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It is only for medical professionals to read and reference.
Contains a comparison of Chinese and foreign guidelines.
Colorectal cancer (CRC) is one of the most common and fatal malignant tumors of the digestive system.
After a lapse of 12 years, the American College of Gastroenterology (ACG) issued a new version of the Colorectal Cancer (CRC) Screening Guidelines (hereinafter referred to as the "Latest Guidelines") in March this year.
This edition of the guide discusses recommendations for CRC screening in general risk populations and populations with family history of CRC, and discusses the role of aspirin in chemoprevention, the quality indicators of colonoscopy, organized CRC screening methods, and the improvement of CRC.
Recommendations are made on the compliance of screening.
Figure 1: Guide topic and information of main participating experts (scan the QR code of the picture to get the original text of the guide~) Guide update content 1.
It is recommended to carry out CRC screening for general risk individuals aged 50 to 75 to reduce advanced adenomas, The incidence of CRC and reduce the mortality of CRC (strong recommendation; moderate-quality evidence).
2.
It is recommended to carry out CRC screening for general risk individuals aged 45 to 49 years to reduce the incidence of advanced adenoma and CRC, and reduce the mortality rate of CRC (conditional recommendation; very low-quality evidence).
3.
It is recommended that whether to continue screening for persons over 75 years old should be based on individual circumstances (conditional recommendation; very low-quality evidence).
4.
Colonoscopy and stool immunochemical testing (FIT) are recommended as the main screening methods for CRC screening (strong recommendation; low-quality evidence).
5.
It is recommended that for those who are unable or unwilling to undergo colonoscopy or FIT, the following screening tests may be considered: fiber sigmoidoscopy, multi-target fecal DNA testing, colon CT imaging or colon capsule endoscopy (recommendation with conditions; Very low-quality evidence).
6.
Septin 9 is not recommended for CRC screening (conditional recommendation; very low-quality evidence). 7.
Recommended screening interval: FIT once a year; colonoscopy once every 10 years (strong recommendation; low-quality evidence).
8.
Recommended screening interval: multi-target stool DNA testing every 3 years; fiber sigmoidoscopy every 5-10 years; colon CT imaging every 5 years; colon capsule endoscopy every 5 years (with Conditional recommendation; very low-quality evidence).
9.
It is recommended that one of the first-degree relatives suffers from CRC or advanced polyps when they are less than 60 years old, or there are two individuals who suffer from CRC or advanced polyps at any age.
CRC screening should start at the age of 40, or at the youngest It started 10 years before the sick relatives became ill.
A colonoscopy is recommended every 5 years (conditional recommendation; very low-quality evidence).
10.
It is recommended that those with a higher family burden of CRC (more affected relatives and/or younger age) consider genetic evaluation (conditional recommendation; very low-quality evidence).
11.
It is recommended that one of the first-degree relatives who suffered from CRC or advanced polyps at the age of <60, start CRC screening 10 years before the onset of the disease at the age of 40 or the youngest relative; then return to general risk screening Recommendations (conditional recommendations; very low-quality evidence).
12.
For individuals with a second-degree relative with CRC or advanced polyps, it is recommended to follow the general risk CRC screening recommendations (conditional recommendation; low-quality evidence).
13.
It is recommended to evaluate all endoscopists performing colonoscopy: cecal intubation rate (CIRs), adenoma detection rate (ADRs) and withdrawal time (WTs) (strong recommendation; for adenoma detection rate) Moderate-quality evidence, and low-quality evidence for the time of withdrawal and cecal intubation).
14.
It is recommended that endoscopists whose adenoma detection rate is lower than the recommended minimum threshold (<25%) receive remedial training (conditional recommendation, very low-quality evidence).
15.
It is recommended that the endoscopist use at least 6 minutes to examine the intestinal mucosa during the withdrawal period (strong recommendation; low-quality evidence).
16.
It is recommended that the cecal intubation rate of endoscopists should be at least 95% (strong recommendation; low-quality evidence). 17.
For individuals who are 50 to 69 years old, have a cardiovascular disease risk ≥10% in the next 10 years, have no increased bleeding risk, and are willing to take aspirin, it is recommended to take a low-dose aspirin for at least 10 years to reduce the risk of CRC (conditional recommendation; low) Quality evidence).
18.
Aspirin is not recommended to replace CRC screening (strong recommendation; low-quality evidence).
19.
Compared with opportunistic screening, an organized screening program is recommended to improve compliance with CRC screening (strong recommendation; low-quality evidence).
20.
The following measures are recommended to improve screening compliance: patient navigation, patient reminders, clinician intervention, provider recommendations, and clinical decision support tools (conditional recommendations, very low-quality evidence).
