American Cancer Society updated guidelines for early screening for colorectal cancer

Colorectal cancer is the third most common cancer in the United States, ranking the leading cause of cancer deaths in the United States by u

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Colorectal cancer is the third most common cancer in the United States, ranking the leading cause of cancer deaths in the United States by up to second. Recently, the American Cancer Society, the American colorectal cancer society and the American Society of Radiology jointly issued the 2008 asymptomatic general population of colorectal cancer and adenomatous polyps early detection guide. Clinicians should be aware of all colorectal cancer screening methods, including methods for early detection of colorectal cancer, as well as methods for early detection and prevention, according to the guidelines. "Guidelines" stressed that the prevention of cancer should be the primary purpose of screening.

Guide summary

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Patients and medical staff should be aware that colorectal cancer screening methods can be broadly divided into two categories (see Table 1). The first is the stool examination, including the guaiac fecal occult blood test method (gFOBT) and immunochemical fecal occult blood test (FIT) and to detect the cancer cell DNA (sDNA), can effectively detect colorectal cancer, but also can detect some malignant adenomatous polyps, but of limited value for colorectal cancer prevention. The second category is all or part of structural inspection, including Shiyi flexible sigmoidoscopy (FSIG), colonoscopy, double contrast barium enema examination (DCBE) and CT colonography (CTC), can effectively detect colorectal cancer and malignant adenomatous polyps.

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The panel urged that the primary goal of colorectal cancer screening should be to prevent colon cancer. If conditions permit, patients are willing to undergo invasive testing, should encourage the implementation of simultaneous detection of early cancer and adenomatous polyps examination methods, including the above part or all of the structural examination. FISG, DCBE and CTC were found to be significantly positive, and colonoscopy follow-up was required.

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Selection of detection methods of fecal occult blood clinical or research institutions, should choose the most common colorectal cancer can be detected, and it was reported in the asymptomatic population in check.

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For patients who are unwilling or unable to receive invasive testing, a noninvasive examination (stool examination) should be provided with the following:

- and invasive compared these checks are less likely to prevent cancer;

All these checks must be regular review;

The test results such as abnormal, the need for invasive test (colonoscopy).

Expert group said

“ colorectal cancer can be prevented by early detection and removal of adenomatous polyps. It can significantly improve the survival rate of patients with colorectal cancer. ”

“ there is ample evidence that in order to detect and prevent colorectal cancer screening should be over 50 years old general risk, because it can be detected in the early stage of cancer treatment, and the clinical significance of adenoma resection, thereby reducing mortality from colorectal cancer. ”

“ there is no perfect method for colorectal cancer screening, whether it is cancer or adenoma. ”

“ we hope that the new guidelines will help to improve the screening rate of colorectal cancer, and reduce the difficulties faced by clinicians in the implementation of screening. ”

(CA Cancer Clin2008 March 5th online) (Xiao Ye) ()

Table 1 screening methods for colorectal cancer and adenoma at age &ge at age 50

Method

Detection frequency

Key content of informed decision

Detection of adenomatous polyps and colorectal cancer

FISG (insert 40cm or to splenic flexure)

1 times in 5 years

Full or partial bowel preparation

Generally do not use sedatives, so there may be discomfort in the operation

There was only a protective effect on the colon

Those with positive findings are generally referred to colonoscopy

Colonoscopy

1 times in 10 years

Complete bowel preparation

Most centers use sedatives, patients need to take a day off and must be accompanied by others

There is a risk of perforation and bleeding, which is rare but may be more severe

DCBE

1 times in 5 years

Complete bowel preparation

If there are one or more ≥ 6 mm polyps, colonoscopy is recommended

The risk is low, and there are few cases of perforation

CTC

1 times in 5 years

Complete bowel preparation

If there are one or more ≥ 6 mm polyps, colonoscopy is recommended

The risk is low, and there are few cases of perforation

There may be abnormal findings of the colon, and further examination if necessary

Detection of colorectal cancer

Gao Min gFOBT

1 times a year

According to the manufacturer's recommendations, 2~3 stool samples should be collected at home. The data collected by the clinical institution in the digital examination should not be used for stool examination

Gao Min FIT

1 times a year

Positive results are associated with increased risk of colon cancer and advanced malignancies, colonoscopy should be recommended

If the results are negative, should be reviewed annually

Patients should be aware that a test is likely to be invalid

Gao Min sDNA

Uncertain

Adequate sample sizes are required to provide a suitable preservative to the laboratory

The cost was significantly higher than that of other stool tests

If the results are positive, colonoscopy is recommended

If the results are negative, the interval of the review is not clear

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Screening of colorectal cancer screening

The United States CDC recently released the survey report, the country's overall screening rate of colorectal cancer showed an upward trend, the proportion of respondents who never received the screening has dropped from 34.2% in 2002 to $29.5% in 2006. In the method of screening guidelines recommend, fecal occult blood test screening rate from 21.6% to 16.2%, in contrast, endoscopic screening rate from 44.8% to 55.7%.

However, the screening of colorectal cancer in the United States is not balanced. The screening rate in addition to regional differences, race and ethnic differences still exist, no medical insurance, low income and low education level of population screening rate was significantly lower than other groups [MMMR Morb Mortal Wkly in Rep 2008, 57 (10): 253].

 

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