Cancer Screening Evaluation Unit, Section of Epidemiology, Institute of Cancer Research, SRD Building, Cotswold Road, Sutton, Surrey SM2 5NG, UK.
Gut. 2012 Jan;61(1):101-7. doi: 10.1136/gut.2010.236430. Epub 2011 May 10.
To compare performance measures across all three rounds of the English bowel cancer screening faecal occult blood test pilot and their relation to social deprivation and ethnicity.
In each round in three primary care trusts, data for a restricted population of over 48,500 aged 60-69 years were analysed. Individual-based data included postcode linked to area-based data on the Index of Multiple Deprivation (IMD) 2004, and ethnicity. Outcomes were the rates of screening and colonoscopy uptake, positivity and detection of neoplasia (adenomas or bowel cancer) and bowel cancer, and the positive predictive values (PPVs) of a positive test for neoplasia and bowel cancer. Sensitivity was calculated by the proportional incidence method using data on interval cancers identified from cancer registrations.
The overall uptake rate was 61.8%, 57.0% and 58.7% in the first, second and third rounds, respectively. Although the PPV for cancer decreased over the course of the three rounds (10.9% in the 1st round, 6.5% in 3rd round), the PPV for all neoplasia remained relatively constant (42.6% in 1st round, 36.9% in 3rd round). Deprivation and non-white ethnic background (principally Indian subcontinent in the pilot region) were associated with low screening and colonoscopy uptake rates, and this changed little over the three screening rounds. Uptake was lower in men, although differences in uptake between men and women decreased over time. Non-participation in previous rounds was a strong predictor of low uptake.
Performance measures are commensurate with expectations in a screening programme reaching its third round of screening, but a substantial ongoing effort is needed, particularly to address the effects of deprivation and ethnicity in relation to uptake.
比较英国结直肠癌筛查粪便潜血试验试点的所有三轮的性能指标及其与社会剥夺和种族的关系。
在三个初级保健信托机构的每一轮中，对超过 48500 名年龄在 60-69 岁的限定人群的数据进行了分析。个体基础数据包括与 2004 年多因素剥夺指数（IMD）相关的邮政编码和种族。结果是筛查和结肠镜检查的参与率、阳性率和肿瘤检出率（腺瘤或结直肠癌）以及结直肠癌，以及肿瘤和结直肠癌阳性检测的阳性预测值（PPV）。敏感性通过使用癌症登记处发现的间隔期癌症的数据，用比例发病率法计算。
在第一轮、第二轮和第三轮中，总体参与率分别为 61.8%、57.0%和 58.7%。尽管癌症的 PPV 在三轮试验过程中呈下降趋势（第一轮为 10.9%，第三轮为 6.5%），但所有肿瘤的 PPV 仍相对稳定（第一轮为 42.6%，第三轮为 36.9%）。贫困和非白种人种族（主要是试点地区的印度次大陆）与低筛查和结肠镜检查参与率相关，这在三轮筛查中变化不大。男性的参与率较低，尽管男性和女性之间的参与率差异随着时间的推移而减少。前几轮的不参与是低参与率的一个强有力的预测因素。
在一项进入第三轮筛查的筛查计划中，性能指标与预期相符，但仍需要做出大量持续努力，特别是要解决与参与率相关的贫困和种族的影响。
