% to 50%), with no significant differences between intervention and control group sites. CONCLUSIONS: Financial incentives and feedback did not improve physician compliance with cancer screening guidelines in a Medicaid HMO.     

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.     

Rural disparities in receipt of colorectal cancer screening among adults ages 50–64 with disabilities

BackgroundColorectal cancer is the third leading cause of cancer deaths in the United States. Early detection can reduce mortality; however, only 59% of U.S. adults age 50 and over meet recommended colorectal cancer screening guidelines. Studies in the general population have observed that rural residents are less likely to have received colorectal cancer screening than residents of urban areas.ObjectiveTo determine whether urban/rural disparities in colorectal cancer screening exist among people with disabilities, similar to the disparities found in the general population.MethodsWe analyzed Medical Expenditure Panel Survey annual data files from 2002 to 2008. We conducted logistic regression analyses to examine the relationship between urban/rural residence and ever having received screening for colorectal cancer (via colonoscopy, sigmoidoscopy, or fecal occult blood test).ResultsAmong U.S. adults ages 50–64 with disabilities, those living in rural areas were significantly less likely to have ever received any type of screening for colorectal cancer. The urban/rural difference was statistically significant regardless of whether or not we controlled for demographic, socioeconomic, health, and health care access variables.ConclusionsDisparity in screening for colorectal cancer places rural residents with disabilities at greater risk for late stage diagnosis and mortality relative to people with disabilities in urban areas. Thus, there is a need for strategies to improve screening among people with disabilities in rural areas.     

Mandated coverage for cancer-screening services: whose guidelines do states follow?

OBJECTIVES: To determine the prevalence and nature of state coverage mandates for cancer screening. METHODS: We contacted insurance departments in 50 states, Washington, DC, and Puerto Rico for copies of state codes that mandate coverage of screening for breast, cervical, prostate, and colorectal cancer by private insurers. We further compared mandates, when identified, with American Cancer Society (ACS) and U.S. Preventive Services Task Force (USPSTF) guidelines for likely sources of screening recommendations. RESULTS: Forty-three states and the District of Columbia currently mandate coverage of cancer screening. Breast cancer-screening coverage was most frequently mandated (n =44), followed by cervical (n =22), prostate (n =18), and colorectal cancer screening (n =1). Twenty-three states used ACS guidelines only, 18 states used ACS and non-ACS/non-USPSTF guidelines, and 3 states used only non-ACS/non-USPSTF guidelines in development of coverage mandates. No state screening coverage mandate reflected USPSTF-screening guidelines. Of 85 mandates in place, 57 have been passed since 1990. CONCLUSIONS: Although state mandates for insurer coverage of cancer screening are common and increasing, we found noticeable inter- and intra-state variation in coverage, selection, and use of screening guidelines.     

Rates and Sociodemographic Correlates of Cancer Screening Among South Asians

Although the third largest Asian subgroup in the U.S., South Asians have rarely been included in cancer research. The purpose of this study was to assess rates and correlates of cancer screening in a community sample of South Asians. This study was a collaboration between the UCLA School of Public Health and South Asian Network (SAN), a social service organization in Southern California. Data were collected from 344 adults including a substantial portion of immigrants and individuals with low income and education. Few participants received screening within guidelines for colorectal (25%), breast (34%), cervical (57%) and prostate cancer (10%). Health insurance, younger age and increased length of stay in the U.S. predicted a higher likelihood of cancer screening. Women were significantly less likely to have received colorectal cancer screening compared to men. These results will guide SAN’s program planning efforts. Future interventions should focus on increasing cancer screening in this population.