護理師與一位 45 歲、無症狀、癌症平均風險的男性病人討論預防性健康篩檢。依美國癌症協會（ACS）指引，護理師應建議病人從這個年齡開始哪一項癌症篩檢？
A nurse is discussing preventive health screening with a 45-year-old male client who has no symptoms and is at average risk for cancer. According to American Cancer Society (ACS) guidelines, which cancer screening should the nurse recommend that the client begin at this age?
- AAnnual low-dose CT scan of the chest to screen for lung cancer每年以低劑量胸部電腦斷層篩檢肺癌
- BProstate-specific antigen (PSA) blood test to screen for prostate cancer以攝護腺特異性抗原（PSA）血液檢測篩檢攝護腺癌
- CColorectal cancer screening with a stool-based test or a visual examination such as colonoscopy以糞便檢測，或大腸鏡等影像／內視鏡檢查篩檢大腸直腸癌正確答案
- DAnnual abdominal ultrasound of the liver to screen for hepatocellular carcinoma每年以腹部超音波篩檢肝細胞癌
- C以糞便檢測，或大腸鏡等影像／內視鏡檢查篩檢大腸直腸癌
正確答案是 C。美國癌症協會（ACS）2018 年大腸直腸癌篩檢指引建議：平均風險成人自 45 歲起開始定期篩檢，可依病人偏好與可近性選擇糞便檢測（每年 FIT 或高敏感度 gFOBT、每 3 年多標的糞便 DNA 檢測）或影像／內視鏡檢查（每 10 年大腸鏡、每 5 年電腦斷層大腸攝影或軟式乙狀結腸鏡）；任何非大腸鏡檢查若為陽性都必須接著做大腸鏡。指引並未把大腸鏡列為優於其他合格方式，最好的檢查是病人願意完成的那一種。A：ACS 肺癌篩檢限 50–80 歲、吸菸史 ≥20 包-年且目前吸菸或曾吸菸者，本病人 45 歲且題幹未提吸菸史。B：ACS 建議平均風險男性 50 歲起才與醫療提供者共同決策是否做 PSA 檢測，高風險者 45 歲。D：ACS 對平均風險成人沒有肝癌常規篩檢建議，僅 B 型或 C 型肝炎、肝硬化等高風險族群依肝病指引監測。來源：American Cancer Society, Colorectal Cancer Screening Guideline（Wolf et al., 2018）；ACS Lung Cancer Screening Guideline（2023）；ACS Recommendations for Prostate Cancer Early Detection。
- A每年以低劑量胸部電腦斷層篩檢肺癌
錯誤。ACS 肺癌篩檢只建議 50–80 歲、吸菸史 ≥20 包-年且目前或曾經吸菸者，本病人 45 歲且無吸菸史描述，不符合條件。
- B以攝護腺特異性抗原（PSA）血液檢測篩檢攝護腺癌
錯誤。ACS 建議平均風險男性 50 歲起才與醫療提供者討論是否做 PSA 檢測，高風險者才從 45 歲開始，不是本病人此時的常規篩檢。
- C · 正確答案以糞便檢測，或大腸鏡等影像／內視鏡檢查篩檢大腸直腸癌
正確。ACS 建議平均風險成人 45 歲起開始大腸直腸癌篩檢，糞便檢測或大腸鏡等影像／內視鏡檢查都是合格方式，選擇病人願意完成的那一種。
- D每年以腹部超音波篩檢肝細胞癌
錯誤。ACS 對平均風險成人沒有肝癌常規篩檢建議；只有 B 型或 C 型肝炎、肝硬化等高風險族群才依肝病指引以超音波監測。
美國 ACS 自 2018 年起建議 45 歲開始大腸直腸癌篩檢，保險多有給付；台灣國民健康署自 2025 年 1 月起也將公費糞便潛血檢查從 50–74 歲擴大為 45–74 歲每 2 年一次，40–44 歲有一等親家族史者亦可受檢。兩地起始年齡已一致，但台灣公費以糞便免疫化學檢測為主，大腸鏡多為陽性後的確診檢查。
English explanation
Option C is correct. The 2018 American Cancer Society colorectal cancer screening guideline recommends that adults at average risk begin regular screening at age 45, choosing according to preference and access either a stool-based test (annual FIT or high-sensitivity gFOBT, or a multitarget stool DNA test every 3 years) or a visual examination (colonoscopy every 10 years, CT colonography every 5 years, or flexible sigmoidoscopy every 5 years). Any positive non-colonoscopy test must be followed by colonoscopy. The guideline does not rank colonoscopy above the other acceptable tests; the best test is the one the client will complete. Option A is incorrect because ACS lung cancer screening applies to adults aged 50 to 80 with a 20 pack-year or greater smoking history who currently smoke or formerly smoked; this client is 45 and no smoking history is described. Option B is incorrect because the ACS recommends that men at average risk begin a shared decision-making discussion about PSA testing at age 50, or at 45 only if at high risk. Option D is incorrect because the ACS has no routine liver cancer screening recommendation for average-risk adults; only high-risk groups such as people with hepatitis B or C or cirrhosis are monitored under liver disease guidelines. Source: American Cancer Society, Colorectal Cancer Screening Guideline (Wolf et al., 2018); ACS Lung Cancer Screening Guideline (2023); ACS Recommendations for Prostate Cancer Early Detection.