粪便潜血试验筛查对结直肠癌的保护作用：筛查拒绝者的预后更差。
Protective effect of faecal occult blood test screening for colorectal cancer: worse prognosis for screening refusers.
作者信息
Niv Y, Lev-El M, Fraser G, Abuksis G, Tamir A
机构信息
Department of Gastroenterology, Rabin Medical Center, Beilinson Campus, Tel-Aviv University, Israel.
出版信息
Gut. 2002 Jan;50(1):33-7. doi: 10.1136/gut.50.1.33.
BACKGROUND AND AIMS
Screening for colorectal cancer (CRC) by faecal occult blood testing (FOBT) decreases CRC mortality by 15-33%. Compliance remains an obstacle to maximising the benefit of FOBT screening. We tested the hypothesis that individuals offered FOBT screening but refused would have an increased incidence and worse prognosis for CRC compared with those tested and with controls.
METHODS
Annual screening was offered to 3548 average risk individuals, > or = 40 years of age, from a highly stable population. A total of 2538 agreed to testing (group 1) and 1010 (28%) refused (group 2). Another 1376 individuals were never offered the test and served as controls (group 3). The groups were followed for 11 years: a three year screening period (1985-1987) and an eight year follow up period at the end of the screening programme (1988-1995). Incidence, stage, and mortality were compared. Characterisation of refusers was completed in 188 and 130 subjects of groups 1 and 2, respectively.
RESULTS
In the screening phase, mortality from CRC was significantly lower in group 1 than in groups 2 and 3. The cumulative incidence of CRC in the eight year follow up period was 21 (0.88%), 23 (2.28%), and 13 (0.94%) in groups 1, 2, and 3, respectively. This shows a reduction of 61.4% in group 1 compared with group 2 (relative risk 0.28 (95% confidence interval (CI) 0.19-0.32)) (p<0.001) and 6.4% compared with group 3 (relative risk 0.93 (95% CI 0.93-1.00)) (NS). During follow up, group 1 subjects also demonstrated a decrease in advanced Dukes' stage and mortality rate by 80% and 64%, and 79% and 62%, compared with groups 2 and 3, respectively. Refusers were more likely to be male, of Asian-African descent, and more likely to smoke, consume more coffee, and less tea or dairy foods.
CONCLUSIONS
When accepted, FOBT may protect against CRC for prolonged periods. Individuals who refuse FOBT have a significantly higher CRC incidence and mortality rates than those who accept testing.
背景与目的
通过粪便潜血试验（FOBT）筛查结直肠癌（CRC）可使CRC死亡率降低15% - 33%。依从性仍是最大化FOBT筛查益处的一个障碍。我们检验了这样一个假设，即与接受检测者和对照组相比，被提供FOBT筛查但拒绝的个体患CRC的发病率会增加且预后更差。
方法
对来自一个高度稳定人群的3548名年龄≥40岁的平均风险个体进行年度筛查。共有2538人同意检测（第1组），1010人（28%）拒绝（第2组）。另外1376人从未被提供检测并作为对照组（第3组）。对这些组进行了11年的随访：一个为期三年的筛查期（1985 - 1987年）以及筛查项目结束后的一个为期八年的随访期（1988 - 1995年）。比较了发病率、分期和死亡率。分别在第1组和第2组的188名和130名受试者中完成了对拒绝者的特征描述。
结果
在筛查阶段，第1组CRC死亡率显著低于第2组和第3组。在八年随访期内，第1组、第2组和第3组CRC的累积发病率分别为21例（0.88%）、23例（2.28%）和13例（0.94%）。这表明第1组与第2组相比降低了61.4%（相对风险0.28（95%置信区间（CI）0.19 - 0.32））（p<0.001），与第3组相比降低了6.4%（相对风险0.93（95%CI 0.93 - 1.00））（无显著性差异）。在随访期间，与第2组和第3组相比，第1组受试者在晚期杜克分期和死亡率方面也分别降低了80%和64%，以及79%和62%。拒绝者更可能为男性，具有亚非血统，更可能吸烟、饮用更多咖啡，饮用茶或食用乳制品较少。
结论
当被接受时，FOBT可能长期预防CRC。拒绝FOBT的个体患CRC的发病率和死亡率显著高于接受检测的个体。
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