During the COVID-19 pandemic, health systems, including federally qualified health centers (FQHCs), experienced disruptions in colorectal cancer (CRC) screening. National organizations called for greater use of at-home stool-based testing followed by colonoscopy for those with abnormal test results to limit (in-person) colonoscopy exams to people with acute symptoms, or who were high-risk. This ‘stool-test-first’ strategy may also be useful for adults with low-risk adenomas who are due for surveillance colonoscopy. We argue that colonoscopy is overused both as a first-line screening method in low and average risk adults and as a surveillance tool among adults with small adenomas. Yet, simultaneously, many people do not receive much-needed colonoscopies. Delivering the right screening tests at intervals that reduce the risk of CRC, while minimizing patient inconvenience and procedural risks, can strengthen health care systems. Risk stratification could improve efficiency of CRC screening, but because models that adequately predict risk are years away from clinical use, we need to optimize use of currently available technology– that is, low-cost fecal testing followed by colonoscopy for those with abnormal test results. The COVID-19 pandemic highlighted the urgent need to adapt to resource constraints around colonoscopies and showed that increased use of stool-based testing was possible. Learning how to adapt to such constraints without sacrificing patients’ health, particularly for patients who receive care at FQHCs, should be a priority for CRC prevention research.

中文翻译：

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最大限度地利用稀缺的结肠镜检查资源：粪便检测的关键作用

在 COVID-19 大流行期间，包括联邦合格卫生中心 (FQHC) 在内的卫生系统的结直肠癌 (CRC) 筛查受到干扰。国家组织呼吁更多地使用家庭粪便检测，然后对检测结果异常的人进行结肠镜检查，以将（现场）结肠镜检查限制在有急性症状或高风险的人身上。这种“粪便测试优先”的策略对于患有低风险腺瘤、需要进行结肠镜监测的成人也可能有用。我们认为，结肠镜检查被过度用作低风险和中等风险成人的一线筛查方法，以及作为患有小腺瘤的成人的监测工具。然而，与此同时，许多人没有接受急需的结肠镜检查。定期提供正确的筛查测试可以降低结直肠癌的风险，同时最大限度地减少患者的不便和程序风险，可以加强医疗保健系统。风险分层可以提高结直肠癌筛查的效率，但由于充分预测风险的模型距离临床使用还需要数年时间，因此我们需要优化现有技术的使用，即低成本粪便检测，然后对检测结果异常的人进行结肠镜检查。 COVID-19 大流行凸显了适应结肠镜检查资源限制的迫切需要，并表明增加粪便检测的使用是可能的。了解如何在不牺牲患者健康的情况下适应这些限制，尤其是在 FQHC 接受护理的患者，应该成为 CRC 预防研究的首要任务。