21.
The following strategies are recommended to improve follow-up compliance for positive screening tests: email and phone reminders, patient navigation, and provider intervention (conditional recommendations, very low-quality evidence).
It can be seen that the latest guidelines recommend that individuals with general risk should be screened for CRC starting at the age of 45 (before that it was 50 years old).
ACG said that this update is based on new epidemiological data: young people aged 45-49 are at an increasing risk of colorectal cancer.
In fact, as early as October 27, 2020, the "Draft Colorectal Cancer Screening Recommendations" issued by the United States Preventive Services Task Force (USPSTF) recommended that adults between the ages of 45-75 should undergo colorectal screening.
To reduce the risk of death from colorectal cancer.
The latest guidelines recommend colonoscopy or FIT for screening of individuals at general risk; if colonoscopy is used, it should be reviewed every 10 years, and FIT should be performed once a year.
This is in contrast to the update of the American Gastroenterology Association (AGA) to some extent.
AGA recommends more non-invasive tests at the beginning, such as stool occult blood testing.
It is recommended that the initial colonoscopy is only used for CRC.
High-risk patients.
In addition, the latest guidelines emphasize the quality indicators of colonoscopy, including cecal intubation rate, adenoma detection rate and withdrawal time.
In 2020, a study published in the Annals of Internal Medicine pointed out that compared with low-quality colonoscopy, high-quality colonoscopy (adequate bowel preparation, high cecal intubation rate, adenoma detection rate) ≥20%) led to a reduction in CRC morbidity and mortality by about half.
Compared with Chinese guidelines, the trend of younger colorectal cancer incidence has also been reflected in my country.
The "China Colorectal Cancer Screening and Early Diagnosis and Treatment Guidelines (2020, Beijing)" (hereinafter referred to as the "China Guidelines") pointed out that the colorectal cancer in the Chinese population The incidence of cancer began to rise from the age of 40, and showed a significant upward trend from the age of 50.
With the younger generation of colorectal cancer and foreign guidelines and consensus, the age of colorectal cancer screening has been advanced to 45 years old.
Some people will have this question: "When I reach 45 years old, do I have to go for colonoscopy?" Although the recognition of colorectal cancer screening has been greatly improved in our country, it is far from enough; and because colonoscopy is an invasive examination, the participation rate is not enough.
At present, the colorectal cancer screening model recommended in my country is an organic combination of population screening and opportunistic screening.
Taking into account the actual conditions of our country, the Chinese guidelines recommend that the general population receive colorectal cancer risk assessment from the age of 40, and it is recommended that people assessed as medium and low risk receive colorectal cancer screening at the age of 50 to 75, and the assessment results are recommended for high-risk populations.
Receive colorectal cancer screening from 40 to 75 years old.
In other words, when you reach the age of 40, you can first check whether you belong to a high-risk or low-risk group based on the colorectal cancer screening scale, and whether you need a colonoscopy.
Table 1: Colorectal cancer screening high-risk factors quantitative questionnaire Table 2: Colorectal cancer screening scores for asymptomatic people In addition, the Chinese guidelines also emphasize that high-quality colonoscopy is the key to ensuring the screening effect, and it is currently more recognized The criteria for high-quality colonoscopy include: ①The rate of good bowel preparation should be >85%.
②The cecal insertion rate is >95%.
③The withdrawal time should be at least 6min.
④The detection rate of adenomas should be >20%, of which males are >25% and females are >15%.
If you want to see more clinical guidelines, go to the doctor's station ~ reference source: [1]Shaukat A, et al.
ACG Clinical Guidelines: Colorectal Cancer Screening 2021.
Am J Gastroeterol.
2021;doi:10.
14309/ajg.
0000000000001122.
[2]https :// ND, et al.
, Long-term colorectal cancer incidence and mortality after a single negative screening colonoscopy, Ann Intern Med 2020; DOI: 10.
7326/M19-2477.
[4] National Research Center for Clinical Medicine of Digestive Diseases (Shanghai), National Alliance of Digestive Tract Early Cancer Prevention and Treatment Centers, Chinese Medical Association Digestive Endoscopy Branch, etc.
Expert consensus opinion on the screening process for early colorectal cancer in China (2019, Shanghai) [J].
Chinese Journal of Health Management, 2019,13( 5 ): 376-386.
Source of this article: Digestive Liver Disease Channel of the medical community.
This article is organized: A congee.
This article is reviewed by: Yang Health, Deputy Chief Physician of Jingdezhen Second People's Hospital Responsible editor: Mary's copyright statement.
If you need to reprint the original article, please contact authorization-End-Click "Read the original text" to get the original text of the guide 👇
Contains a comparison of Chinese and foreign guidelines.
