Проблемы и перспективы скрининга колоректального рака

Abstract

Colorectal cancer (CRC) is a widespread malignancy that is asymptomatic in the early stages, and late diagnosis is associated with poor outcome. Several levels of CRC risk exist. Thus, 80% of CRCs are sporadic (medium risk), and the rate of their detection increases with age, in particular, after 50 years. 15% of CRCs are caused by familial predisposition or pre-existing colon disease (high risk). 5% of CRCs are associated with genetic diseases (very high risk). Methods for preventing CRC are tailored to these levels of risk. If a patient is classified as having high or very high risk, colonoscopy is the first-line choice depending on the level of risk and age. In very high risk, patients are also referred for genetic counseling. Medium-risk patients are the target group for an organized CRC screening program. Regular screening identifies the disease even at the precancer stage. Noninvasive screening tests for CRC detect blood in the stool. These include stool guaiac test and fecal immunochemical tests. Colonoscopy is the "gold standard" for CRC screening. In addition to colonoscopy, flexible sigmoidoscopy is used for CRC screening. In recent years, molecular genetic tests to identify CRC biomarkers, computed tomography colonography, magnetic resonance colonography, and colon capsule endoscopy have emerged. This paper reviews current issues of CRC screening, i.e., age and gender structure of risk groups, the rate and algorithms used in different countries for CRC early detection, and ways to improve screening efficacy, including artificial intelligence technologies. KEYWORDS: colorectal cancer, age, screening, methods, algorithms, artificial intelligence. FOR CITATION: Radygina L.V., Mochalova L.V. Challenges and prospects of colorectal cancer screening. Russian Medical Inquiry. 2023;7(6):359–365 (in Russ.). DOI: 10.32364/2587-6821-2023-7-6-4.