Colorectal Cancer Screening Program in China：Recent Advances and Screening Dilemma

doi:10.12114/j.issn.1007-9572.2021.00.480

Abstract

Abstract: In recent years，the incidence and mortality of colorectal cancer （CRC） in China are increasing rapidly. But CRC screening is quite feasible，because its development from normal intestinal mucosa to abnormal growth and to malignancy can last for decades，which makes early screening and removal of precancerous colorectal lesions before cancerization become possible. Increasing countries aim to reduce high incidence and mortality of CRC and enhance its current low early diagnosis rate via implementing CRC screening programs. We reviewed recent advances in the common methods and means as well as relevant studies regarding CRC screening，providing a reference for clinical practice.

Key words: Colorectal neoplasms, Early detection of cancer, Mass screening

摘要： 近年来，我国结直肠癌的发病率及死亡率呈上升趋势且增长迅速。大多数结直肠癌从正常肠黏膜到异常增生，再到最终恶性变的发展过程长达数十年，该时机使结直肠癌平均风险个体发生癌变之前就检测和移除早期癌前病变成为可能，这一生物学特性使其成为理想的在人群中进行筛查的癌症之一。现阶段，越来越多的国家拟通过在人群中进行结直肠癌筛查来改变结直肠癌高发病率、高死亡率和早期低诊断率的现状。本文阐述了常用结直肠癌筛查方法及手段，总结了结直肠癌筛查的研究现状，以期为临床实践提供参考。

关键词: 结直肠肿瘤, 癌症早期检测, 普查

HAN Xi,LIU Jun,MA Qi, et al. Colorectal Cancer Screening Program in China：Recent Advances and Screening Dilemma　[J]. Chinese General Practice, 2021, 24(33): 4172-4176. DOI: 10.12114/j.issn.1007-9572.2021.00.480.
韩西,刘君,马麒等. 我国结直肠癌筛查方案的研究进展及筛查困境分析[J]. 中国全科医学, 2021, 24(33): 4172-4176. DOI: 10.12114/j.issn.1007-9572.2021.00.480.

