Gastrointestinal Unit, A. Manzoni Hospital, Lecco, Italy.
Endoscopy. 2013;45(1):27-34. doi: 10.1055/s-0032-1325800. Epub 2012 Dec 19.
Colorectal cancer (CRC) screening aims to reduce mortality by detecting cancers at an early stage and removing adenomatous polyps at an acceptable cost. The aim of the current study were to assess the outcomes and costs of the first two biennial rounds of a population-based CRC screening program using the immunochemical fecal occult blood test (i-FOBT) in a northern Italian province.
All residents aged 50 - 69 years were invited to take part in a biennial screening program using a 1-day i-FOBT, followed by colonoscopy in positive individuals. The i-FOBT uptake, compliance to colonoscopy, detection rate for cancer or advanced adenomas according to age and sex, and direct cost analysis were carried out separately for the 1st and 2nd rounds of screening.
In 78 083 (1st round) and 81 619 (2nd round) individuals who were invited to screening, the participation rates were 49.7 % and 54.4 % and i-FOBT positivity rates were 6.2 % and 5.8 %, respectively. Detection rates for cancer and advanced adenomas were lower in the 2nd screening compared with the 1st one (1.6‰ vs. 2.5‰ for cancers and 15.8‰ vs. 17.9‰ for advanced adenomas, respectively), whereas positive predictive values for cancer and advanced adenoma were similar in both rounds. In 165 adenocarcinomas detected, 52 % were Dukes' stage A and 21 % were stage B. All cost indicators were slightly higher in the 1st round of screening compared with the 2nd. The direct cost per cancer or advanced adenoma detection was similar in the two rounds (€ 1252 and € 1260, respectively).
Compliance and diagnostic yield of i-FOBT screening were satisfactory. Most detected cancers were at a very early stage. Program costs were reasonable and did not increase with repeat screening. Screening could contribute to decreasing the cost of CRC care by improving the stage at diagnosis.
结直肠癌（CRC）筛查旨在通过早期发现癌症和以可接受的成本去除腺瘤性息肉来降低死亡率。本研究旨在评估在意大利北部一个省使用免疫化学粪便潜血试验（i-FOBT）进行基于人群的 CRC 筛查计划的前两轮的结果和成本。
所有 50-69 岁的居民均被邀请参加一项两年一次的筛查计划，使用 1 天的 i-FOBT，阳性者进行结肠镜检查。分别对第一轮和第二轮筛查的 i-FOBT 参与率、结肠镜检查依从性、按年龄和性别计算的癌症或高级腺瘤检出率以及直接成本分析进行了分析。
在 78083 名（第一轮）和 81619 名（第二轮）受邀参加筛查的人中，参与率分别为 49.7%和 54.4%，i-FOBT 阳性率分别为 6.2%和 5.8%。与第一轮相比，第二轮筛查的癌症和高级腺瘤检出率较低（癌症为 1.6‰对 2.5‰，高级腺瘤为 15.8‰对 17.9‰），但癌症和高级腺瘤的阳性预测值在两轮筛查中相似。在检测到的 165 例腺癌中，52%为 Dukes' A 期，21%为 B 期。与第二轮相比，第一轮筛查的所有成本指标略高。两轮筛查的每例癌症或高级腺瘤检出成本相似（分别为 1252 欧元和 1260 欧元）。
i-FOBT 筛查的依从性和诊断效果令人满意。大多数检出的癌症都处于非常早期的阶段。计划成本合理，且随着重复筛查而增加。通过改善诊断阶段，筛查可能有助于降低 CRC 治疗的成本。
