方法:自2000年代初以来,结直肠癌(CRC)死亡率迅速下降,在很大程度上是由于筛查和切除癌前息肉。尽管有这些改进,CRC仍然是美国癌症死亡的第二大原因,预计2023年约有53,000人死亡。美国胃肠病学协会(AGA)临床实践更新专家审查的目的是描述应如何对个体进行CRC筛查和息肉切除术后监测的风险分层,并强调未来研究的机会,以填补现有文献中的空白。
方法:本专家评审是由美国胃肠病学协会(AGA)研究所临床实践更新委员会(CPUC)和AGA理事会委托并批准的,目的是就对AGA会员具有很高临床重要性的主题提供及时的指导。并接受了CPUC的内部同行评审和通过胃肠病学标准程序的外部同行评审。这些最佳实践建议声明来自对已发表文献的回顾和专家意见。因为没有进行系统评价,这些最佳实践建议声明没有对证据质量或所提出考虑因素的强度进行正式评级。最佳实践建议声明最佳实践建议1:所有具有一级亲属的个人(定义为父母,兄弟姐妹,或儿童)被诊断患有CRC,特别是在50岁之前,应考虑CRC风险增加。最佳实践建议2:所有没有CRC个人历史的人,炎症性肠病,遗传性CRC综合征,其他CRC易感条件,或CRC家族史应被视为CRC的平均风险.最佳做法建议3:具有平均CRC风险的个体应在45岁时开始筛查,由于具有CRC一级亲属而具有CRC风险增加的个体应在诊断出最年轻的受影响亲属或40岁之前10年开始筛查。以较早的为准。最佳实践建议4:开始CRC筛查的风险分层应基于个人的年龄,已知或疑似易感遗传性CRC综合征,和/或CRC家族史。最佳实践建议5:在75岁以上的人群中继续进行CRC筛查的决定应该是个性化的,基于对风险的评估,好处,筛查史,和合并症。最佳实践建议6:对CRC平均风险个体的筛查选择应包括结肠镜检查,粪便免疫化学试验,软式乙状结肠镜检查加粪便免疫化学试验,多目标粪便DNA粪便免疫化学试验,和计算机断层扫描结肠成像,基于可用性和个人偏好。最佳实践建议7:结肠镜检查应作为CRC风险增加的个体的筛查策略。最佳实践建议8:继续对75岁以上的人进行息肉切除术后监测的决定应该是个性化的,基于对风险的评估,好处,和合并症。最佳实践建议9:应检查研究中出现的CRC筛查和息肉切除术后监测的风险分层工具,以了解不同人群的实际有效性和成本效益(例如,按种族,种族,性别,以及与CRC结局差异相关的其他社会人口统计学因素)在广泛实施之前。
METHODS: Since the early 2000s, there has been a rapid decline in colorectal cancer (CRC) mortality, due in large part to screening and removal of precancerous polyps. Despite these improvements, CRC remains the second leading cause of cancer deaths in the United States, with approximately 53,000 deaths projected in 2023. The aim of this American Gastroenterological Association (AGA) Clinical Practice Update Expert Review was to describe how individuals should be risk-stratified for CRC screening and post-polypectomy surveillance and to highlight opportunities for future research to fill gaps in the existing literature.
METHODS: This Expert Review was commissioned and approved by the American Gastroenterological Association (AGA) Institute Clinical Practice Updates Committee (CPUC) and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership, and underwent internal peer review by the CPUC and external peer review through standard procedures of Gastroenterology. These Best Practice Advice statements were drawn from a review of the published literature and from expert opinion. Because systematic reviews were not performed, these Best Practice Advice statements do not carry formal ratings regarding the quality of evidence or strength of the presented considerations. Best Practice Advice Statements BEST PRACTICE ADVICE 1: All individuals with a first-degree relative (defined as a parent, sibling, or child) who was diagnosed with CRC, particularly before the age of 50 years, should be considered at increased risk for CRC. BEST PRACTICE ADVICE 2: All individuals without a personal history of CRC, inflammatory bowel disease, hereditary CRC syndromes, other CRC predisposing conditions, or a family history of CRC should be considered at average risk for CRC. BEST PRACTICE ADVICE 3: Individuals at average risk for CRC should initiate screening at age 45 years and individuals at increased risk for CRC due to having a first-degree relative with CRC should initiate screening 10 years before the age at diagnosis of the youngest affected relative or age 40 years, whichever is earlier. BEST PRACTICE ADVICE 4: Risk stratification for initiation of CRC screening should be based on an individual\'s age, a known or suspected predisposing hereditary CRC syndrome, and/or a family history of CRC. BEST PRACTICE ADVICE 5: The decision to continue CRC screening in individuals older than 75 years should be individualized, based on an assessment of risks, benefits, screening history, and comorbidities. BEST PRACTICE ADVICE 6: Screening options for individuals at average risk for CRC should include colonoscopy, fecal immunochemical test, flexible sigmoidoscopy plus fecal immunochemical test, multitarget stool DNA fecal immunochemical test, and computed tomography colonography, based on availability and individual preference. BEST PRACTICE ADVICE 7: Colonoscopy should be the screening strategy used for individuals at increased CRC risk. BEST PRACTICE ADVICE 8: The decision to continue post-polypectomy surveillance for individuals older than 75 years should be individualized, based on an assessment of risks, benefits, and comorbidities. BEST PRACTICE ADVICE 9: Risk-stratification tools for CRC screening and post-polypectomy surveillance that emerge from research should be examined for real-world effectiveness and cost-effectiveness in diverse populations (eg, by race, ethnicity, sex, and other sociodemographic factors associated with disparities in CRC outcomes) before widespread implementation.