Long-term effectiveness of faecal immunochemical test screening for proximal and distal colorectal cancers. Chiu, H., Jen, G. H., Wang, Y., Fann, J. C., Hsu, C., Jeng, Y., Yen, A. M., Chiu, S. Y., Chen, S. L., Hsu, W., Lee, Y., Wu, M., Wu, C., Jou, Y., & Chen, T. H. Gut, January, 2021. Publisher: BMJ Publishing Group Section: GI cancer
Long-term effectiveness of faecal immunochemical test screening for proximal and distal colorectal cancers [link]Paper  doi  abstract   bibtex   
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.
@article{chiu_long-term_2021,
	title = {Long-term effectiveness of faecal immunochemical test screening for proximal and distal colorectal cancers},
	copyright = {© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.. http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.},
	issn = {0017-5749, 1468-3288},
	url = {https://gut.bmj.com/content/early/2021/01/24/gutjnl-2020-322545},
	doi = {10.1136/gutjnl-2020-322545},
	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.},
	language = {en},
	urldate = {2021-03-24},
	journal = {Gut},
	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},
	month = jan,
	year = {2021},
	pmid = {33495268},
	note = {Publisher: BMJ Publishing Group
Section: GI cancer},
	keywords = {cancer epidemiology, cancer prevention, colorectal cancer screening},
}
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