References

［1］邹小农，贾漫漫，王鑫，等．《2020 全球癌症报告》要点解读.中国胸心血管外科临床杂志，2021，28（1）：11-18．DOI：10.7507/1007-4848.202010033.
［2］国家消化系统疾病临床医学研究中心（上海），国家消化道早癌防治中心联盟，中华医学会消化内镜学分会，等．中国早期结直肠癌筛查流程专家共识意见（2019，上海）［J］．中华健康管理学杂志，2019，13（5）：376-386．DOI：10.3760/cma.j.issn.1674-0815.2019.05.002.
［3］SIEGEL R L，MILLER K D，JEMAL A.Cancer statistics，2019［J］．CA Cancer J Clin，2019，69（1）．DOI：10.3322/caac.21551.
［4］陈锴，陈锦锋，关小明，等．结直肠癌早期筛查高危评分模型的建立［J］．中国医药科学，2016，6（8）：27-30.
CHEN K，CHEN J F，GUAN X M，et al．Establishment of high risk scoring model for early colorectal cancer screening［J］．China Medicine and Pharmacy，2016，6（8）：27-30.
［5］中华医学会消化病学分会.中国大肠肿瘤筛查、早诊早治和综合预防共识意见［J］．胃肠病学和肝病学杂志，2011，20（11）：979-995．DOI：10.3969/j.issn.1006-5709.2011.11.001.
［6］郑树，张苏展，蔡善荣，等．大肠癌筛查方案及其实践［J］．中国肿瘤，2009，18（9）：700-704.
ZHENG S，ZHANG S Z，CAI S R，et al．Protocol and practice for colorectal cancer screening［J］．Bulletin of Chinese Cancer，2009，18（9）：700-704.
［7］黄铖，蔡滨欣，朱美英，等．大肠癌危险度评估问卷在社区筛查阳性居民次年复筛中的有效性分析［J］．中国肿瘤，2019，28（7）：487-493.
HUANG C，CAI B X，ZHU M Y，et al．Validity of risk assessment questionnaire among residents with positive results participating in colorectal cancer screening in the following year［J］．Bulletin of Chinese Cancer，2019，28（7）：487-493.
［8］李娟，李其龙，薛峰，等．粪便潜血试验和问卷调查在人群结直肠癌筛查中的应用评价［J］．中国肿瘤，2015，24（5）：385-389.
LI J，LI Q L，XUE F，et al．Application of faecal occult blood testing and ques- tionnaire risk assessment in population screening for colorectal cancer［J］．Bulletin of Chinese Cancer，2015，24（5）：385-389.
［9］丁娟娟，李强，吴雪燕，等．大肠癌筛查高危因素量化问卷结合粪便隐血试验在大肠癌伺机性筛查中的应用价值分析［J］．中国药物与临床，2020，20（3）：371-373.
［10］中国早期结直肠癌及癌前病变筛查与诊治共识意见（2014年11月•重庆）［J］．中华内科杂志，2015，54（4）：375-389.
［11］翟爱军，翟惠虹，陈洪，等．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［J］．中华保健医学杂志，2018，20（3）：217-219．DOI：10.3969/.issn.1674-3245.2018.03.012.
ZHAI A J，ZHAI H H，CHEN H，et al．Comparison of APCS scoring system and a high risk factors questionnaire（HRFQ）in physical examination population opportunistic screening for colorectal cancer［J］．Chin J Heal Care Med，2018，20（3）：217-219．DOI：10.3969/.issn.1674-3245.2018.03.012.
［12］陈坤，裘炯良，张扬.大肠癌危险因素的Meta分析［J］．浙江大学学报：医学版，2002，31（4）：254-258．DOI：10.3785/j.issn.1008-9292.2002.04.007.
CHEN K，QIU J L，ZHANG Y.Meta-analysis study on risk factors of colorectal cancer［J］．J Zhejiang Univ：Med Sci，2002，31（4）：254-258．DOI：10.3785/j.issn.1008-9292.2002.04.007.
［13］苏悦兴，蒋智锋，陈淮林.粪便潜血免疫法与化学法检测试验的对比分析［J］．世界最新医学信息文摘：电子版，2015，15（57）：134.
［14］ZHENG S，CHEN K，LIU X，et al．Cluster randomization trial of sequence mass screening for colorectal cancer［J］．Dis Colon Rectum，2003，46（1）：51-58．DOI：10.1007/s10350-004-6496-2.
［15］陈德东，叶倩，周旭升，等．OC-SENSOR μ全自动粪便潜血分析仪临床应用评价［J］．福建医药杂志，2009，31（1）：97-99．DOI：10.3969/j.issn.1002-2600.2009.01.059.
［16］TERHAAR SIVE DROSTE J S，OORT F A，VAN DER HULST R W M，et al．Higher fecal immunochemical test cutoff levels：lower positivity rates but still acceptable detection rates for early-stage colorectal cancers［J］．Cancer Epidemiol Biomarkers Prev，2011，20（2）：272-280．DOI：10.1158/1055-9965.EPI-10-0848.
［17］VAN ROSSUM L G M，VAN RIJN A F，LAHEIJ R J F，et al．Cutoff value determines the performance of a semi-quantitative immunochemical faecal occult blood test in a colorectal cancer screening programme［J］．Br J Cancer，2009，101（8）：1274-1281．DOI：10.1038/sj.bjc.6605326.
