In 2020, colorectal cancer has risen to the second most common cancer in China, and new cases are among the most common cancers in China The fastest growing, but also a cancer that is clearly recommended by the World Health Organization to be effectively preventable through regular screening.
The experience in the prevention and treatment of colorectal cancer in my country and the United States has shown that the detection of precancerous lesions through screening and intervention can reduce the mortality and morbidity of colorectal cancer. For individuals, the earlier it is detected, the higher the cure rate. If precancerous lesions can be detected and intervened effectively, precancerous lesions can be blocked, and colon cancer will not be prevented.
To obtain a radical cure for cancer, it should be detected and treated during asymptomatic healthy period. The use of accurate and effective technical means in the anti-cancer physical examination can not only detect early tumors, but also detect precancerous lesions and carcinoma in situ.
High-risk individuals should be screened for colorectal cancer starting at age 40. According to the recommendations of national guidelines, there are three effective screening methods for the prevention of colon cancer: fecal occult blood detection, multi-target fecal FIT-DNA detection, and colonoscopy.
These three screening methods are also recommended by all current guidelines for colorectal cancer screening and diagnosis and treatment in my country. The difference is that fecal occult blood test and multi-target fecal FIT-DNA test are non-invasive tests, which can be done at home or in the hospital, and do not require bowel preparation; while colonoscopy is an invasive test that requires bowel Prepare. Clinically, it is usually regarded as an effective means for the diagnosis and treatment of colorectal cancer.
According to the results of China’s first prospective large-scale multi-center registration clinical trial for early cancer screening, the sensitivity of multi-target stool FIT-DNA detection for colorectal cancer was 95.5 %; the detection sensitivity for advanced adenoma is 63.5%, which is more than twice that of traditional fecal occult blood detection, which can effectively detect precancerous lesions; the negative predictive value for colorectal cancer is as high as 99.6%, which can minimize the possibility of missed detection . At present, Changweiqing, a colorectal cancer screening product using this technology, has been approved by the State Food and Drug Administration as the “First Certificate of Early Cancer Screening in China”.
Wang Guiqi, a long-term professor at the Cancer Hospital of the Chinese Academy of Medical Sciences/Peking Union Medical College, once pointed out that there are 190 million people in my country who are at high risk for the digestive tract, and the annual supply of gastrointestinal endoscopy is 38 million, a huge gap between supply and demand. However, in clinical practice, the compliance of patients with colonoscopy is relatively poor. If there is a primary screening method to confirm that a patient is indeed a high-risk group, his compliance with colonoscopy will be significantly improved.
The COVID-19 pandemic has led to an unprecedented reduction in colorectal cancer screening and colonoscopy procedures worldwide. Studies have shown that colorectal cancer screening activities in the United States decreased by 85% to 95% during the peak of the epidemic. A 2021 study of Australia, Canada and the Netherlands reported that screening interruptions of up to 12 months due to the COVID-19 pandemic could lead to a relative increase of 0.6%-1.8% in the incidence of colorectal cancer.
A recent review article published in the sub-journal of Nature pointed out that providing non-invasive testing as a screening option can effectively improve screening compliance. The use of non-invasive screening methods to carry out general population screening may become a feasible method to improve the effect of early screening and early diagnosis of colorectal cancer after the new crown epidemic.
（Pan Jiayi）