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It is only for medical professionals to read and refer to the general population.
Under the premise that the colonoscopy is of high quality and life expectancy is less than 80 years old, once the colonoscopy is still negative at the age of 60, CRC screening is no longer recommended in the future.
From 03:30-05:00 on May 24th, 2021, Beijing time, the American Digestive Disease Week (DDW) AGA venue was held with the theme "Open Questions in Colorectal Cancer Screening (Open Questions in Colorectal Cancer Screening)" Seminars.
In this topic, based on existing guidelines and high-quality evidence, experts and scholars mainly discussed the difficult and difficult problems in colorectal cancer (CRC) screening, such as the timing of screening, the choice of screening technology, and how to deal with negative colonoscopy results Wait.
1When will the first colorectal cancer screening start and what technology should be used? Dr.
Aasma Shaukat from the Minneapolis Veterans Medical Center compiled research evidence and recommended guidelines on the timing and method of first screening for CRC in the general population.
Early guidelines, such as the 2016 US Preventative Services Task Force (USPSTF) guide and the 2017 US multi-Society Task Force (USMSTF) guide, both recommend that the general population start CRC screening at the age of 50, and the latter's primary recommended screening method is Stool immunochemical test (FIT) every year or colonoscopy every 10 years.
The 2018 American Cancer Society (ACS) guidelines, based on the evidence of the rising incidence of rectal cancer under the age of 50 and estimated data from the MISCAN/SimCRC model, have advanced the recommended time for the first screening to 45 years old.
The 2021 American College of Gastroenterology (ACG) guidelines and the USPSTF guidelines (issued in May 2021) continue the recommendations for screening at the age of 45.
In the context of the global increase in the incidence of CRC, starting screening earlier will help to further reduce its incidence and mortality, avoid premature deaths caused by CRC, and improve the initiative and compliance of screening for people aged 50 to 55.
.
For various screening methods, Dr.
Aasma Shaukat summarized and compared the sensitivity and specificity of FIT, multi-target fecal DNA detection, capsule endoscopy, colonoscopy and other methods, as well as the advantages and disadvantages in practical applications.
Screening methods are highly effective, and colonoscopy screening can also greatly reduce the incidence and mortality of CRC in the population.
She also emphasized that improving screening compliance is a key link in CRC prevention.
2 If the result of a normal colonoscopy is checked, when will it be rechecked? Next, Professor Michal F.
Kaminski from the National Cancer Research Center in Warsaw focused on the analysis of the interval between negative colonoscopy.
For the general population, most current guidelines (ACS, 2018; ACG, 2021, etc.
) recommend that after high-quality colonoscopy with negative results, the interval before the next colonoscopy is 10 years.
Professor Kaminski summarized the high-quality evidence supporting this interval and further analyzed related research on longer intervals (>10 years).
Multiple cohort studies support that a single negative colonoscopy can reduce the risk of CRC for up to 12 to 20 years, but there are currently no randomized controlled clinical studies (4 are still in progress).
At the same time, the significance of negative colonoscopy in reducing the risk of CRC may not be realized until 5 to 8 years later.
A cost-benefit model analysis shows that a colonoscopy interval of 20 years still has a benefit advantage.
Based on the above evidence, Professor Kaminski boldly proposed that for the general population, on the premise that colonoscopy is of high quality and life expectancy is less than 80 years, once the colonoscopy is still negative at the age of 60, CRC screening may no longer be recommended in the future.
3 Will genomic and metabolome testing replace existing screening methods? Finally, Dr.
Carol A.
Burke from the Cleveland Clinic combined with the background of the rapid development of current genomics and metabonomics technology, introduced the relevant progress in the field of assisting in the screening of colorectal tumors in recent years and analyzed its development prospects.
On the one hand, metabolites present in feces and various body fluids have the potential as biomarkers to reflect disease or health status.
