■粪便免疫化学测试(FIT)广泛用于结直肠癌(CRC)筛查,但其有效性的证据有限。
■为了评估FIT筛查是否与降低CRC总体死亡风险相关,根据癌症的位置,在人口群体中。
■这项巢式病例对照研究是在2个大型人群中进行的,种族综合卫生系统,种族,以及具有长期邮寄FIT筛查外展计划的社会经济多样性成员。符合条件的参与者包括在2011年至2017年期间死于结直肠腺癌的52至85岁的人(病例);病例根据年龄以1:8的比例匹配,性别,健康计划会员期限,和地理区域,随机选择在病例诊断日期时存活且无CRC的人(对照)。数据分析时间为2002年1月至2017年12月。
■在病例中的CRC诊断日期或对照组中的相应日期之前的5年内完成1次或更多次FIT筛查;在二次分析中,评估2至10年的间隔。
■主要研究结果是CRC总体死亡和肿瘤位置。进行二次分析以按种族和种族评估CRC死亡。
■从2127128人的队列中,共有10711名参与者(3529名60-69岁[32.9%];5587名男性[52.1%]和5124名女性[47.8%];1254名非西班牙裔亚洲人[11.7%];973名非西班牙裔黑人[9.1%];1929名西班牙裔或拉丁裔[18.0%];6345名非西班牙裔白人[59.2%])被确认,包括1103例和9608例控制。在参考日期之前的10年期间的控制中,6101(63.5%)完成1个或多个FIT,累计阳性率为12.6%(768个对照),其中610人(79.4%)在1年内进行了结肠镜检查。在5年期间,494例(44.8%)和5345例(55.6%)对照完成1个或多个FIT。在回归分析中,完成1次或更多次FIT筛查与CRC死亡风险降低33%相关(调整后比值比[aOR],0.67;95%CI,0.59-0.76),左结肠和直肠风险降低42%(aOR,0.58;95%CI,0.48-0.71)。与右结肠癌无关(aOR,0.83;95%CI,0.69-1.01),但右半结肠与左半结肠或直肠之间的估计值差异具有统计学意义(P=0.01)。FIT筛查与非西班牙裔亚洲人中较低的CRC死亡率风险相关(aOR,0.37;95%CI,0.23-0.59),非西班牙裔黑人(AOR,0.58;95%CI,0.39-0.85)和非西班牙裔白人个体(aOR,0.70;95%CI,0.57-0.86)(同质性P=0.04同质性)。
■在这项嵌套病例对照研究中,完成FIT与CRC总体死亡风险较低相关,特别是在左结肠,这些协会是在种族和族裔群体中观察到的。这些发现支持FIT在基于人群的筛查策略中的使用。
UNASSIGNED: The fecal immunochemical test (FIT) is widely used for colorectal cancer (CRC) screening, but evidence of its effectiveness is limited.
UNASSIGNED: To evaluate whether FIT screening is associated with a lower risk of dying from CRC overall, according to cancer location, and within demographic groups.
UNASSIGNED: This nested case-control study in a cohort of screening-eligible people was conducted in 2 large, integrated health systems of racially, ethnically, and socioeconomically diverse members with long-term programs of mailed FIT screening outreach. Eligible participants included people aged 52 to 85 years who died from colorectal adenocarcinoma between 2011 and 2017 (cases); cases were matched in a 1:8 ratio based on age, sex, health-plan membership duration, and geographic area to randomly selected persons who were alive and CRC-free on case\'s diagnosis date (controls). Data analysis was conducted from January 2002 to December 2017.
UNASSIGNED: Completing 1 or more FIT screenings in the 5-year period prior to the CRC diagnosis date among cases or the corresponding date among controls; in secondary analyses, 2- to 10-year intervals were evaluated.
UNASSIGNED: The primary study outcome was CRC death overall and by tumor location. Secondary analyses were performed to assess CRC death by race and ethnicity.
UNASSIGNED: From a cohort of 2 127 128 people, a total of 10 711 participants (3529 aged 60-69 years [32.9%]; 5587 male [52.1%] and 5124 female [47.8%]; 1254 non-Hispanic Asian [11.7%]; 973 non-Hispanic Black [9.1%]; 1929 Hispanic or Latino [18.0%]; 6345 non-Hispanic White [59.2%]) was identified, including 1103 cases and 9608 controls. Among controls during the 10-year period prior to the reference date, 6101 (63.5%) completed 1 or more FITs with a cumulative 12.6% positivity rate (768 controls), of whom 610 (79.4%) had a colonoscopy within 1 year. During the 5-year period, 494 cases (44.8%) and 5345 controls (55.6%) completed 1 or more FITs. In regression analysis, completing 1 or more FIT screening was associated with a 33% lower risk of death from CRC (adjusted odds ratio [aOR], 0.67; 95% CI, 0.59-0.76) and 42% lower risk in the left colon and rectum (aOR, 0.58; 95% CI, 0.48-0.71). There was no association with right colon cancers (aOR, 0.83; 95% CI, 0.69-1.01) but the difference in the estimates between the right colon and left colon or rectum was statistically significant (P = .01). FIT screening was associated with lower CRC mortality risk among non-Hispanic Asian (aOR, 0.37; 95% CI, 0.23-0.59), non-Hispanic Black (aOR, 0.58; 95% CI, 0.39-0.85) and non-Hispanic White individuals (aOR, 0.70; 95% CI, 0.57-0.86) (P for homogeneity = .04 for homogeneity).
UNASSIGNED: In this nested case-control study, completing FIT was associated with a lower risk of overall death from CRC, particularly in the left colon, and the associations were observed across racial and ethnic groups. These findings support the use of FIT in population-based screening strategies.