结肠镜筛查 有没有更简单、有效地方法？

你或者某人了解推迟结肠镜检查吗？也许这就是需要准备的意思。结肠镜检查前一天要求好待在家或者靠近厕所。更糟糕的是，它让你感觉非常不舒服，或者也许是检验的侵袭，至多让你感觉不愉快。糟糕的是，可能会有严重的并发症，包括器械穿刺肠，出血和器官损伤。这也很费时，需要请假，还需要人把你送回家。

为什么结肠镜检查值得这么麻烦？

结肠癌和直肠癌是常见的，早期检测是可以挽救生命的。

结直肠癌是美国第四大常见的癌症，也是癌症死亡的大原因。有超过一百万人确诊，今年预计有134000个新病例。

   大约4％的成年人在其一生中将被诊断为结直肠癌；有结直肠癌或癌前息肉有关的亲属，息肉个人病史，年龄增长，肥胖，酗酒，吸烟和非洲裔美国人都会增加患病风险。

在癌症还没有扩散之前被诊断的患者，五年生存率达到90%，刚开始转移的，是68%，已经大量转移的，是10%。

因此，专家们认为筛查一般从50岁到75岁是言之有理的，随后在个案基础上决定继续筛查。根据美国预防服务工作组2016年草案，有六种认可的方法筛查结直肠癌和癌前息肉：乙状结肠镜检查和结肠镜检查的方法;特殊成像技术（CT结肠成像）;粪便潜血实验（因为肠道出血可能是癌症的征兆）; FIT检验是一个空想家，更敏感的粪便潜血实验;以及寻找分子，基因突变和血液的组合的粪便DNA测试。使用哪种测试取决于患者的情况和喜好，美国预防服务工作组需要更多的研究，以便能够提出更准确的建议。

Cologuard：结肠癌筛查新办法

    近我的病人一直在询问精密科学的Cologuard联合粪便DNA测试，这是由FDA2014年批准的。你可能已经看到它在电视上做广告，设有一个可爱的小谈话盒。 Medicare和Medicaid将为没有胃肠道症状的一般人群支付每三年一次的全部测试费用（约500美元）。

这个检验很简单。我们去网上打印出订单表格，病人填保险信息，我签名的文件通过邮件发送给公司。他们按照顺序邮寄给病人一个收集粪便的小盒子。

患者按照惯例，饮食不需要改变，也不要任何准备，在精心设计的马桶盖或收集罐里面排便，并在两天内将其邮寄回公司。公司进行检验，每个检验成分的数值结果是通过特殊方程运行，截断分为阳性或阴性结果。他们将结果发送给医生，然后向患者报告。阳性检验意味着进一步评估是必要的，并且涉及结肠镜检查寻找息肉或癌症。

Cologuard有多好？

就如一个重要研究中所引用的，它是相当好的：Cologuard检测到92％的结直肠癌和42％的晚期息肉。作为比较，FIT测试检测到74％的癌症和24％的晚期息肉。所以它比的非侵入性选择更好，没有任何痛苦的准备和潜在的不适，以及结肠镜或CT结肠镜潜在的严重风险。（重要的是要知道，这两个粪便试验都容易产生假阳性结果。这意味着粪便试验可以在没有任何癌症时提示癌症，要确切知道，患者需要结肠镜检查或CT结肠成像。）

现在，每三年的检验保险都已经覆盖，但是需要更多的研究来了解这是否是一个合适的间隔;终，该检验可能或多或少的会被推荐。

Cologuard听起来太棒了。病人应该知道，实际上这项重要研究的数据主要是由赞助商精准科学推荐的。另外一个更小的研究显示类似的结果，是由Cologuard技术的联合发明人和精准科学的科学顾问创作的辅助性结果。

知道这一点真的很重要，拿着有一大粒盐令人惊人的小说话盒。可以理解为什么美国预防服务工作组要求更多的研究，为什么医生不放弃传统的、可靠的，但结束会很痛苦的结肠镜检查作为一个基本的筛选测试。

    我为我自己的病人推荐Cologuard？当然啦。我有许多患者，一直鼓励他们结肠镜检查多年，由于某种原因，他们推迟了。或者存在一些医学问题的患者，其结肠镜检查可能在后勤保障上困难或风险过高。在这些情况下，粪便测试是非常可行的选择，肯定比没有进行结肠镜筛查好，也可能比传统筛查更好。我们只是还不能确定。(美域健康漆琳翻译)

Colon cancer screening: Is there an easier, effective way?