A meta-analysis in 2020 showed that for volatile compounds (VOCs) in exhaled breath, feces, and urine, the sensitivity of diagnosing colorectal cancer is between 80% and 85%, and the specificity is between 70% and 86%.
However, the diagnostic specificity of urine VOCs is low (70%).
The algorithm model established in conjunction with urine metabolome analysis data has a sensitivity of more than 80% for the diagnosis of colorectal adenoma, which is much higher than the fecal occult blood test.
On the other hand, the use of genomic data (such as multiple SNP alleles) to calculate genetic risk scores can help doctors further stratify people at general risk of colorectal cancer and make appropriate long-term screening recommendations for people at different risks.
At the same time, scientists have begun to use multi-omics combined methods to assess the risk of colorectal tumors, and two large studies (ECLIPSE Trial, NCT04136002 and PREEMPT CRC, NCT04369053) are ongoing.
However, Dr.
Burke cautiously stated that genomics and metabolomics analysis will not be able to replace existing screening technologies such as FIT and colonoscopy in the next ten years.
Its application is mainly limited by limited clinical evidence, population heterogeneity, patient preference and compliance, etc.
, and there is room for improvement in the effectiveness of colonoscopy and other non-invasive screening methods.
Experts comment that colorectal cancer is one of the common cancers.
The mortality rate of colorectal cancer in my country is on the rise.
The key to effectively reducing the burden of the disease lies in early treatment and early intervention. The occurrence of colorectal cancer mostly follows the "adenoma-carcinoma" process, which takes 5-10 years or even longer, which provides an ideal time window for early diagnosis and intervention.
Colonoscopy is the most important method of colorectal screening.
Although colonoscopy in my country has a clear price advantage compared to Europe and the United States, its invasiveness restricts the public's willingness to actively accept screening.
The key to effectively improving the status quo of early diagnosis and treatment of colorectal cancer in my country is to strengthen the health education of the public for colorectal cancer screening, increase the popularization of colorectal cancer screening and the implementation of high-quality colonoscopy.
Expert profile Deng Kai Associate Professor/Associate Chief Physician of the Department of Gastroenterology, West China Hospital of Sichuan University, and a master's supervisor.
After graduating from the Department of Medicine of Peking University, he worked in the Department of Gastroenterology, West China Hospital of Sichuan University.
The pathogenesis of early cancer and related sub-specialties of diagnosis and treatment.
Presided over national, provincial and ministerial scientific research projects; published more than 20 SCI papers, including many papers published in well-known journals in the field (Gastroenterology, Hepatology, Am J Gastroentero, etc.
); won a number of provincial and ministerial awards; served as the current Chinese Medicine He is a member of the Helicobacter pylori group of Gastroenterology and other academic associations. References: [1] Shaukat A, Kahi CJ, Burke CA, Rabeneck L, Sauer BG, Rex DK.
ACG Clinical Guidelines: Colorectal Cancer Screening 2021.
Am J Gastroenterol.
2021 Mar 1;116(3):458-479.
doi:10.
14309/ajg.
0000000000001122.
PMID:33657038.
[2]Ng K,May FP,Schrag D.
US Preventive Services Task Force Recommendations for Colorectal Cancer Screening:Forty-Five Is the New Fifty.
JAMA.
2021 May 18;325 (19):1943-1945.
doi:10.
1001/jama.
2021.
4133.
PMID:34003238.
[3]Imperiale TF,Gruber RN,Stump TE,Emmett TW,Monahan PO.
Performance Characteristics of Fecal Immunochemical Tests for Colorectal Cancer and Advanced Adenomatous Polyps:A Systematic Review and Meta-analysis.
Ann Intern Med.
2019 Mar 5;170(5):319-329.
doi:10.
7326/M18-2390.
Epub 2019 Feb 26.
PMID:30802902.
[4]Heisser T, Peng L, Weigl K, Hoffmeister M, Brenner H.
Outcomes at follow-up of negative colonoscopy in average risk population:systematic review and meta-analysis.
