colorectal screening：大肠癌筛查

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1、ColorectalScreeningNZBowelScreeningPilotWHOScreeningcriteriaImptHealthconditionIdentifiableLatentorearlystageUnderstandnaturalhxofdiseaseSuitableeffectivetestforscreeningexistsTestshouldbesafeandacceptabletoscreenedpopulationAcceptedRx(earlyRxleadstobetteroutcomes)

2、AgreedpolicyastowhomtotreatFacilitiesforDxandRxshouldbeavailableCostofcasefindingshouldbeviableCasefindingshouldbeacontinualprocessnotonceandforall.WilsonJMG,JungnerGPrinciplesandPracticeofScreeningforDisease.Geneva:WHOpublicpapersNo.341968ColorectalCancerGoodunder

3、standingofdiseaseprocessandofearlystagesPolyptocarcinomasequenceLongLagtimefromearlytolatestagesStage1approx94%5yearsurvivalStage4approx8%5yearsurvivalWellestablishedtreatmentprotocolsTheprobleminNewZealand2966newregistrationsforc/rcancer20101501male,1465female44.8

4、/100000agestandardised49.3/100000male,40.9/100000femaleNZColorectalCancerRegistrationsperageandsex2010LatepresentationColorectalscreeninggFOBTiFOBTFlexiblesigmoidoscopyCTcolonographyColonoscopy(Faecalbiomarkers)gFOBTGuaiacFOBTGumofGuaiacumOfficinale(tree)Oxidationr

5、xnwithhydrogenperoxideleadstocolourchangescatalysedbyHaemNothumanspecificHemocultIIgFOBTReductioninC/Rcancermortalitybyabout15%(11to18%)Lowsensitivityforcancerifusedonce(around13to38%)Improvedbymultiplesamplesandbiennialscreening(~50%)Lowuptakearound40to50%Multiple

6、samplesDietaryrestrictionsImmuno-FOBT(iFOBT)AntibodytoGlobinHumanspecificNodietaryrestrictionsGlobinisbrokendowninsmallbowelCanmeasureabsolutelevelsthereforecanpresetthethresholdfor+vetestCanautomatethetestingFlexibleSigmoidoscopyAtleastassensitiveasiFOBTforcaandmo

7、resoforadvancedadenomaApprox70%cancersarestage1or2Doesn’tlookattherightcolon(approx30-40%allmalignancies)Lowparticipationintruepopbasedtrials(around30%)NeedsverylargeendoscopiccapacityOthertechnologyColonoscopyCTcolonographyCapsuleendoscopyMoleculartests(stool)DNAm

8、ethylationGeneticmarkersRNABloodNZBowelScreeningPilotPilotusingiFOB(OC-sensor,Eiken)CompetitiveRFPwonbyWDHBwithsupportofADHBandCMDHBWDHBresidents