Department of Surgery, University of North Norway, Narvik Hospital, Narvik, Norway.
Br J Surg. 2010 Oct;97(10):1567-71. doi: 10.1002/bjs.7150.
Faecal occult blood test (FOBT) screening has been shown to decrease the incidence and mortality from colorectal cancer. This study compared the stage profile of patients with colorectal cancer diagnosed at the first FOBT screening round with that of an unscreened control group.
Subjects aged 60-64 years were allocated randomly to biennial FOBT screening (52 998 subjects) or a control group (53 002) in a Finnish prospective public health policy in 2004-2006. FOBT was performed with a guaiac test. At the end of 2007 the screened and control populations were linked to the Finnish Cancer Registry database, and the colonoscopic findings in the screen positives were analysed.
Early-stage colorectal cancer was observed in 52 per cent of the FOBT-positive subjects, in 42.2 per cent of the total screened population and in 38 per cent of the control population (P = 0.191 for FOBT positives, P = 0.592 for total screened population). The prevalence of adenomas and colorectal cancer was 31.5 and 8.2 per cent respectively among the 806 subjects with a positive FOBT. Some 27.3 per cent of all colorectal tumours in the screened population were interval cancers. The tumour was located in the right colon in 28.9 per cent of the screened subjects and 22 per cent of controls (P = 0.255).
Biennial FOBT screening improves detection of colorectal cancer at the first screening round, but the high percentage of interval cancers is a cause for concern.
粪便潜血试验（FOBT）筛查已被证明可降低结直肠癌的发病率和死亡率。本研究比较了首次 FOBT 筛查轮次诊断的结直肠癌患者与未筛查对照组的分期情况。
2004-2006 年，芬兰采用前瞻性公共卫生政策，将 60-64 岁的受试者随机分配至每两年进行一次 FOBT 筛查（52998 例）或对照组（53002 例）。FOBT 采用愈创木脂检测法进行。2007 年末，筛查人群和对照组与芬兰癌症登记数据库进行了关联，并分析了筛查阳性者的结肠镜检查结果。
FOBT 阳性者中，52%为早期结直肠癌，总筛查人群中为 42.2%，对照组中为 38%（FOBT 阳性者 P = 0.191，总筛查人群 P = 0.592）。在 806 例 FOBT 阳性者中，腺瘤和结直肠癌的患病率分别为 31.5%和 8.2%。在筛查人群中，所有结直肠肿瘤的 27.3%为间隔期癌症。在筛查组中，28.9%的肿瘤位于右半结肠，对照组中为 22%（P = 0.255）。
每两年进行一次 FOBT 筛查可提高首次筛查轮次的结直肠癌检出率，但间隔期癌症的高比例令人担忧。
