Screening for colorectal cancer, the 2020 China Guidelines recommend this!

Colorectal cancer is one of the main cancers that threaten the lives and health of our residents, causing a serious social burden.

Initiated by the National Cancer Center, and multidisciplinary experts jointly formulated the "Guidelines for Screening and Early Diagnosis and Treatment of Colorectal Cancer in China (2020, Beijing)".

Regarding colorectal cancer screening, the guidelines mainly give the following recommendations.

1 Definition of general risk population ➤ Those who do not have the following risk factors can be defined as "general risk population": (1) First-degree relatives have a history of colorectal cancer (including family history of non-hereditary colorectal cancer and hereditary colorectal cancer Family history); (2) I have a history of colorectal cancer; (3) I have a history of intestinal adenoma; (4) I have chronic inflammatory bowel disease that does not heal for 8-10 years; (5) I have fecal occult blood The test is positive.

(Strong recommendation, GRADE evidence grade: Medium) 2 Definition of high-risk population of sporadic colorectal cancer ➤ The definition of high-risk population of sporadic colorectal cancer should be based on basic information such as individual age, gender, body mass index, family history of colorectal cancer, bowel The history of diseases such as polyps and various risk factors such as smoking and drinking are comprehensively determined (strong recommendation, GRADE evidence classification: medium) ➤ To improve the risk prediction performance, the results of fecal occult blood test and other laboratory tests can be combined with the applicable population In reality, consider including other factors with higher risk levels to finally determine the criteria for determining high-risk groups of colorectal cancer (strong recommendation, GRADE evidence grade: low) 3 Definition of high-risk groups of hereditary colorectal cancer ➤ Hereditary colorectal cancer includes Non-polyposis colorectal cancer and polyposis colorectal cancer syndrome (strong recommendation, GRADE evidence grade: high) ➤Non-polyposis colorectal cancer includes Lynch Syndrome and familial colorectal cancer X Lynch-like syndrome (strong recommendation, GRADE evidence grade: high) ➤ Polyposis colorectal cancer syndrome includes familial adenomatous polyposis, MUTYH gene-related polyposis, and hereditary pigmented digestive polyposis syndrome ( Peutz-Jeghers syndrome), juvenile polyp syndrome, serrated polyposis syndrome, etc.
(Strong recommendation, GRADE evidence grade: high) 4 Starting and ending age for general population screening ➤ It is recommended that the general population begin to receive colorectal cancer risk assessment from 40 years old (Weak recommendation, GRADE evidence grade: low).
It is recommended that people who are assessed as low-medium risk receive colorectal cancer screening at the age of 50 to 75 (strong recommendation, GRADE evidence grade: medium).
It is recommended that people whose assessment results are high-risk should be screened for colorectal cancer.
Receive colorectal cancer screening from 40 to 75 years old (strong recommendation, GRADE evidence grade: medium) ➤If one or more first-degree relatives suffer from colorectal cancer, the recommended starting age for colorectal cancer screening is 40 or 10 years earlier than the youngest patient among first-degree relatives (weak recommendation, GRADE evidence grade: medium) 5 Start and stop age of screening for high-risk populations of hereditary colorectal cancer ➤High-risk populations of Lynch syndrome caused by MLH1/MSH2 mutations receive colon The starting age for mirror screening is 20-25 years old or 2-5 years earlier than the youngest patient in the family (strong recommendation, GRADE evidence grade: low) ➤ MSH6/PMS2 mutations caused by Lynch syndrome high-risk population The starting age for colonoscopy screening is 30 to 35 years or 2 to 5 years earlier than the age of onset of the youngest patient in the familyYears (strong recommendation, GRADE evidence grade: low) ➤ The high-risk population of familial colorectal cancer type X Lynch-like syndrome receives colonoscopy screening at the beginning age 5-10 years before the age of onset of the youngest patient in the family ( Strong recommendation, GRADE evidence grade: low) ➤High-risk populations in a typical FAP family begin to undergo colonoscopy screening from 10 to 11 years old, colonoscopy is performed every 1 to 2 years, and continue for life (strong recommendation, GRADE evidence grade) : Low) ➤High-risk populations of mild FAP families should start colonoscopy every 2 years from 18 to 20 years old, and continue for life (strong recommendation, GRADE evidence grade: low) ➤MUTYH high-risk populations of gene-related polyposis receive colon The starting age of mirror screening is 40 years old or 10 years earlier than the diagnosis age of colorectal cancer in first-degree relatives (strong recommendation, GRADE evidence grade: low) ➤ Hereditary pigmented digestive polyposis syndrome (Peutz-Jeghers) The high-risk population of juvenile polyp syndrome begins to receive colonoscopy screening from the age of 18 to 20 (strong recommendation, GRADE evidence grade: low) ➤ The high-risk population of juvenile polyp syndrome begins to receive colonoscopy screening from the age of 15 (strong recommendation, GRADE Evidence level: low) ➤For high-risk groups of serrated polyposis syndrome, the starting age for colonoscopy screening is 40 years old or 10 years earlier than the diagnosis age of colorectal cancer in first-degree relatives (strong recommendation, GRADE evidence level: Low) 6 Colorectal cancer screening and early diagnosis tools ➤ Colonoscopy is the gold standard for colorectal cancer screening (strong recommendation, GRADE evidence grade: high) ➤ Immune fecal occult blood test (FIT) is suitable for colorectal cancer screening It has high sensitivity for colorectal cancer diagnosis, but limited sensitivity for precancerous lesions (strong recommendation, GRADE evidence classification: medium) ➤Sigmoidoscopy can be used for colorectal cancer screening, and its sensitivity and specificity for distal colorectal cancer High degree (weak recommendation, GRADE evidence grade: medium) ➤Colon CT imaging technology can be used for colorectal cancer screening under certain conditions, and has certain screening capabilities for colorectal cancer and precancerous lesions (weak recommendation, GRADE Evidence grade: low) ➤Multi-target stool FIT-DNA test can be used for colorectal cancer screening under certain conditions, and it has certain screening capabilities for colorectal cancer and precancerous lesions (weak recommendation, GRADE evidence grade: low ) The above content is extracted from: National Cancer Center China Colorectal Cancer Screening and Early Diagnosis and Treatment Guidelines Development Expert Group.
China Colorectal Cancer Screening, Early Diagnosis and Early Treatment Guidelines (2020, Beijing)[J].
Chinese Cancer, 2021, 30(1):1-28.