IACCS — Chapter III

Why this matters

普篩有效 ── 但每個人真的都該兩年一次嗎? Universal screening works — but does everyone really need it every two years?

第二展廳結尾,我們看到全民兩年一次的 FIT 篩檢已經把大腸癌死亡率降低 40%。但隨著計畫成熟、人口老化,大腸鏡需求逐年上升,醫療量能開始吃緊 ── 每個人,真的都該兩年一次嗎?

如果第一展廳告訴我們「f-Hb 是一條連續的風險軌跡」, 那麼這條軌跡上,每個人應該得到不同的篩檢節奏。

在台灣的篩檢資料上,陳秀熙教授團隊把這個想法拆成三層,各自有對應的研究支持。

Chapter Two showed that universal screening every two years cut colorectal cancer deaths by 40%. But as the program matures and the population ages, colonoscopy demand keeps rising — does everyone really need to be screened every two years?

If Chapter One taught us that f-Hb is a continuous risk trajectory, then it follows that different people should get different screening rhythms.

Using Taiwan's screening data, Professor Chen's team breaks this idea into three layers — each with its own evidence.

Featured Exhibit

三層精準化 ── 從首次篩檢到大腸鏡後追蹤 Three Layers of Precision — From First Screen to Post-Colonoscopy

VIDEO

點擊觀看影片 Watch the film

敘事影片 · 第三集 Narrative · Episode 3 Yen 2024 · Chuang 2026

The Architecture

三層精準化的架構 The Architecture of Precision

I

First Screen · Risk-based

首次篩檢:依基線 f-Hb 訂間隔 First Screen: Baseline-Driven Interval

第一次參與 FIT 篩檢時,以基線 f-Hb 數值決定下次的間隔。風險越低,間隔越長;風險越高,介入越緊。至於 FIT 陽性但未去做大腸鏡的人,則以較密集的 FIT 間隔持續追蹤。 On a person's first FIT, the baseline f-Hb value defines the next interval. Lower risk → longer wait. Higher risk → tighter follow-up. For those who test FIT-positive but do not proceed to colonoscopy (non-referral), a tighter FIT interval is used for continued monitoring.

Yen et al. · JAMA Oncology · 2024

f-Hb (μg/g) → Interval

< 105 yr
10–144 yr
15–193 yr
20–492 yr^†
50–991 yr^†
100–1491 yr^†
≥ 1500.5 yr

† FIT 陽性但未轉介大腸鏡者 † FIT-positive but non-referral to colonoscopy

II

Subsequent Screen · Adaptive

後續篩檢:依動態 f-Hb 調整 Subsequent Screen: Adaptive Interval

同一個人,這次的 f-Hb 變了,間隔也跟著變。把每一次檢驗都當作風險訊號的更新。 For the same person, when this round's f-Hb changes, the interval adapts. Each test becomes a fresh risk update.

Yen et al. · JAMA Oncology · 2024

Updated f-Hb → Interval

< 106 yr
10–143 yr
15–192 yr
20–4910 yr
50–995 yr
100–1491 yr
≥ 1500.5 yr

III

Post-Colonoscopy · Surveillance

大腸鏡後追蹤:結合腺瘤風險與 f-Hb Post-Colonoscopy: Adenoma Risk × f-Hb

大腸鏡後切除過息肉的人,把息肉本身的風險(低/高)和後續 f-Hb 兩個維度結合,訂出個人化的下次大腸鏡時間。 After a polyp is removed by colonoscopy, the next surveillance interval combines two things: the polyp's own risk (low or high) and the person's subsequent f-Hb.

Chuang et al. · Gastroenterology · 2026

f-Hb · Low vs High Risk

20–4910 / 3 yr
50–999 / 3 yr
100–1497 / 3 yr
150–2497 / 2 yr
250–4496 / 2 yr
≥ 4506 / 2 yr

The Impact

三層精準化,各自的成果 Three Layers, Three Wins

每一層精準化,都在減量。把三層加起來,就是台灣未來篩檢量能能否持續的關鍵。 Each layer reduces something. Together, they decide whether Taiwan's screening capacity can keep up.

Layer I + II

↓ 49%

FIT 檢驗次數減少近一半 ── 同樣的偵測效益,民眾少做一半的篩檢。 FIT tests nearly halved — same detection, half the screening burden.

Yen et al. · JAMA Oncology · 2024

Layer I + II

↓ 28%

大腸鏡需求減少近三成 ── 醫療量能直接得到釋放。 Colonoscopy demand down by nearly a third — direct capacity relief.

Yen et al. · JAMA Oncology · 2024

Layer III

↓ 9.8%

追蹤大腸鏡再省近一成 ── 大腸鏡後的追蹤也能更精準。 Surveillance colonoscopies reduced by nearly 10% — post-colonoscopy follow-up made smarter too.

Chuang et al. · Gastroenterology · 2026

三層精準化、三個數字,做的是同一件事:用更聰明的節奏,把量能留給真正需要的人。 Three layers, three numbers — all doing the same thing: a smarter rhythm that saves capacity for those who need it most.

— The Takeaway —

普篩拯救生命。
精準篩檢讓量能可以持續。

下一個時代,屬於兩者的結合。 Universal screening saves lives.
Precision screening makes it sustainable.

The next era belongs to both.

進入精準時代篩檢 2.0 Entering the Precision EraScreening 2.0

普篩有效 ── 但每個人真的都該兩年一次嗎? Universal screening works — but does everyone really need it every two years?

三層精準化 ── 從首次篩檢到大腸鏡後追蹤 Three Layers of Precision — From First Screen to Post-Colonoscopy

三層精準化的架構 The Architecture of Precision

首次篩檢:依基線 f-Hb 訂間隔 First Screen: Baseline-Driven Interval

後續篩檢:依動態 f-Hb 調整 Subsequent Screen: Adaptive Interval

大腸鏡後追蹤:結合腺瘤風險與 f-Hb Post-Colonoscopy: Adenoma Risk × f-Hb

三層精準化,各自的成果 Three Layers, Three Wins

進入精準時代
篩檢 2.0 Entering the Precision Era
Screening 2.0