作者：Norra MacReady 齣處：WebMD醫學新聞 　　February 17 2009（加州洛杉磯）－美國預防服務小組（USPSTF）不再建議對50歲以上的病患進行大腸直腸癌篩檢。　　 ACPM 2009：不再建議對50歲以上者進行大腸直腸癌篩檢 - 趣味新聞網

發表日期 2009-03-06T08:10:34+08:00

     本帖最後由 goodcat1111 於 2009-4-5 09:13 編輯

作者：Norra MacReady
齣處：WebMD醫學新聞

February 17, 2009（加州洛杉磯）－美國預防服務小組（USPSTF）不再建議對50歲以上的病患進行大腸直腸癌篩檢。

在針對2002年建議的更新中，USPSTF目前建議50至74歲成人應該接受以下篩檢：每年接受高敏感度糞便潛血檢驗（FOBT）；每10年接受一次大腸鏡檢驗；或是每5年接受一次乙狀結腸鏡加上間隔高敏感度FOBT。

USPSTF學術主任Mary Barton醫師在預防醫學2009年年會：美國預防醫學會年會上發錶這項更新，這項建議等級為A，代錶任務小組力促臨床醫師們提供這些服務給適閤的病患們，同時有良好的證據顯示，改善健康預後的服務，顯然益處大於壞處。

此外，任務小組也不建議對76至85歲成人常規性地進行篩檢，雖然個體病患可能有支持篩檢的考量。

在2002年，USPSTF建議針對所有50歲以上的人進行篩檢，當時服務小組也錶示那時的證據不足以建議或是反對使用斷層掃描大腸造影（CTC）作為篩檢方式之一。

自從那時候開始，許多新研究想要釐清篩檢的價值，任務小組用奧勒岡證據醫學執業中心的一項綜論，這項文獻分析聯邦、州、或私人機構臨床研究以製定政策與給付決定。

為瞭檢驗CTC研究數據，該中心分析四項被認為品質良好或不佳的研究，共有4,312位病患；依照該檢驗結果是否由腸胃科醫師或是有經驗的放射科醫師判讀，CTC在四項不同的研究中，偵測到12或13個大腸直腸癌，而總數量為14個；相較於大腸直腸鏡，CTC的敏感度，在偵測腺瘤方麵為59至94%，視腫瘤大小而定。專一度介於80至96%。

Barton醫師錶示，CTC有許多僞陽性的狀況，這項結果是醫師可能讓許多想跳過大腸直腸鏡的人們接受CTC檢驗，因為大腸直腸鏡有真實且中等程度的檢驗相關損傷，例如穿孔與重大齣血。醫療保險宣稱不會給付CTC作為大腸直腸癌篩檢，Barton醫師錶示，目前可獲得之針對CTC的研究，在品質上的差異很大，緻使要確認這項檢驗的好處和壞處並不容易；任務小組的結論是，目前並沒有足夠的資訊讓我們評估CTC的好處與壞處，因此當更新大腸直腸癌篩檢時，並未提到這項檢驗措施。

加州Loma Linda大學預防醫學部門的Wane Dysinger醫師錶示，這項更新的發現顯示，我們目前尚未準備好進行電腦斷層大腸直腸顯影，即使病患要求進行這項檢驗。這項建議讓我們可以告訴病患，目前並沒有足夠的科學證據來鼓吹進行CT大腸直腸顯影。Dysinger醫師並未參與研議這項建議，她對任務小組不建議CTC的結論感到意外。

ACPM 2009: Colorectal Cancer Screening No Longer Recommended for Those Older Than 50 Years

By Norra MacReady
Medscape Medical News

February 17, 2009 (Los Angeles, California) — The US Preventive Services Task Force (USPSTF) no longer recommends colorectal cancer screening for everyone older than 50 years.

In an update of its 2002 recommendation, the USPSTF now recommends that adults aged 50 to 74 years be screened in 1 of the following ways: every year with high-sensitivity fecal occult blood testing (FOBT); every 10 years with colonoscopy; or every 5 years with flexible sigmoidoscopy plus interval high-sensitivity FOBT.

The recommendation has a rating of A, meaning that the task force urges the clinician to provide the service to eligible patients and that there is good evidence that the service improves health outcomes, with benefits substantially outweighing harms, said USPSTF scientific director Mary Barton, MD, who presented the update here at Preventive Medicine 2009: The Annual Meeting of the American College of Preventive Medicine.

The task force also recommended against routine screening of people aged 76 to 85 years, although individual patients might have considerations that support screening.

In 2002, the USPSTF recommended screening for everyone older than 50 years. That year, the task force also noted that there was insufficient evidence to recommend for or against using computed tomography colonography (CTC) as 1 of the screening modalities.

Since then, several new studies have been performed that clarify the value of screening. The task force evaluated these data using a review conducted by the Oregon Evidence-Based Practice Center, which analyses clinical studies that federal, state, and private agencies use in making policy and coverage decisions.

To examine the data on CTC, the center analyzed 4 studies it considered to be of good or fair quality, which involved a total of 4312 patients. Depending on whether the scan was read by a gastroenterologist or an experienced radiologist, CTC identified 12 or 13 of a total of 14 colorectal cancers across the 4 studies. Compared with colonoscopy, the sensitivity of CTC ranged from 59% to 94% for detecting adenomas, depending on the size. The specificity ranged from 80% to 96%.

CTC produces "lots of false positives," Dr. Barton said. The result is that doctors might be "sending many people to colonoscopy who [they] were trying to spare colonoscopy," with its "real and moderate-sized procedure-related harms," such as perforation and major bleeding. Noting that Medicare is announcing that it will not cover CTC for colorectal screening, Dr. Barton said that the currently available studies on CTC vary widely in quality, making it hard to determine the true net benefit or harm of the test. The task force concluded that there is not yet enough information to permit an assessment of the benefits and harms of CTC, so it did not mention the procedure at all when updating its recommendations for colorectal cancer screening.

The updated findings show that "we're not ready for CT colonography yet," even though patients are requesting it, said Wayne Dysinger, MD, chair of the Department of Preventive Medicine at Loma Linda University, in California. "This makes it clear that I can tell patients we don't have the science yet to pursue CT colonography." Dr. Dysinger, who was not involved in developing the recommendations, said he was a little surprised that the task force concluded it could not recommend CTC.

Preventive Medicine 2009: The Annual Meeting of the American College of Preventive Medicine (ACPM). Session 30. Presented February 13, 2009.

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