Colorectal cancer (CRC) is one of the most common and fatal malignant tumors of the digestive system.
After a lapse of 12 years, the American College of Gastroenterology (ACG) issued a new version of the Colorectal Cancer (CRC) Screening Guidelines (hereinafter referred to as the "Latest Guidelines") in March this year.
This edition of the guide discusses recommendations for CRC screening in general risk populations and populations with family history of CRC, and discusses the role of aspirin in chemoprevention, the quality indicators of colonoscopy, organized CRC screening methods, and the improvement of CRC.
Recommendations are made on the compliance of screening.
Figure 1: Guide topic and information of main participating experts (scan the QR code of the picture to get the original text of the guide~) Guide update content 1.
It is recommended to carry out CRC screening for general risk individuals aged 50 to 75 to reduce advanced adenomas, The incidence of CRC and reduce the mortality of CRC (strong recommendation; moderate-quality evidence).
2.
It is recommended to carry out CRC screening for general risk individuals aged 45 to 49 years to reduce the incidence of advanced adenoma and CRC, and reduce the mortality rate of CRC (conditional recommendation; very low-quality evidence).
3.
It is recommended that whether to continue screening for persons over 75 years old should be based on individual circumstances (conditional recommendation; very low-quality evidence).
4.
Colonoscopy and stool immunochemical testing (FIT) are recommended as the main screening methods for CRC screening (strong recommendation; low-quality evidence).
5.
It is recommended that for those who are unable or unwilling to undergo colonoscopy or FIT, the following screening tests may be considered: fiber sigmoidoscopy, multi-target fecal DNA testing, colon CT imaging or colon capsule endoscopy (recommendation with conditions; Very low-quality evidence).
6.
Septin 9 is not recommended for CRC screening (conditional recommendation; very low-quality evidence). 7.
Recommended screening interval: FIT once a year; colonoscopy once every 10 years (strong recommendation; low-quality evidence).
8.
Recommended screening interval: multi-target stool DNA testing every 3 years; fiber sigmoidoscopy every 5-10 years; colon CT imaging every 5 years; colon capsule endoscopy every 5 years (with Conditional recommendation; very low-quality evidence).
9.
It is recommended that one of the first-degree relatives suffers from CRC or advanced polyps when they are less than 60 years old, or there are two individuals who suffer from CRC or advanced polyps at any age.
CRC screening should start at the age of 40, or at the youngest It started 10 years before the sick relatives became ill.
A colonoscopy is recommended every 5 years (conditional recommendation; very low-quality evidence).
10.
It is recommended that those with a higher family burden of CRC (more affected relatives and/or younger age) consider genetic evaluation (conditional recommendation; very low-quality evidence).
11.
It is recommended that one of the first-degree relatives who suffered from CRC or advanced polyps at the age of <60, start CRC screening 10 years before the onset of the disease at the age of 40 or the youngest relative; then return to general risk screening Recommendations (conditional recommendations; very low-quality evidence).
12.
For individuals with a second-degree relative with CRC or advanced polyps, it is recommended to follow the general risk CRC screening recommendations (conditional recommendation; low-quality evidence).
13.
It is recommended to evaluate all endoscopists performing colonoscopy: cecal intubation rate (CIRs), adenoma detection rate (ADRs) and withdrawal time (WTs) (strong recommendation; for adenoma detection rate) Moderate-quality evidence, and low-quality evidence for the time of withdrawal and cecal intubation).
14.
It is recommended that endoscopists whose adenoma detection rate is lower than the recommended minimum threshold (<25%) receive remedial training (conditional recommendation, very low-quality evidence).
15.
It is recommended that the endoscopist use at least 6 minutes to examine the intestinal mucosa during the withdrawal period (strong recommendation; low-quality evidence).
16.
It is recommended that the cecal intubation rate of endoscopists should be at least 95% (strong recommendation; low-quality evidence). 17.
For individuals who are 50 to 69 years old, have a cardiovascular disease risk ≥10% in the next 10 years, have no increased bleeding risk, and are willing to take aspirin, it is recommended to take a low-dose aspirin for at least 10 years to reduce the risk of CRC (conditional recommendation; low) Quality evidence).
18.
Aspirin is not recommended to replace CRC screening (strong recommendation; low-quality evidence).
19.
Compared with opportunistic screening, an organized screening program is recommended to improve compliance with CRC screening (strong recommendation; low-quality evidence).
20.
The following measures are recommended to improve screening compliance: patient navigation, patient reminders, clinician intervention, provider recommendations, and clinical decision support tools (conditional recommendations, very low-quality evidence).