BMJ.
2019 Nov 13;367:l6109.
doi:10.
1136/bmj.
l6109.
PMID:31722884;PMCID:PMC6853024.
[5]Nishihara R,Wu K,Lochhead P,Morikawa T,Liao X , Qian ZR, Inamura K, Kim SA, Kuchiba A, Yamauchi M, Imamura Y, Willett WC, Rosner BA, Fuchs CS, Giovannucci E, Ogino S, Chan AT.
Long-term colorectal-cancer incidence and mortality after lower endoscopy.
N Engl J Med.
2013 Sep 19;369(12):1095-105.
doi:10.
1056/NEJMoa1301969.
PMID:24047059;PMCID:PMC3840160.
[6]Brenner H,Chang-Claude J,Seiler CM,Hoffmeister M.
Long -term risk of colorectal cancer after negative colonoscopy.
J Clin Oncol.
2011 Oct 1;29(28):3761-7.
doi:10.
1200/JCO.
2011.
35.
9307.
Epub 2011 Aug 29.
PMID:21876077.
[7]Zhou W,Tao J,Li J,Tao S.
Volatile organic compounds analysis as a potential novel screening tool for colorectal cancer:A systematic review and meta-analysis.
Medicine(Baltimore).
2020 Jul 2;99(27):e20937.
doi:10.
1097/MD.
0000000000020937.
PMID:32629696;PMCID:PMC7337537.
[8]Wang H,Tso V,Wong C,Sadowski D,Fedorak RN.
Development and validation of a highly sensitive urine- based test to identify patients with colonic adenomatous polyps.
Clin Transl Gastroenterol.
2014 Mar 20;5(3):e54.
doi:10.
1038/ctg.
2014.
2.
PMID:24646506;PMCID:PMC3940838.
[9]Carr PR,Weigl K, Edelmann D, Jansen L, Chang-Claude J, Brenner H, Hoffmeister M.
Estimate of Absolute Risk of Colorectal Cancer Based on Healthy Life>
Under the premise that the colonoscopy is of high quality and life expectancy is less than 80 years old, once the colonoscopy is still negative at the age of 60, CRC screening is no longer recommended in the future.
From 03:30-05:00 on May 24th, 2021, Beijing time, the American Digestive Disease Week (DDW) AGA venue was held with the theme "Open Questions in Colorectal Cancer Screening (Open Questions in Colorectal Cancer Screening)" Seminars.
In this topic, based on existing guidelines and high-quality evidence, experts and scholars mainly discussed the difficult and difficult problems in colorectal cancer (CRC) screening, such as the timing of screening, the choice of screening technology, and how to deal with negative colonoscopy results Wait.
1When will the first colorectal cancer screening start and what technology should be used? Dr.
Aasma Shaukat from the Minneapolis Veterans Medical Center compiled research evidence and recommended guidelines on the timing and method of first screening for CRC in the general population.
Early guidelines, such as the 2016 US Preventative Services Task Force (USPSTF) guide and the 2017 US multi-Society Task Force (USMSTF) guide, both recommend that the general population start CRC screening at the age of 50, and the latter's primary recommended screening method is Stool immunochemical test (FIT) every year or colonoscopy every 10 years.
The 2018 American Cancer Society (ACS) guidelines, based on the evidence of the rising incidence of rectal cancer under the age of 50 and estimated data from the MISCAN/SimCRC model, have advanced the recommended time for the first screening to 45 years old.
The 2021 American College of Gastroenterology (ACG) guidelines and the USPSTF guidelines (issued in May 2021) continue the recommendations for screening at the age of 45.
In the context of the global increase in the incidence of CRC, starting screening earlier will help to further reduce its incidence and mortality, avoid premature deaths caused by CRC, and improve the initiative and compliance of screening for people aged 50 to 55.
.
For various screening methods, Dr.
