Group Health Research Institute; Department of Biostatistics, School of Public Health, University of Washington; and Group Health Permanente, Seattle, WA 98101, USA.
Cancer Epidemiol Biomarkers Prev. 2013 Sep;22(9):1612-9. doi: 10.1158/1055-9965.EPI-13-0254. Epub 2013 Jul 18.
Annual colorectal cancer screening with fecal occult blood test (FOBT) is a noninvasive alternative to screening colonoscopy once every 10 years. If false-positive FOBT results are common, then many patients selecting an FOBT regimen will be exposed to the same invasive testing as those selecting a colonoscopy regimen. The objective of this study was to estimate the probability of experiencing a false-positive after receiving annual FOBT screening for 10 years.
Medical records for patients aged 50 to 79 years receiving FOBT screening with Hemoccult Sensa between 1997 and 2009 at Group Health of Washington State captured the date and results of each FOBT, along with subsequent colorectal cancer diagnoses. We used logistic regression to analyze associations between patient characteristics and odds of a positive FOBT with no invasive cancer diagnosis within 1 year (FOBT+, CRC-). We estimated the probability of receiving at least one FOBT+, CRC- result after 10 years of screening.
We observed 181,950 FOBTs from 94,637 individuals. Older patients, males, and non-White patients were significantly more likely to receive FOBT+, CRC- results (P < 0.001 for all risk factors). After 10 years of annual FOBT, 23.0% [95% confidence interval (CI), 18.2-27.0] will receive at least one FOBT+, CRC- result.
Most patients participating in annual FOBT screening for 10 years will not have a positive result, reinforcing the potential value of this regimen as a noninvasive alternative to colonoscopy.
Annual stool-based screening is a screening alternative resulting in substantially fewer colonoscopies than once per decade colonoscopy.
每年一次的粪便潜血试验（FOBT）筛查是一种非侵入性的替代方案，可替代每 10 年进行一次的结肠镜检查。如果 FOBT 的假阳性结果很常见，那么选择 FOBT 方案的许多患者将与选择结肠镜方案的患者一样接受相同的侵入性检查。本研究的目的是估计在接受 10 年每年 FOBT 筛查后出现假阳性的概率。
华盛顿州 Group Health 1997 年至 2009 年间接受 Hemoccult Sensa FOBT 筛查的 50 至 79 岁患者的病历记录了每次 FOBT 的日期和结果，以及随后的结直肠癌诊断。我们使用逻辑回归分析了患者特征与一年内无侵袭性癌症诊断的阳性 FOBT（FOBT+，CRC-）之间的关联。我们估计了在 10 年的筛查后至少接受一次 FOBT+，CRC-结果的概率。
我们观察了 94637 名患者的 181950 次 FOBT。年龄较大的患者、男性和非白人患者更有可能出现 FOBT+，CRC-结果（所有危险因素的 P<0.001）。经过 10 年的年度 FOBT，23.0%（95%置信区间，18.2-27.0）将至少出现一次 FOBT+，CRC-结果。
大多数参加 10 年年度 FOBT 筛查的患者不会出现阳性结果，这进一步证实了该方案作为结肠镜检查的非侵入性替代方案的潜在价值。
每年一次的基于粪便的筛查是一种替代方案，与每 10 年一次的结肠镜检查相比，结肠镜检查的数量要少得多。