Are you, or is someone you know, postponing their colonoscopy? Maybe it’s the idea of that prep. At best, it requires being home and near a toilet for a day. Worse, it can make people feel awfully ill. Or maybe it’s the invasiveness of the test. At best, it’s unpleasant. At worst, there can be serious complications, including an instrument puncturing the bowel, bleeding, and organ damage. It’s also time-consuming, requiring time off work for you and whoever will be driving you home.

Why is a colonoscopy worth the hassle?

Cancers of the colon and rectum are common, and lives can be saved with early detection.

Colorectal cancer is the fourth most common cancer in the United States and the second leading cause of cancer death. There are well over a million people living with the diagnosis, and 134,000 new cases are expected this year.

About 4% of all adults will be diagnosed with colorectal cancer in their lifetime; having a first-degree relative with colorectal cancer or precancerous polyps, a personal history of polyps, advancing age, obesity, alcohol use, smoking, and African-American race all increase the risk substantially.

The five-year survival rate for these cancers is about 90% when the cancer is caught before it spreads at all, but only 68% when it has started to spread, and 10% when it is widely spread (metastatic).

For this reason, experts agree that it makes sense to screen people at average risk starting at age 50 and up to age 75, with the decision to continue screening after that on a case-by-case basis.

According to the 2016 guidelines from the U.S. Preventive Services Task Force (USPSTF), there are six acceptable ways to screen for colorectal cancers and precancerous polyps: procedures like sigmoidoscopy and colonoscopy; special imaging techniques (CT colonography); basic stool tests for blood (because bleeding in the intestine can be a sign of cancer);   FIT test, which is a fancier, more sensitive stool test for blood; and the combined stool DNA test that looks for molecules, gene mutations, and blood. Which test to use depends on the patient’s situation and preferences, and the USPSTF has called for more research in order to be able to make more precise recommendations.

Cologuard: The new kid on the colon cancer screening block

Recently my patients have been asking about Exact Sciences’ Cologuard combined stool DNA test, which was approved by the FDA in 2014. You may have seen it advertised on TV, featuring a cute little talking box. Medicare and Medicaid will cover the entire cost of this test (about $500) once every three years for average-risk people who have no gastrointestinal symptoms.

The test is easy-peasy. One of us goes to the website and prints out the order form, the patient fills in the insurance information, and I sign the paper, which gets mailed to the company. They in turn mail the patient a little box with the stool collection kit. The patient goes about their usual routine, without any change to diet or prep whatsoever, poops into the cleverly designed toilet cover/collection jar, and mails it back to the company within two days.

The company runs the tests, and the numerical results from each test component are run through a special equation, with a cutoff score for a positive or negative result.They send the results to me, and then I report to the patient. A positive test means that further evaluation is necessary, and that involves a colonoscopy looking for a polyp or cancer.

Just how good is Cologuard?

Based on the one major study cited,it is pretty darned good: Cologuard detected 92% of colorectal cancers and 42% of advanced polyps. As a comparison, the FIT test detected 74% of cancers and 24% of advanced polyps. So it’s better than the only other real non-invasive option, and without the painful prep, potential discomfort, and potentially serious risks of a colonoscopy or CT colonography. (It is important to know that both of these stool tests are more likely to have a false positive result. That means that the stool test can suggest cancer when there isn’t any, and to know for sure, a patient will need a colonoscopy or CT colonography after all.)Right now, the test is covered by insurance every three years, but more research is needed to know if that is an appropriate interval; eventually, the test may be recommended more or less often than that.

Cologuard sounds so wonderful. And it may actually be, but patients should know that the one major study that provided the data upon which most of the recommendations are based was 100% funded by Exact Sciences, the company that makes the test. Even the one other smaller study showing similar, supporting results was authored by co-inventors of the Cologuard technology and scientific advisors to Exact Sciences.

It’s really important to know that, and to take this amazing little talking box with a big grain of salt.I can understand why the USPSTF is calling for more research, and why doctors aren’t abandoning the good old, dependable, but pain-in-the-rear-end colonoscopy as a basic screening test. Yet.

Am I recommending the Cologuard for my own patients? You bet. I have many patients whom I’ve been encouraging to have their colonoscopies for years, and for one reason or another, they have delayed. Or, there are some patients with medical issues for whom a colonoscopy may be logistically difficult or too risky. In their cases, the stool tests are very viable options, definitely better than no screening, and maybe better than traditional screening. We just don’t know for sure yet.

媒体链接：结肠镜筛查 有没有更简单、有效地方法？