Aasma Shaukat summarized and compared the sensitivity and specificity of FIT, multi-target fecal DNA detection, capsule endoscopy, colonoscopy and other methods, as well as the advantages and disadvantages in practical applications.
Screening methods are highly effective, and colonoscopy screening can also greatly reduce the incidence and mortality of CRC in the population.
She also emphasized that improving screening compliance is a key link in CRC prevention.
2 If the result of a normal colonoscopy is checked, when will it be rechecked? Next, Professor Michal F.
Kaminski from the National Cancer Research Center in Warsaw focused on the analysis of the interval between negative colonoscopy.
For the general population, most current guidelines (ACS, 2018; ACG, 2021, etc.
) recommend that after high-quality colonoscopy with negative results, the interval before the next colonoscopy is 10 years.
Professor Kaminski summarized the high-quality evidence supporting this interval and further analyzed related research on longer intervals (>10 years).
Multiple cohort studies support that a single negative colonoscopy can reduce the risk of CRC for up to 12 to 20 years, but there are currently no randomized controlled clinical studies (4 are still in progress).
At the same time, the significance of negative colonoscopy in reducing the risk of CRC may not be realized until 5 to 8 years later.
A cost-benefit model analysis shows that a colonoscopy interval of 20 years still has a benefit advantage.
Based on the above evidence, Professor Kaminski boldly proposed that for the general population, on the premise that colonoscopy is of high quality and life expectancy is less than 80 years, once the colonoscopy is still negative at the age of 60, CRC screening may no longer be recommended in the future.
3 Will genomic and metabolome testing replace existing screening methods? Finally, Dr.
Carol A.
Burke from the Cleveland Clinic combined with the background of the rapid development of current genomics and metabonomics technology, introduced the relevant progress in the field of assisting in the screening of colorectal tumors in recent years and analyzed its development prospects.
On the one hand, metabolites present in feces and various body fluids have the potential as biomarkers to reflect disease or health status.
A meta-analysis in 2020 showed that for volatile compounds (VOCs) in exhaled breath, feces, and urine, the sensitivity of diagnosing colorectal cancer is between 80% and 85%, and the specificity is between 70% and 86%.
However, the diagnostic specificity of urine VOCs is low (70%).
The algorithm model established in conjunction with urine metabolome analysis data has a sensitivity of more than 80% for the diagnosis of colorectal adenoma, which is much higher than the fecal occult blood test.
On the other hand, the use of genomic data (such as multiple SNP alleles) to calculate genetic risk scores can help doctors further stratify people at general risk of colorectal cancer and make appropriate long-term screening recommendations for people at different risks.
At the same time, scientists have begun to use multi-omics combined methods to assess the risk of colorectal tumors, and two large studies (ECLIPSE Trial, NCT04136002 and PREEMPT CRC, NCT04369053) are ongoing.
However, Dr.
Burke cautiously stated that genomics and metabolomics analysis will not be able to replace existing screening technologies such as FIT and colonoscopy in the next ten years.
Its application is mainly limited by limited clinical evidence, population heterogeneity, patient preference and compliance, etc.
, and there is room for improvement in the effectiveness of colonoscopy and other non-invasive screening methods.
Experts comment that colorectal cancer is one of the common cancers.
The mortality rate of colorectal cancer in my country is on the rise.
The key to effectively reducing the burden of the disease lies in early treatment and early intervention. The occurrence of colorectal cancer mostly follows the "adenoma-carcinoma" process, which takes 5-10 years or even longer, which provides an ideal time window for early diagnosis and intervention.
Colonoscopy is the most important method of colorectal screening.
Although colonoscopy in my country has a clear price advantage compared to Europe and the United States, its invasiveness restricts the public's willingness to actively accept screening.
The key to effectively improving the status quo of early diagnosis and treatment of colorectal cancer in my country is to strengthen the health education of the public for colorectal cancer screening, increase the popularization of colorectal cancer screening and the implementation of high-quality colonoscopy.
