Colon cancer screening in 2005: status and challenges.
نویسنده
چکیده
o a t he field of colon cancer screening has evolved dramatically in the last 15 years regarding evidence, guideines, and practice. In 1990, no evidence from a randomized ontrolled clinical trial (RCT) existed to show that colorecal cancer (CRC) screening was effective in reducing CRC ortality. In 1990, although some guidelines endorsed creening, there was disagreement among recommending rganizations about which tests to recommend or whether o recommend any screening tests at all. The US Preventive ervices Task Force (USPSTF), arguably the most influential f the recommending organizations and the most rigorously vidence based, said that evidence was insufficient to recmmend either for or against CRC screening.1 In this nvironment, CRC screening was not widely practiced, uch less reimbursed by payers. If screening was performed t all, fecal occult blood testing (FOBT) was the most ommon test. Sigmoidoscopy was performed less freuently, and colonoscopy, rarely performed for screening, as used mainly for workup of a positive FOBT or sigoidoscopy and for postpolypectomy surveillance. The priary questions facing academics, recommending organizaions, and practicing clinicians in 1990 were (1) does CRC creening—of any kind—work to reduce CRC mortality, nd (2) should it be implemented and reimbursed? In 2005, the situation is dramatically different. We ow know that CRC screening works, and it is now eing implemented and reimbursed. Colonoscopy has ecome popular as a primary screening test, and new ests, such as virtual colonoscopy, are being developed. he purpose of this article is to identify current chalenges in light of the evolution of evidence, guidelines, nd practice and to anticipate the next phase of develpment and implementation.
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عنوان ژورنال:
- Gastroenterology
دوره 128 6 شماره
صفحات -
تاریخ انتشار 2005