大腸がんのスクリーニング:米国予防サービスタスクフォースの最新証拠報告と体系的なレビュー
Jennifer S Lin1, Leslie A Perdue1, Nora B Henrikson1
1Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon.
JAMA
|May 18, 2021
まとめ
結腸直腸がん (CRC) のスクリーニングオプションは,死亡率を効果的に減らす. 便の免疫化学検査 (FIT) と柔軟なシグモイドスコーピーは,CRCの死亡率を減らすための強力な証拠を示しますが,大腸内視鏡は,穿孔などのリスクを持っています.
科学分野:
- 腫瘍学
- 予防 医療
- 胃腸内科
背景:
- 結腸直腸がん (CRC) は,米国における主要な死因です.
- 早期発見と死亡率の低減には 効果的なスクリーニング方法が不可欠です
研究 の 目的:
- 大腸がんスクリーニングの有効性,検査の正確性,および有害性を体系的に検討する.
- 予防サービスタスクフォースのガイドラインの証拠を提供するためです.
主な方法:
- MEDLINE,PubMed,およびコクラン・セントラル・レジスター・オブ・コントロールド・トライアル (2015年1月〜2019年12月,監視期間2021年3月) の体系的レビュー.
- 症状のない一般リスク集団における英語研究を含む.
- 2人の独立した審査員によるデータ抽出とメタ分析
主要な成果:
- 柔軟なシグモイドスコーピーのスクリーニングにより,CRC特異的な死亡率 (IRR,0. 74) が減少しました.
- の隠れた血液検査 (gFOBT) との免疫化学検査 (FIT) もCRCの死亡率を低下させた.
- FITと糞便のDNAは,がんの検出においてgFOBTよりも高い感度と特異性を示し,大腸内視鏡検査は穿孔と出血のリスクを伴う.
結論:
- 多数の結腸直腸がんのスクリーニングオプションがあり,有効性,正確性,有害性によって異なります.
- 柔軟なシグモイドスコピーとFITがCRCの死亡率を減らすことを支持する証拠があります.
- スクリーニング方法の選択は,その実証された利点と潜在的な害を考慮する必要があります.
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