Expert profile Deng Kai Associate Professor/Associate Chief Physician of the Department of Gastroenterology, West China Hospital of Sichuan University, and a master's supervisor.
After graduating from the Department of Medicine of Peking University, he worked in the Department of Gastroenterology, West China Hospital of Sichuan University.
The pathogenesis of early cancer and related sub-specialties of diagnosis and treatment.
Presided over national, provincial and ministerial scientific research projects; published more than 20 SCI papers, including many papers published in well-known journals in the field (Gastroenterology, Hepatology, Am J Gastroentero, etc.
); won a number of provincial and ministerial awards; served as the current Chinese Medicine He is a member of the Helicobacter pylori group of Gastroenterology and other academic associations. References: [1] Shaukat A, Kahi CJ, Burke CA, Rabeneck L, Sauer BG, Rex DK.
ACG Clinical Guidelines: Colorectal Cancer Screening 2021.
Am J Gastroenterol.
2021 Mar 1;116(3):458-479.
doi:10.
14309/ajg.
0000000000001122.
PMID:33657038.
[2]Ng K,May FP,Schrag D.
US Preventive Services Task Force Recommendations for Colorectal Cancer Screening:Forty-Five Is the New Fifty.
JAMA.
2021 May 18;325 (19):1943-1945.
doi:10.
1001/jama.
2021.
4133.
PMID:34003238.
[3]Imperiale TF,Gruber RN,Stump TE,Emmett TW,Monahan PO.
Performance Characteristics of Fecal Immunochemical Tests for Colorectal Cancer and Advanced Adenomatous Polyps:A Systematic Review and Meta-analysis.
Ann Intern Med.
2019 Mar 5;170(5):319-329.
doi:10.
7326/M18-2390.
Epub 2019 Feb 26.
PMID:30802902.
[4]Heisser T, Peng L, Weigl K, Hoffmeister M, Brenner H.
Outcomes at follow-up of negative colonoscopy in average risk population:systematic review and meta-analysis.
BMJ.
2019 Nov 13;367:l6109.
doi:10.
1136/bmj.
l6109.
PMID:31722884;PMCID:PMC6853024.
[5]Nishihara R,Wu K,Lochhead P,Morikawa T,Liao X , Qian ZR, Inamura K, Kim SA, Kuchiba A, Yamauchi M, Imamura Y, Willett WC, Rosner BA, Fuchs CS, Giovannucci E, Ogino S, Chan AT.
Long-term colorectal-cancer incidence and mortality after lower endoscopy.
N Engl J Med.
2013 Sep 19;369(12):1095-105.
doi:10.
1056/NEJMoa1301969.
PMID:24047059;PMCID:PMC3840160.
[6]Brenner H,Chang-Claude J,Seiler CM,Hoffmeister M.
Long -term risk of colorectal cancer after negative colonoscopy.
J Clin Oncol.
2011 Oct 1;29(28):3761-7.
doi:10.
1200/JCO.
2011.
35.
9307.
Epub 2011 Aug 29.
PMID:21876077.
[7]Zhou W,Tao J,Li J,Tao S.
Volatile organic compounds analysis as a potential novel screening tool for colorectal cancer:A systematic review and meta-analysis.
Medicine(Baltimore).
2020 Jul 2;99(27):e20937.
doi:10.
1097/MD.
0000000000020937.
PMID:32629696;PMCID:PMC7337537.
[8]Wang H,Tso V,Wong C,Sadowski D,Fedorak RN.
Development and validation of a highly sensitive urine- based test to identify patients with colonic adenomatous polyps.
Clin Transl Gastroenterol.
2014 Mar 20;5(3):e54.
doi:10.
1038/ctg.
2014.
2.
PMID:24646506;PMCID:PMC3940838.
[9]Carr PR,Weigl K, Edelmann D, Jansen L, Chang-Claude J, Brenner H, Hoffmeister M.
Estimate of Absolute Risk of Colorectal Cancer Based on Healthy Life>