21.
The following strategies are recommended to improve follow-up compliance for positive screening tests: email and phone reminders, patient navigation, and provider intervention (conditional recommendations, very low-quality evidence).
It can be seen that the latest guidelines recommend that individuals with general risk should be screened for CRC starting at the age of 45 (before that it was 50 years old).
ACG said that this update is based on new epidemiological data: young people aged 45-49 are at an increasing risk of colorectal cancer.
In fact, as early as October 27, 2020, the "Draft Colorectal Cancer Screening Recommendations" issued by the United States Preventive Services Task Force (USPSTF) recommended that adults between the ages of 45-75 should undergo colorectal screening.
To reduce the risk of death from colorectal cancer.
The latest guidelines recommend colonoscopy or FIT for screening of individuals at general risk; if colonoscopy is used, it should be reviewed every 10 years, and FIT should be performed once a year.
This is in contrast to the update of the American Gastroenterology Association (AGA) to some extent.
AGA recommends more non-invasive tests at the beginning, such as stool occult blood testing.
It is recommended that the initial colonoscopy is only used for CRC.
High-risk patients.
In addition, the latest guidelines emphasize the quality indicators of colonoscopy, including cecal intubation rate, adenoma detection rate and withdrawal time.
In 2020, a study published in the Annals of Internal Medicine pointed out that compared with low-quality colonoscopy, high-quality colonoscopy (adequate bowel preparation, high cecal intubation rate, adenoma detection rate) ≥20%) led to a reduction in CRC morbidity and mortality by about half.
Compared with Chinese guidelines, the trend of younger colorectal cancer incidence has also been reflected in my country.
The "China Colorectal Cancer Screening and Early Diagnosis and Treatment Guidelines (2020, Beijing)" (hereinafter referred to as the "China Guidelines") pointed out that the colorectal cancer in the Chinese population The incidence of cancer began to rise from the age of 40, and showed a significant upward trend from the age of 50.
With the younger generation of colorectal cancer and foreign guidelines and consensus, the age of colorectal cancer screening has been advanced to 45 years old.
Some people will have this question: "When I reach 45 years old, do I have to go for colonoscopy?" Although the recognition of colorectal cancer screening has been greatly improved in our country, it is far from enough; and because colonoscopy is an invasive examination, the participation rate is not enough.
At present, the colorectal cancer screening model recommended in my country is an organic combination of population screening and opportunistic screening.
Taking into account the actual conditions of our country, the Chinese guidelines recommend that the general population receive colorectal cancer risk assessment from the age of 40, and it is recommended that people assessed as medium and low risk receive colorectal cancer screening at the age of 50 to 75, and the assessment results are recommended for high-risk populations.
Receive colorectal cancer screening from 40 to 75 years old.
In other words, when you reach the age of 40, you can first check whether you belong to a high-risk or low-risk group based on the colorectal cancer screening scale, and whether you need a colonoscopy.
Table 1: Colorectal cancer screening high-risk factors quantitative questionnaire Table 2: Colorectal cancer screening scores for asymptomatic people In addition, the Chinese guidelines also emphasize that high-quality colonoscopy is the key to ensuring the screening effect, and it is currently more recognized The criteria for high-quality colonoscopy include: ①The rate of good bowel preparation should be >85%.
②The cecal insertion rate is >95%.
③The withdrawal time should be at least 6min.
④The detection rate of adenomas should be >20%, of which males are >25% and females are >15%.
If you want to see more clinical guidelines, go to the doctor's station ~ reference source: [1]Shaukat A, et al.
ACG Clinical Guidelines: Colorectal Cancer Screening 2021.
Am J Gastroeterol.
2021;doi:10.
14309/ajg.
0000000000001122.
[2]https :// ND, et al.
, Long-term colorectal cancer incidence and mortality after a single negative screening colonoscopy, Ann Intern Med 2020; DOI: 10.
7326/M19-2477.
[4] National Research Center for Clinical Medicine of Digestive Diseases (Shanghai), National Alliance of Digestive Tract Early Cancer Prevention and Treatment Centers, Chinese Medical Association Digestive Endoscopy Branch, etc.
Expert consensus opinion on the screening process for early colorectal cancer in China (2019, Shanghai) [J].
Chinese Journal of Health Management, 2019,13( 5 ): 376-386.
Source of this article: Digestive Liver Disease Channel of the medical community.
This article is organized: A congee.
This article is reviewed by: Yang Health, Deputy Chief Physician of Jingdezhen Second People's Hospital Responsible editor: Mary's copyright statement.
If you need to reprint the original article, please contact authorization-End-Click "Read the original text" to get the original text of the guide 👇
