ORGANIZATIONAL BASICS OF SCREENING FOR COLORECTAL CANCER IN WORLD MEDICAL PRACTICE. LITERATURE REVIEW
Actuality Colorectal cancer (CRC) tacked the third place in worldwide common cancer. The revealing of CRC on premalignant, latent and curable stages is important method of decrease of mortality. CRC screening can use direct or indirect tests, delivered opportunistically or via organized programs. Most CRCs are diagnosed after 60 years of age; most screening programs apply to individuals 50-75 years of age.
The purpose of the review is to analyze the approaches and results of screening of colorectal cancer in the world medical practice in order to formulate recommendations for domestic health care.
Search strategy The search for literary sources was carried out in the Medline and Cochrane Register of Controlled Studies using the following keywords / combinations: "This test is carried out on the basis of the blood test (gFOBT), faecal haemoglobin immunochemical test (FIT), flexible sigmoidoscopy (FS), CT colonography (CTC), DNA-marker and video capsule endoscopy. ” The search depth was 20 years from 2000 to 2019. The review includes data from meta-analyzes and randomized clinical studies conducted and published over the period 2000-2019. Data of studies of evidence less than B class is excluded.
Results Screening may reduce disease-specific mortality by detecting CRC in earlier stages, and CRC incidence by detecting premalignant polyps, which can subsequently be removed. In randomized controlled trials (RCTs) guaiac fecal occult blood testing (gFOBt) was found to reduce CRC mortality by 13%-33%. Fecal immunochemical testing (FIT) has no RCT data comparing it to no screening, but is superior to gFOBt. Flexible sigmoidoscopy (FS) trials demonstrated an 18% reduction in CRC incidence and a 28% reduction in CRC mortality. Currently, RCT evidence for colonoscopy screening is scarce. Although not yet corroborated by RCTs, it is likely that colonoscopy is the best screening modality for an individual. From a population perspective, organized programs are superior to opportunistic screening. Thus, organized programs using cheaper modalities, such as FS/FIT, can be tailored to budget and capacity.
Conclusion The screening of colorectal cancer in Kazakhstan should take more account of the monitoring of the current resources of the health care system and be based on a staged screening.
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Жолмурзаева Р.С. Организационные основы скрининга колоректального рака в мировой медицинской практике. Обзор литературы // Наука и Здравоохранение. 2019. 2 (Т.21). С. 13-24. Zholmurzaeva R.S. Organizational basics of screening for colorectal cancer in world medical practice. Literature review. Nauka i Zdravookhranenie [Science & Healthcare]. 2019, (Vol.21) 2, pp. 13-24. Жолмурзаева Р.С. Дүниежүзілік медициналық практикадағы колоректалды обыр скринингінің ұйымдастырушылық негіздері. Әдебиеттік шолу // Ғылым және Денсаулық сақтау. 2019. 2 (Т.21). Б. 13-24.Related publications:
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