［18］宋国威，李立新，梁翠娟，等．不同的阳性阈值在结直肠癌便隐血定量法筛查中的诊断价值［J］．临床合理用药杂志，2016，9（21）：172-173.
［19］康倩，李娜，苏惠，等．定量免疫法便潜血阈值设定在结直肠肿瘤伺机性筛查中的意义［J］．中华医学杂志，2020，100（10）：767-770.
KANG Q，LI N，SU H，et al．The optimal thresholds of the quantitative fecal immunochemical test for opportunistic screening of colorectal neoplasia［J］．National Medical Journal of China，2020，100（10）：767-770.
［20］严俊，徐东杰，李其龙，等．胶体金法和免疫比浊法大便隐血检测在人群结直肠癌筛查中的应用［J］．中国肿瘤，2014，23（2）：92-96．DOI：10.11735/j.issn.1004-0242.02.A003.
YAN J，XU D J，LI Q L，et al．Application of colloidal gold method or immunoturbidimetry fecal occult blood test in screening for colorectal cancer［J］．China Cancer，2014，23（2）：92-96．DOI：10.11735/j.issn.1004-0242.02.A003.
［21］BERGER B M，LEVIN B，HILSDEN R J.Multitarget stool DNA for colorectal cancer screening：a review and commentary on the United States Preventive Services Draft Guidelines［J］．World J Gastrointest Oncol，2016，8（5）：450-458．DOI：10.4251/wjgo.v8.i5.450.
［22］彭晨，蒋小华，姜景蔚，等．多靶点粪便基因检测在社区结直肠癌筛查中的应用价值研究［J］．中国全科医学，2017，20（25）：3132-3135. DOI：10.3969/j.issn.1007-9572.2017.25.014.
PENG C，JIANG X H，JIANG J W，et al．Values of multi -target stool DNA test for community -based colorectal cancer screening［J］．Chinese General Practice，2017，20（25）：3132-3135. DOI：10.3969/j.issn.1007-9572.2017.25.014.
［23］IMPERIALE T F，RANSOHOFF D F，ITZKOWITZ S H，et al．Multitarget stool DNA testing for colorectal-cancer screening［J］．N Engl J Med，2014，370（14）：1287-1297．DOI：10.1056/nejmoa1311194.
［24］DICKINSON B T，KISIEL J，AHLQUIST D A，et al．Molecular markers for colorectal cancer screening［J］．Gut，2015，64（9）：1485-1494．DOI：10.1136/gutjnl-2014-308075.
［25］ZOU H Z，ALLAWI H，CAO X M，et al．Quantification of methylated markers with a multiplex methylation-specific technology［J］．Clin Chem，2012，58（2）：375-383．DOI：10.1373/clinchem.2011.171264.
［26］KADIYSKA T，NOSSIKOFF A.Stool DNA methylation assays in colorectal cancer screening［J］．World J Gastroenterol，2015，21（35）：10057-10061．DOI：10.3748/wjg.v21.i35.10057.
［27］刘学勇.血清肿瘤标志物联合检测在结直肠癌患者病情监测中的应用研究［J］．中国继续医学教育，2016，8（25）：40-42．DOI：10.3969/j.issn.1674-9308.2016.25.023.
LIU X Y.Application of combined detection of serum tumor markers in the monitoring of patients with colorectal cancer［J］．China Continuing Medical Education，2016，8（25）：40-42．DOI：10.3969/j.issn.1674-9308.2016.25.023.
［28］NIU F，WEN J，FU X H，et al．Stool DNA test of methylated syndecan-2 for the early detection of colorectal neoplasia［J］．Cancer Epidemiology，Biomarkers & Prevention，2017，26（9）：1411-1419．DOI：10.1158/1055-9965.EPI-17-0153.
［29］CARETHERS J M.Fecal DNA testing for colorectal cancer screening［J］．Annu Rev Med，2020，71：59-69．DOI：10.1146/annurev-med-103018-123125.
［30］PARK S K，BAEK H L，YU J，et al．Is methylation analysis of SFRP2，TFPI2，NDRG4，and BMP3 promoters suitable for colorectal cancer screening in the Korean population?［J］．Intest Res，2017，15（4）：495-501．DOI：10.5217/ir.2017.15.4.495.
［31］AHLQUIST D A，ZOU H，DOMANICO M，et al．Next-generation stool DNA test accurately detects colorectal cancer and large adenomas［J］．Gastroenterology，2012，142（2）：248-256；quiz e25-26．DOI：10.1053/j.gastro.2011.10.031.
