護理師輔導一位有大腸癌家族史的個案。針對此個案，推薦的篩檢指引為何？
A nurse is counseling a client with a family history of colon cancer. What is the recommended screening guideline for this client?
- AFecal occult blood test annually starting at age 50自 50 歲起每年進行糞便潛血檢查
- BBarium enema every 5 years starting at age 45自 45 歲起每五年進行鋇劑灌腸檢查
- CDigital rectal exam every year starting at age 35自 35 歲起每年進行直腸指診
- DColonoscopy starting at age 40 or 10 years before the youngest relative's diagnosis✓ 正解自 40 歲或比最年輕患病親屬確診年齡早 10 歲開始進行大腸鏡檢查
大腸癌篩檢策略取決於個案的風險分級。對於具有大腸癌家族史（特別是一等親）的個案，其罹病風險顯著高於一般族群，因此需採取更積極的預防性檢查。臨床指引建議，若親屬發病年齡較早，應從該親屬確診年齡提早 10 年開始進行大腸鏡檢查，或最晚於 40 歲開始，以利於早期發現腺瘤並切除，阻斷癌變過程。其他篩檢如糞便潛血（FOBT）敏感度不足以篩檢高風險群，鋇劑灌腸或直腸指診並非現行針對高風險族群的首選篩檢標準。
For clients with a family history of colon cancer, particularly first-degree relatives, screening should begin at age 40 or 10 years prior to the youngest relative's diagnosis, whichever comes first. Colonoscopy is the gold standard for high-risk individuals because it allows for both detection and removal of precancerous polyps. Other methods like fecal occult blood testing or barium enemas are less sensitive or not preferred for this population.
美國醫學會（AMA）及美國癌症協會（ACS）對大腸癌篩檢指引極為嚴謹，且強調「大腸鏡（Colonoscopy）」為黃金標準。在台灣，部分健檢中心仍提供鋇劑攝影，但在美國臨床實務中幾乎已由大腸鏡全面取代。