背景:英国国家肠癌筛查计划于2006年7月开始提供愈创木脂粪便潜血测试。在愈创木胶粪便隐血试验筛选的随机对照试验中,死亡率的降低伴随着晚期结直肠癌(CRC)的降低.我们旨在评估参与国家肠癌筛查计划对特定阶段CRC发病率的影响,这可能是死亡率影响的前兆。
方法:在这项基于人群的病例对照研究中,病例为2012年1月1日至2013年12月31日期间诊断为60-79岁CRC的个体.每个病例在地理区域匹配两个对照,性别,出生日期,和第一次放映邀请的年份。从筛选数据库中提取筛选历史。使用具有自我选择偏差校正的条件逻辑回归来估计杜克阶段的赔率比(针对自我选择偏差校正的赔率比[cOR])和95%置信区间(CI),性别,和年龄。
结果:14636例CRC患者和29036例无CRC患者符合分析条件。CRC(任何阶段)的几率在筛选测试的30天内增加,此后降低。与未筛查的个体相比,未观察到筛查个体中CRC(任何阶段)的减少(cOR=1.00,95%CI=0.89至1.15)。然而,筛选出的个体患Duke期D期CRC的几率较低(cOR=0.68,95%CI=0.50~0.93).我们估计,与未筛查的队列相比,每两年在60至74岁之间进行筛查的100,000人中,80岁的DukeDCRC减少了435。
结论:结直肠筛查对晚期CRC发病率的影响表明,该计划将实现其降低死亡率的目标。
BACKGROUND: The English national bowel cancer screening program offering a guaiac fecal occult blood test began in July 2006. In randomized controlled trials of guaiac fecal occult blood test screening, reductions in mortality were accompanied by reductions in advanced stage colorectal cancer (CRC). We aimed to evaluate the effect of participation in the national bowel cancer screening program on stage-specific CRC incidence as a likely precursor of a mortality effect.
METHODS: In this population-based
case-control study, cases were individuals diagnosed with CRC aged 60-79 years between January 1, 2012, and December 31, 2013. Two controls per
case were matched on geographic region, gender, date of birth, and year of first screening invitation. Screening histories were extracted from the screening database. Conditional logistic regression with correction for self-selection bias was used to estimate odds ratios (odds ratios corrected for self-selection bias [cOR]) and 95% confidence intervals (CIs) by Duke stage, sex, and age.
RESULTS: 14 636 individuals with CRC and 29 036 without were eligible for analysis. The odds of CRC (any stage) were increased within 30 days of a screening test and decreased thereafter. No reduction in CRC (any stage) among screened individuals compared with those not screened was observed (cOR = 1.00, 95% CI = 0.89 to 1.15). However, screened individuals had lower odds of Duke stage D CRC (cOR = 0.68, 95% CI = 0.50 to 0.93). We estimate 435 fewer Duke D CRC by age 80 years in 100 000 people screened biennially between ages 60 and 74 years compared with an unscreened cohort.
CONCLUSIONS: The impact of colorectal screening on advanced CRC incidence suggests that the program will meet its aim of reducing mortality.