BJC：超过三分之一的结肠癌筛查结果异常的个体不会进行深入的癌症检查

  近日，一项发表于国际杂志British Journal of Cancer上的研究中，来自伦敦大学学院(University College London)的研究人员通过研究表明，在结肠癌筛查中发现异常结果的个体中大约有40% 的个体都会忽视在2年后进行下一次筛查检测。相比而言，有13%的结果异常个体并不会立即进行筛查；那些经过大便隐血测试发现异常结果的个体在接下来会进行一系列测试，包括结肠镜检查来进行癌症早期诊断，但如果个体不进行结肠镜检查的话往往会使其处于患癌风险之中。

  此前研究人员发现，11%至12%的个体并不会再继续进行随后的筛查，研究者Siu Hing Lo说，一些处于风险的小型群体并不会立即进行结肠镜检查，目前我们急需知道为何人们不愿意参与结肠镜检查以及随后的一系列深入检查。NHS结肠癌筛查程序目的在于检测处于早期结肠癌的患者，以便可以及时对患者进行治疗来挽救患者的生命。文章中研究人员对有结肠癌症状患者的粪便样本进行采集并且检测，随后进行结肠镜检查，如果对患者的癌症诊断疗法早日开始则可以有效增加患者生存的希望。

  目前在英国、威尔士及北爱尔兰的60岁至74岁的男性和女性，以及苏格兰的50岁至74岁的男性和女性个体都会每隔两年进行进行一次家庭筛查程序；通过这种筛查可以及时告诉个体是否需要再进行测试以及结肠镜检查。目前结肠癌在英国所有被诊断的癌症中占到了13%，而每年有超过4.1万人被诊断为结肠癌患者，而且有超过1.6万人死于该疾病。

  最后研究者Julie Sharp表示，结肠癌是第四大常见的癌症，进行结肠癌筛查可以有效帮助我们去抵御该疾病的发生，目前在英国提供结肠癌筛查的个体中仅有58%的个体会完成整个测试过程，但研究人员更关注的是一些初期检测有异常结果的个体往往会放弃进行更为深入的检测。研究者希望本文研究可以让更多个体知晓结肠癌筛查的重要性，并且可以有效帮助其进行诊断筛查，以提前做好预防措施。（转化医学网360zhyx.com）

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转化医学网推荐的原文摘要：

Predictors of repeat participation in the NHS bowel cancer screening programme
BJC doi:10.1038/bjc.2014.569
S H Lo1, S Halloran2,3,4, J Snowball2, H Seaman2,3,4, J Wardle1 and C von Wagner1
objectives: Most types of population-based cancer screening require repeat participation to be effective. This study investigated predictors of repeat participation in the NHS Bowel Cancer Screening Programme (BCSP).
methods: The BCSP in England offers biennial colorectal cancer screening using a guaiac fecal occult blood test (gFOBt) from age 60–74 years. This analysis included 62 081 individuals aged 60–64 years at the time of the first invitation (R1). The main outcome was repeat participation at their second (R2) or third (R3) invitation. Behavioural measures derived from screening records included late return of the gFOBt kit, compliance with follow-up investigations and previous screening participation. Other potential predictors of repeat participation included results of individual test kit analysis (normal, weak positive, strong positive, spoilt) and the definitive result of the gFOBt screening episode (normal or abnormal). Age, sex and socioeconomic deprivation were also recorded.
results: Overall repeat uptake was 86.6% in R2 and 88.6% in R3. Late return of the test kit was consistently associated with lower uptake (R2: 82.3% vs 88.6%, P<0.001; R3: 84.5% vs 90.5%, P<0.001). A definitive abnormal gFOBt result in the previous screening episode was a negative predictor of repeat uptake (R2: 61.4% vs 86.8%, P<0.001; R3: 65.7% vs 88.8%, P<0.001). Weak positive (R2: 76.9% vs 86.8%, P<0.001; R3: 81.7% vs 88.8%, P<0.05) and spoilt test kits (R2: 79.0% vs 86.6%, NS; R3: 84.2% vs 92.2%, P<0.05) were associated with lower repeat uptake, but were not consistently independent predictors in all invitation rounds or subgroups. Among those with a definitive abnormal gFOBt result, noncompliance with follow-up in a previous screening episode was also associated with lower repeat uptake (R2: 24.3% vs 67.1%, P<0.001; R3: 43.2% vs 69.9%, P<0.001).
conclusions: Behavioural markers and test results from previous screening episodes have been implicated in subsequent gFOBt uptake.