［32］US Preventive Services Task Force，BIBBINS-DOMINGO K，GROSSMAN D C，et al．Screening for colorectal cancer：US Preventive Services Task Force recommendation statement［J］．JAMA，2016，315（23）：2564-2575．DOI：10.1001/jama.2016.5989.
［33］CHURCH T R，WANDELL M，LOFTON-DAY C，et al．Prospective evaluation of methylated SEPT9 in plasma for detection of asymptomatic colorectal cancer［J］．Gut，2014，63（2）：317-325．DOI：10.1136/gutjnl-2012-304149.
［34］康倩，谢惠，王昕，等．粪便SFRP2基因甲基化联合定量免疫便潜血检测在结直肠癌筛查的应用［J］．河北医学，2020，26（7）：1097-1100．DOI：10.3969/j.issn.1006-6233.2020.07.010.
KANG Q，XIE H，WANG X，et al．An analysis of the role of fecal SFRP2 gene methylation combined with quantitative immunochemical fecal occult blood test in colorectal cancer screening［J］．Hebei Med，2020，26（7）：1097-1100．DOI：10.3969/j.issn.1006-6233.2020.07.010.
［35］OH T，KIM N，MOON Y，et al．Genome-wide identification and validation of a novel methylation biomarker，SDC2，for blood-based detection of colorectal cancer［J］．J Mol Diagn，2013，15（4）：498-507．DOI：10.1016/j.jmoldx.2013.03.004.
［36］KIM J H，PARK S C.Syndecan-2 methylation as a new biomarker for early detection of colorectal neoplasm［J］．Gut Liver，2018，12（5）：479-480．DOI：10.5009/gnl18286.
［37］HAN Y D，OH T J，CHUNG T H，et al．Early detection of colorectal cancer based on presence of methylated syndecan-2 （SDC2） in stool DNA［J］．Clin Epigenetics，2019，11（1）：51．DOI：10.1186/s13148-019-0642-0.
［38］CHEN J，SUN H，TANG W，et al．DNA methylation biomarkers in stool for early screening of colorectal cancer［J］．J Cancer，2019，10（21）：5264-5271．DOI：10.7150/jca.34944.
［39］李创坤，黄颖烽，邹瞭南，等．粪便SDC2基因甲基化检测在结直肠肿瘤早期检测中的应用价值［J］．外科研究与新技术，2020，9（1）：10-13．DOI：10.3969/j.issn.2095-378X.2020.01.003.
［40］马晓阳，张爽，江泽友.大肠肿瘤Syndecan-2基因甲基化及临床意义［J］．临床肿瘤学杂志，2020，25（4）：305-310.
MA X Y，ZHANG S，JIANG Z Y.Syndecan-2 gene methylation in colorectal neoplasms and its clinical significance［J］．Chin Clin Oncol，2020，25（4）：305-310.
［41］SIMON K.Colorectal cancer development and advances in screening［J］．Clin Interv Aging，2016，11：967-976．DOI：10.2147/cia.s109285.
［42］BIAN J.Overuse of colorectal cancer screening services in the United States and its implications［J］．Chin J Cancer，2016，35（1）：88．DOI：10.1186/s40880-016-0148-5.
［43］OBARO A E，BURLING D N，PLUMB A A.Colon cancer screening with CT colonography：logistics，cost-effectiveness，efficiency and progress［J］．Br J Radiol，2018，91（1090）：20180307．DOI：10.1259/bjr.20180307.
［44］POOLER B D，BAUMEL M J，CASH B D，et al．Screening CT colonography：multicenter survey of patient experience，preference，and potential impact on adherence［J］．AJR Am J Roentgenol，2012，198（6）：1361-1366．DOI：10.2214/ajr.11.7671.
［45］NERI E，HALLIGAN S，HELLSTRO M，et al．The second ESGAR consensus statement on CT colonography［J］．Eur Radiol，2013，23（3）：720-729．DOI：10.1007/s00330-012-2632-x.
［46］朱国兵.粪便隐血试验序贯结肠镜检查在社区高危人群结直肠癌筛查中的应用价值［J］．广西医学，2019，41（21）：2748-2750．DOI：10.11675/j.issn.0253-4304.2019.21.16.
ZHU G B.Application value of sequential examination of fecal occult blood test and colonoscopy for colorectal cancer screening in community high-risk residents［J］．Guangxi Med J，2019，41（21）：2748-2750．DOI：10.11675/j.issn.0253-4304.2019.21.16.

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