Long-term effectiveness of faecal immunochemical test screening for proximal and distal colorectal cancers

Han Mo Chiu; Grace Hsiao Hsuan Jen; Ying Wei Wang; Jean Ching Yuan Fann; Chen Yang Hsu; Ya Chung Jeng; Amy Ming Fang Yen; Sherry Yueh Hsia Chiu; Sam Li Sheng Chen; Wen Feng Hsu; Yi Chia Lee; Ming Shiang Wu; Chien Yuan Wu; Yann Yuh Jou; Tony Hsiu Hsi Chen

doi:10.1136/gutjnl-2020-322545

Long-term effectiveness of faecal immunochemical test screening for proximal and distal colorectal cancers

Han Mo Chiu, Grace Hsiao Hsuan Jen, Ying Wei Wang, Jean Ching Yuan Fann, Chen Yang Hsu, Ya Chung Jeng, Amy Ming Fang Yen, Sherry Yueh Hsia Chiu, Sam Li Sheng Chen, Wen Feng Hsu, Yi Chia Lee, Ming Shiang Wu, Chien Yuan Wu, Yann Yuh Jou, Tony Hsiu Hsi Chen^*

^*Corresponding author for this work

Research output: Contribution to journal › Journal Article › peer-review

53 Scopus citations

Abstract

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.

Original language	English
Pages (from-to)	2321-2329
Number of pages	9
Journal	Gut
Volume	70
Issue number	12
DOIs	https://doi.org/10.1136/gutjnl-2020-322545
State	Published - 01 12 2021
Externally published	Yes

Bibliographical note

Publisher Copyright:
© 2021 Author(s) (or their employer(s)).

Keywords

cancer epidemiology
cancer prevention
colorectal cancer screening

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1136/gutjnl-2020-322545

Cite this

Chiu, H. M., Jen, G. H. H., Wang, Y. W., Fann, J. C. Y., Hsu, C. Y., Jeng, Y. C., Yen, A. M. F., Chiu, S. Y. H., Chen, S. L. S., Hsu, W. F., Lee, Y. C., Wu, M. S., Wu, C. Y., Jou, Y. Y., & Chen, T. H. H. (2021). Long-term effectiveness of faecal immunochemical test screening for proximal and distal colorectal cancers. Gut, 70(12), 2321-2329. https://doi.org/10.1136/gutjnl-2020-322545

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title = "Long-term effectiveness of faecal immunochemical test screening for proximal and distal colorectal cancers",

abstract = "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.",

keywords = "cancer epidemiology, cancer prevention, colorectal cancer screening",

author = "Chiu, {Han Mo} and Jen, {Grace Hsiao Hsuan} and Wang, {Ying Wei} and Fann, {Jean Ching Yuan} and Hsu, {Chen Yang} and Jeng, {Ya Chung} and Yen, {Amy Ming Fang} and Chiu, {Sherry Yueh Hsia} and Chen, {Sam Li Sheng} and Hsu, {Wen Feng} and Lee, {Yi Chia} and Wu, {Ming Shiang} and Wu, {Chien Yuan} and Jou, {Yann Yuh} and Chen, {Tony Hsiu Hsi}",

note = "Publisher Copyright: {\textcopyright} 2021 Author(s) (or their employer(s)).",

year = "2021",

month = dec,

day = "1",

doi = "10.1136/gutjnl-2020-322545",

language = "英语",

volume = "70",

pages = "2321--2329",

journal = "Gut",

issn = "0017-5749",

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TY - JOUR

T1 - Long-term effectiveness of faecal immunochemical test screening for proximal and distal colorectal cancers

AU - Chiu, Han Mo

AU - Jen, Grace Hsiao Hsuan

AU - Wang, Ying Wei

AU - Fann, Jean Ching Yuan

AU - Hsu, Chen Yang

AU - Jeng, Ya Chung

AU - Yen, Amy Ming Fang

AU - Chiu, Sherry Yueh Hsia

AU - Chen, Sam Li Sheng

AU - Hsu, Wen Feng

AU - Lee, Yi Chia

AU - Wu, Ming Shiang

AU - Wu, Chien Yuan

AU - Jou, Yann Yuh

AU - Chen, Tony Hsiu Hsi

PY - 2021/12/1

Y1 - 2021/12/1

N2 - 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.

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.

KW - cancer epidemiology

KW - cancer prevention

KW - colorectal cancer screening

UR - http://www.scopus.com/inward/record.url?scp=85100191017&partnerID=8YFLogxK

U2 - 10.1136/gutjnl-2020-322545

DO - 10.1136/gutjnl-2020-322545

M3 - 文章

C2 - 33495268

AN - SCOPUS:85100191017

SN - 0017-5749

VL - 70

SP - 2321

EP - 2329

JO - Gut

JF - Gut

IS - 12

ER -

Long-term effectiveness of faecal immunochemical test screening for proximal and distal colorectal cancers

Abstract

Bibliographical note

Keywords

UN SDGs

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