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首页> 外文期刊>Annals of Internal Medicine >Evaluating Test Strategies for Colorectal Cancer Screening: A Decision Analysis for the U.S. Preventive Services Task Force
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Evaluating Test Strategies for Colorectal Cancer Screening: A Decision Analysis for the U.S. Preventive Services Task Force

机译：评估结肠直肠癌筛查的测试策略：美国预防服务工作队的决策分析

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Background: The U.S. Preventive Services Task Force requested a decision analysis to inform their update of recommendations for colorectal cancer screening. nnObjective: To assess life-years gained and colonoscopy requirements for colorectal cancer screening strategies and identify a set of recommendable screening strategies. nnDesign: Decision analysis using 2 colorectal cancer microsimulation models from the Cancer Intervention and Surveillance Modeling Network. nnData Sources: Derived from the literature. nnTarget Population: U.S. average-risk 40-year-old population. nnPerspective: Societal. nnTime Horizon: Lifetime. nnInterventions: Fecal occult blood tests (FOBTs), flexible sigmoidoscopy, or colonoscopy screening beginning at age 40, 50, or 60 years and stopping at age 75 or 85 years, with screening intervals of 1, 2, or 3 years for FOBT and 5, 10, or 20 years for sigmoidoscopy and colonoscopy. nnOutcome Measures: Number of life-years gained compared with no screening and number of colonoscopies and noncolonoscopy tests required. nnResults of Base-Case Analysis: Beginning screening at age 50 years was consistently better than at age 60. Decreasing the stop age from 85 to 75 years decreased life-years gained by 1% to 4%, whereas colonoscopy use decreased by 4% to 15%. Assuming equally high adherence, 4 strategies provided similar life-years gained: colonoscopy every 10 years, annual Hemoccult SENSA (Beckman Coulter, Fullerton, California) testing or fecal immunochemical testing, and sigmoidoscopy every 5 years with midinterval Hemoccult SENSA testing. Annual Hemoccult II and flexible sigmoidoscopy every 5 years alone were less effective. nnResults of Sensitivity Analysis: The results were most sensitive to beginning screening at age 40 years. nnLimitation: The stop age for screening was based only on chronologic age. nnConclusion: The findings support colorectal cancer screening with the following: colonoscopy every 10 years, annual screening with a sensitive FOBT, or flexible sigmoidoscopy every 5 years with a midinterval sensitive FOBT from age 50 to 75 years.
机译：背景：美国预防服务工作队要求进行决策分析，以告知他们有关大肠癌筛查建议的最新信息。 nn目的：评估大肠癌筛查策略的生存年限和结肠镜检查要求，并确定一组推荐的筛查策略。 nnDesign：使用来自癌症干预和监测建模网络的2个结肠直肠癌微观模拟模型进行决策分析。 nnData来源：源自文献。 nn目标人群：美国40岁平均风险人群。 nnPerspective：社会。 nnTime Horizo​​n：生命周期。 nn干预：粪便潜血测试（FOBT），柔性乙状结肠镜或结肠镜检查从40、50或60岁开始，直到75或85岁停止，FOBT和5的检查间隔分别为1、2或3年。乙状结肠镜和结肠镜检查需要10年或20年。 nn指标：与未进行筛查相比，需要延长的生命年；需要进行结肠镜检查和非结肠镜检查的人数。 nn基本病例分析的结果：从50岁开始筛查始终比60岁更好。将终止年龄从85岁降低到75岁，使生命年延长1％至4％，而结肠镜检查的使用年限降低4％至15％。假设依从性相同，则有4种策略可提供相似的生命年：每10年进行一次结肠镜检查，每年的Hemoccult SENSA（贝克曼库尔特，加利福尼亚州富勒顿）测试或粪便免疫化学测试，以及乙状结肠镜检查，每5年进行一次中间隔Hemoccult SENSA测试。仅每5年进行一次年度Hemoccult II和柔性乙状结肠镜检查的效果较差。 nn敏感性分析的结果：该结果对40岁开始筛查最为敏感。限制：筛选的终止年龄仅基于年龄。 nn结论：这些发现支持以下方面的大肠癌筛查：每10年进行一次结肠镜检查，使用敏感的FOBT进行年度筛查，或每5年使用50到75岁的中间隔敏感FOBT进行柔性乙状结肠镜检查。

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