Lopes Sara Ramos, Martins Claudio, Santos Inês Costa, Teixeira Madalena, Gamito Élia, Alves Ana Luisa
Department of Gastroenterology, Centro Hospitalar de Setúbal, Setúbal 2910-446, Portugal.
World J Gastrointest Oncol. 2024 Apr 15;16(4):1119-1133. doi: 10.4251/wjgo.v16.i4.1119.
Colorectal cancer (CRC) is one of the most prevalent malignancies worldwide, being the third most commonly diagnosed malignancy and the second leading cause of cancer-related deaths globally. Despite the progress in screening, early diagnosis, and treatment, approximately 20%-25% of CRC patients still present with metastatic disease at the time of their initial diagnosis. Furthermore, the burden of disease is still expected to increase, especially in individuals younger than 50 years old, among whom early-onset CRC incidence has been increasing. Screening and early detection are pivotal to improve CRC-related outcomes. It is well established that CRC screening not only reduces incidence, but also decreases deaths from CRC. Diverse screening strategies have proven effective in decreasing both CRC incidence and mortality, though variations in efficacy have been reported across the literature. However, uncertainties persist regarding the optimal screening method, age intervals and periodicity. Moreover, adherence to CRC screening remains globally low. In recent years, emerging technologies, notably artificial intelligence, and non-invasive biomarkers, have been developed to overcome these barriers. However, controversy exists over the actual impact of some of the new discoveries on CRC-related outcomes and how to effectively integrate them into daily practice. In this review, we aim to cover the current evidence surrounding CRC screening. We will further critically assess novel approaches under investigation, in an effort to differentiate promising innovations from mere novelties.
结直肠癌(CRC)是全球最常见的恶性肿瘤之一,是第三大最常被诊断出的恶性肿瘤,也是全球癌症相关死亡的第二大主要原因。尽管在筛查、早期诊断和治疗方面取得了进展,但仍有大约20%-25%的CRC患者在初次诊断时就已出现转移性疾病。此外,疾病负担预计仍将增加,尤其是在50岁以下的人群中,早发性CRC的发病率一直在上升。筛查和早期检测对于改善CRC相关结局至关重要。众所周知,CRC筛查不仅能降低发病率,还能减少CRC导致的死亡。多种筛查策略已被证明在降低CRC发病率和死亡率方面有效,不过文献报道的疗效存在差异。然而,关于最佳筛查方法、年龄间隔和筛查周期仍存在不确定性。此外,全球范围内对CRC筛查的依从性仍然很低。近年来,为克服这些障碍,已开发出新兴技术,尤其是人工智能和非侵入性生物标志物。然而,对于一些新发现对CRC相关结局的实际影响以及如何将它们有效整合到日常实践中存在争议。在本综述中,我们旨在涵盖围绕CRC筛查的当前证据。我们还将进一步批判性地评估正在研究的新方法,以努力区分有前景的创新与单纯的新奇事物。