Lee Kyung-Jae, Inoue Manami, Otani Tetsuya, Iwasaki Motoki, Sasazuki Shizuka, Tsugane Shoichiro
Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
Cancer Detect Prev. 2007;31(1):3-11. doi: 10.1016/j.cdp.2006.11.002. Epub 2007 Feb 7.
To investigate prospectively the association between colorectal cancer screening and subsequent risk of colorectal cancer death in a large-scale population-based cohort study (the JPHC study) with a 13-year follow-up period in Japan.
We analyzed data from a population-based cohort of 42,150 (20,326 men and 21,824 women) subjects. Subjects who had undergone fecal occult blood test (FOBT) screening during the preceding 12 months were defined as the screened group. A total of 132 colorectal cancer deaths and 597 cases of newly diagnosed colorectal cancer were identified during the follow-up period.
We observed a nearly 70% decrease in colorectal cancer mortality in screened versus unscreened subjects (RR=0.28, 95% CI=0.13-0.61). Screening participation was associated with a 30% reduced risk of death from all causes other than colorectal cancer (RR=0.70, 95% CI=0.61-0.79). However, the extent of mortality reduction was greater for colorectal cancer than other causes. A significant decrease in the incidence of advanced colorectal cancer was seen in screened subjects (RR=0.41, 95% CI=0.27-0.63), although the overall incidence rate did not differ significantly between the screened and unscreened groups.
Although self-selection bias could not be fully controlled, these findings suggest that colorectal cancer screening may be associated with a reduction in mortality from colorectal cancer in the Japanese population.
在一项对日本人群进行了13年随访的大规模队列研究（JPHC研究）中，前瞻性地调查结直肠癌筛查与随后结直肠癌死亡风险之间的关联。
我们分析了一个基于人群的队列中42,150名受试者（20,326名男性和21,824名女性）的数据。在之前12个月内接受过粪便潜血试验（FOBT）筛查的受试者被定义为筛查组。在随访期间共确定了132例结直肠癌死亡病例和597例新诊断的结直肠癌病例。
我们观察到，与未筛查的受试者相比，筛查组的结直肠癌死亡率降低了近70%（风险比=0.28，95%置信区间=0.13-0.61）。参与筛查与结直肠癌以外的所有其他原因导致的死亡风险降低30%相关（风险比=0.70，95%置信区间=0.61-0.79）。然而，结直肠癌死亡率的降低幅度大于其他原因。在筛查的受试者中，晚期结直肠癌的发病率显著降低（风险比=0.41，95%置信区间=0.27-0.63），尽管筛查组和未筛查组的总体发病率没有显著差异。
尽管无法完全控制自我选择偏倚，但这些发现表明，结直肠癌筛查可能与日本人群中结直肠癌死亡率的降低有关。
