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English英语译成Chinese汉语: Colorectal cancer screening reduces incidence, mortality and morbidity General field: 医学 Detailed field: 医疗（总称）
原文文本 - English英语 Colorectal cancer (CRC) is the second most commonly diagnosed cancer in Australia in both men and women; there were about 17 000 new cases and more than 4000 deaths during 2017. It imposes a tremendous burden of disease, dominated by mortality rather than disability; in the 2011 Australian Burden of Disease Study, almost 86 000 years of life were lost because of CRC. The disorder is also a substantial economic burden; it costs more than $100 000 to treat one case of advanced CRC.
CRC is one of the few cancers for which screening has reduced the incidence. The long adenoma-to-carcinoma sequence allows endoscopic polypectomy of pre-cancerous polyps, substantially reducing the risk for individuals in whom they are detected. In Australia, the National Bowel Cancer Screening Program (NBCSP) targets those at population or average risk of CRC, and employs the immunochemical faecal occult blood test for screening. The program has proved effective, reducing predicted CRC mortality by 15%, and earlier diagnostic staging has reduced morbidity. Although participation in the program is rising, the rate remains disappointingly low, with only 39% of eligible Australians participating in 2016. Participation is even lower in rural and remote areas (as low as 27% in very remote areas) and among people from low socio-economic backgrounds (37%).
Barriers to CRC screening are multifactorial and often have both patient- and health care provider-related elements, including level of health literacy, cultural and religious beliefs, logistic factors (eg, language, scheduling, transport), private health insurance coverage, recommendations by primary health care providers, and the availability of health care resources, including access to colonoscopy services. Identifying and overcoming these barriers is challenging, but necessary for optimising access to CRC screening.
The adoption of evidence-based colonoscopy surveillance guidelines is another area of great importance. Application of national surveillance colonoscopy guidelines for patients at higher risk of CRC (eg, those with a history of adenomas or a strong family history of CRC) has been consistently suboptimal and, in some cases, astonishingly poor. Many surveillance colonoscopies are either performed too early or are delayed, causing harm; the former exposes the patient to unnecessary procedural risks and depletes limited health care resources, while the latter is associated with an increased risk of advanced adenoma and CRC.
翻译文本 - Chinese汉语 在澳大利亚，结直肠癌（Colorectal cancer, 简称CRC）是男性和女性第二大常见癌症。2017年，新发病例约为1.7万例，死亡人数超过4000人。结直肠癌带来巨大的疾病负担，其主要损失不是残疾，而是死亡。《2011澳大利亚疾病负担研究》（2011 Australian Burden of Disease Study）显示，因结直肠癌造成健康生命年的损失近8.6万年。该疾病还带来沉重的经济负担，一名晚期结直肠癌患者的治疗费用超过10万澳元。
只有少数癌症可以通过筛查来减少发病率，这其中就有结直肠癌。从腺瘤发展到腺癌要很长时间，因而有时间采用内窥镜息肉切除术来切除癌前病变息肉，大大降低患者息肉癌变的风险。在澳大利亚，全国肠癌筛查计划（National Bowel Cancer Screening Program, 简称NBCSP）针对具有结直肠癌发病一般风险的人群进行免疫化学法粪便隐血检测。该筛查计划经证实有效，结直肠癌的预计死亡率降低15%，并且通过开展早期诊断，患病率已经降低。虽然参与筛查计划的人数正在增加，但是参与率仍然低得令人失望 — 2016年在符合检查资格的澳大利亚人中只有39%的人接受了检测。农村和偏远地区人群的参与率甚至更低（特别偏远地区低至27%）， 社会经济背景处于劣势的人群参与率也不高（37%）。
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