Consensus on the Prevention, Screening, Early Diagnosis and Treatment of Colorectal Tumors in China: Chinese Society of Gastroenterology, October 14-15, 2011, Shanghai, China

Abstract

Background: Colorectal cancer (CRC) is steadily increasing in China. Colorectal adenoma (CRA) is the most important precancerous disease of CRC. Screening for colorectal tumors can aid early diagnosis. Advances in endoscopic mucosal resection and endoscopic submucosal dissection can aid the early treatment of colorectal tumors. Furthermore, because of high risk of recurrence after removal of adenomas under endoscopy, factors contributing to recurrence, the follow-up mode and the interval established, and the feasibility of application and the time of various chemical preventions should be concerned. However, a relevant consensus on the screening, early diagnosis and treatment, and prevention of colorectal tumors in China is lacking. Summary: The consensus recommendations include epidemiology, pathology, screening, early diagnosis, endoscopic treatment, monitoring and follow-up, and chemoprevention of colorectal tumors in China. Key Message: This is the first consensus on the prevention, screening, early diagnosis and treatment of CRA and CRC in China based on evidence in the literature and on local data. Practical Implications: Through reviewing the literature, regional data and passing the consensus by an anonymous vote, gastroenterology experts from all over China launch the consensus recommendations in Shanghai. The incidence and mortality of CRC in China has increased, and the incidence or detection rate of CRA has increased rapidly. Screening for colorectal tumors should be performed at age 50-74 years. Preliminary screening should be undertaken to find persons at high risk, followed by colonoscopy. A screening cycle of 3 years is recommended for persistent interventions. Opportunistic screening is a mode suitable for the current healthcare system and national situation. Colonoscopy combined with pathological examination is the standard method for the diagnosis of colorectal tumors. CRA removal under endoscopy can prevent CRC to some extent, but CRA has an obvious recurrence trend. The follow-up interval after the removal or surgery of colorectal tumors should be different with lesions. Primary prevention of CRA includes improved diet with more fiber, supplements containing calcium and vitamin D, supplements containing folic acid for those with low hemoglobin levels, and cessation of tobacco smoking. Non-steroidal anti-inflammatory drugs and selective cyclooxygenase-2 inhibitors have been recognized to prevent recurrence after adenoma removal.

Effects of age, sex and pathological type on the risk of multiple polyps: A Chinese teaching hospital study

“…A scientific team from Oakland estimated that the increase in number with age was similar for both men and women, with prevalence rising across all 5‐year age categories, reaching a peak at 70‐74 years of age. A 2011 study reported that the highest incidence of colorectal tumors in the age range of 75‐80 years 22 . Our findings not only support the current Chinese consensus, but also suggest that colonoscopists should focus on elderly patients with multiple polyps who may be at risk of CRC.…”

Chinese consensus on the prevention of colorectal cancer (2016, Shanghai)

“…This consensus was developed on the basis of the ‘comprehensive prevention’ paragraph set forth in the Chinese consensus on screening, early diagnosis, early therapy, and prevention of colorectal cancer issued by the Chinese Society of Gastroenterology, CMA, in October 2011, as well as the progress in relevant international and domestic research achieved over the past 5 years. The Chinese Consensus on the Prevention of Colorectal Cancer (2016, Shanghai) conference was held on 8 May 2016 in Shanghai, hosted by the Chinese Society of Gastroenterology, CMA and its Committee on Gastrointestinal Tumors, and organized by the Division of Gastroenterology and Hepatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University and the Shanghai Institute of Digestive Disease.…”

“…Most of the clinical intervention studies on NSAIDs such as aspirin and COX‐2 inhibitors did not categorize whether it was for primary (prevention of initial development of adenoma) or secondary prevention (prevention of recurrence after adenoma resection) . However, clinical trials and epidemiological studies suggested that regular administration of aspirin could reduce the recurrence of adenoma and decrease the incidence and mortality of colorectal neoplasms …”

Colorectal cancer, screening: achievements и opportunities

“…Оценка тенденций заболеваемости и смертности позволила выявить снижение данных параметров в более развитых странах (США и Японии) за счет внедрения программ скрининга и раннего обнаружения КРР, реализуемых с 1990-х годов) [1]. В настоящее время скрининговые программы приняты и широко используются различными обществами [2][3][4][5][6][7][8][9][10][11].…”

“…Идея быстро привлекла внимание ученых по всему миру. На данный момент gFOBT является самым распространенным скрининговым тестом в мире, он широко используется в ряде европейских стран [3, 4], Канаде [5], США [6][7][8], Австралии, Китае и Японии [11]. В РФ тест использовался для диспансеризации населения до 2018 г.…”