RT Journal Article
SR Electronic
T1 Long-term effectiveness of faecal immunochemical test screening for proximal and distal colorectal cancers
JF Gut
JO Gut
FD BMJ Publishing Group Ltd and British Society of Gastroenterology
SP gutjnl-2020-322545
DO 10.1136/gutjnl-2020-322545
A1 Han-Mo Chiu
A1 Grace Hsiao-Hsuan Jen
A1 Ying-Wei Wang
A1 Jean Ching-Yuan Fann
A1 Chen-Yang Hsu
A1 Ya-Chung Jeng
A1 Amy Ming-Fang Yen
A1 Sherry Yueh-Hsia Chiu
A1 Sam Li-Sheng Chen
A1 Wen-Feng Hsu
A1 Yi-Chia Lee
A1 Ming-Shiang Wu
A1 Chien-Yuan Wu
A1 Yann-Yuh Jou
A1 Tony Hsiu-Hsi Chen
YR 2021
UL http://gut.bmj.com/content/early/2021/01/24/gutjnl-2020-322545.abstract
AB Objective To measure the effects of faecal immunochemical test (FIT) for colorectal cancer (CRC) screening on overall and site-specific long-term effectiveness of population-based organised service screening.Design A prospective cohort study of Taiwanese nationwide biennial FIT screening was performed. A total of 5 417 699 eligible subjects were invited to attend screening from 2004 through 2009 and were followed up until 2014. We estimated the adjusted relative rates (aRRs) on the effectiveness of reducing advanced-stage CRC (stage II+) and CRC death by Bayesian Poisson regression models with the full adjustment for a cascade of self-selection factors (including the screening rate and the colonoscopy rate) and the completeness of colonoscopy together with demographic features.Results FIT screening (exposed vs unexposed) reduced the incidence of advanced-stage CRC (48.4 vs 75.7 per 100 000) and mortality (20.3 vs 41.3 per 100 000). Statistically significant reductions of both incidence of advanced-stage CRCs (aRR=0.66, 95% CI 0.63 to 0.70) and deaths from CRC (aRR=0.60, 95% CI 0.57 to 0.64) were noted. FIT screening was more effective in reducing distal advanced-stage CRCs (aRR=0.61, 95% CI 0.58 to 0.64) and CRC mortality (aRR=0.56, 95% CI 0.53 to 0.69) than proximal advanced CRCs (aRR=0.84, 95% CI 0.77 to 0.92) and CRC mortality (aRR=0.72, 95% CI 0.66 to 0.80).Conclusion A large-scale population-based biennial FIT screening demonstrates 34% significant reduction of advanced-stage CRCs and 40% reduction of death from CRC with larger long-term effectiveness in the distal colon than the proximal colon. Our findings provide a strong and consistent evidence-based policy for supporting a sustainable population-based FIT organised service screening worldwide. The disparity of site-specific long-term effectiveness also provides an insight into the remedy for lower effectiveness of FIT screening in the proximal colon.