Colorectal cancer screening from 45 years of age: Thesis, antithesis and synthesis  

作　　者：Alessandro Mannucci Raffaella Alessia Zuppardo Riccardo Rosati Milena Di Leo José Perea Giulia Martina Cavestro 

机构地区：[1]Gastroenterology and Gastrointestinal Endoscopy Unit,Division of Experimental Oncology,Vita-Salute San Raffaele University,IRCCS San Raffaele Scientific Institute,Milan 20132,Italy [2]Department of Surgery,Vita-Salute San Raffaele University,IRCCS San Raffaele Scientific Institute,Milan 20132,Italy [3]Digestive Endoscopy Unit,Division of Gastroenterology,Humanitas Research Hospital,Department of Biomedical Science,Humanitas University,Milan 20090,Italy [4]Surgery Department,“Fundación Jiménez Díaz” University Hospital,Madrid 28040,Spain [5]Health Research Institute-Fundación Jiménez Díaz University Hospital,Madrid 28040,Spain

出　　处：《World Journal of Gastroenterology》2019年第21期2565-2580,共16页世界胃肠病学杂志（英文版）

摘　　要：Colorectal cancer incidence and mortality in patients younger than 50 years are increasing, but screening before the age of 50 is not offered in Europe. Advancedstage diagnosis and mortality from colorectal cancer before 50 years of age are increasing. This is not a detection-bias effect;it is a real issue affecting the entire population. Three independent computational models indicate that screening from 45 years of age would yield a better balance of benefits and risks than the current start at 50 years of age. Experimental data support these predictions in a sex- and race-independent manner. Earlier screening is seemingly affordable, with minimal impediments to providing younger adults with colonoscopy. Indeed, the American Cancer Society has already started to recommend screening from 45 years of age in the United States. Implementing early screening is a societal and public health problem. The three independent computational models that suggested earlier screening were criticized for assuming perfect compliance. Guidelines and recommendations should be derived from well-collected and reproducible data, and not from mathematical predictions. In the era of personalized medicine, screening decisions might not be based solely on age, and sophisticated prediction software may better guide screening. Moreover, early screening might divert resources away from older individuals with greater biological risks. Finally, it is still unknown whether early colorectal cancer is part of a continuum of disease or a biologically distinct disease and, as such, it might not benefit from screening at all. The increase in early-onset colorectal cancer incidence and mortality demonstrates an obligation to take actions. Earlier screening would save lives, and starting at the age of 45 years may be a robust screening option.Colorectal cancer incidence and mortality in patients younger than 50 years are increasing, but screening before the age of 50 is not offered in Europe. Advancedstage diagnosis and mortality from colorectal cancer before 50 years of age are increasing. This is not a detection-bias effect; it is a real issue affecting the entire population. Three independent computational models indicate that screening from 45 years of age would yield a better balance of benefits and risks than the current start at 50 years of age. Experimental data support these predictions in a sex-and race-independent manner. Earlier screening is seemingly affordable,with minimal impediments to providing younger adults with colonoscopy.Indeed, the American Cancer Society has already started to recommend screening from 45 years of age in the United States. Implementing early screening is a societal and public health problem. The three independent computational models that suggested earlier screening were criticized for assuming perfect compliance.Guidelines and recommendations should be derived from well-collected and reproducible data, and not from mathematical predictions. In the era of personalized medicine, screening decisions might not be based solely on age, and sophisticated prediction software may better guide screening. Moreover, early screening might divert resources away from older individuals with greater biological risks. Finally, it is still unknown whether early colorectal cancer is part of a continuum of disease or a biologically distinct disease and, as such, it might not benefit from screening at all. The increase in early-onset colorectal cancer incidence and mortality demonstrates an obligation to take actions. Earlier screening would save lives, and starting at the age of 45 years may be a robust screening option.

关 键 词：COLONOSCOPY Guidelines Pros and CONS Early ONSET EARLY-ONSET colorectal cancer 

分 类 号：R[医药卫生]