Kapidzic Atija, Grobbee Elisabeth J, Hol Lieke, van Roon Aafke Hc, van Vuuren Anneke J, Spijker Wolfert, Izelaar Kirsten, van Ballegooijen Marjolein, Kuipers Ernst J, van Leerdam Monique E
Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands.
Regional Organization for Population Screening South-West Netherlands, Rotterdam, The Netherlands.
Am J Gastroenterol. 2014 Aug;109(8):1257-64. doi: 10.1038/ajg.2014.168. Epub 2014 Jul 1.
Fecal immunochemical test (FIT) screening for colorectal cancer (CRC) requires timely successive rounds for an optimal preventive effect. However, data on attendance and trend in yield over multiple rounds of FIT screening are limited. We therefore conducted a consecutive third round of FIT screening in a population-based CRC screening trial.
Average-risk subjects aged 50-74 years were approached for three rounds of 1-sample FIT (OC-sensor) screening. Subjects with a hemoglobin level ≥50 ng/ml (≥10 μg Hb/g) feces were referred for colonoscopy. Subjects with a positive FIT in previous rounds were not re-invited for FIT screening.
In the first round, 7,501 subjects were invited. The participation rate was 62.6% in the first round, 63.2% in the second round, and 68.3% in the third round (P<0.001). In total, 73% (5,241/7,229) of all eligible subjects participated in at least one of three rounds. The positivity rate was significantly higher in the first (8.4%) round compared with the second (6.0%) and third (5.7%) screening rounds (P<0.001). The detection rate of advanced neoplasia (AN) declined from the first round to subsequent rounds (round 1: 3.3%; round 2: 1.9%; and round 3: 1.3%; P<0.001). The positive predictive value for AN was 40.7% in the first screening round, 33.2% in the second screening round, and 24.0% in the third screening round (P<0.001).
Repeated biennial FIT screening is acceptable with increased participation in successive screening rounds, and >70% of all eligible subjects participating at least once over three rounds. The decline in screen-detected AN over three screening rounds is compatible with a decreased prevalence of AN as a result of repeated FIT screening. These findings provide strong evidence for the effectiveness of FIT screening and stress the importance of ongoing research over multiple screening rounds.
粪便免疫化学检测（FIT）用于结直肠癌（CRC）筛查时，需要及时进行连续多轮检测以获得最佳预防效果。然而，关于多轮FIT筛查的参与率及检出率趋势的数据有限。因此，我们在一项基于人群的CRC筛查试验中进行了连续三轮FIT筛查。
邀请年龄在50 - 74岁的平均风险受试者进行三轮单样本FIT（OC传感器）筛查。血红蛋白水平≥50 ng/ml（≥10 μg Hb/g）粪便的受试者被转诊进行结肠镜检查。前一轮FIT检测呈阳性的受试者不再被邀请参加FIT筛查。
第一轮邀请了7501名受试者。第一轮参与率为62.6%，第二轮为63.2%，第三轮为68.3%（P<0.001）。总共有73%（5241/7229）的符合条件的受试者参加了三轮筛查中的至少一轮。第一轮的阳性率（8.4%）显著高于第二轮（6.0%）和第三轮（5.7%）（P<0.001）。高级别瘤变（AN）的检出率从第一轮到后续轮次逐渐下降（第一轮：3.3%；第二轮：1.9%；第三轮：1.3%；P<0.001）。第一轮筛查中AN的阳性预测值为40.7%，第二轮筛查中为33.2%，第三轮筛查中为24.０%（P<0.001）。
每两年重复进行FIT筛查是可行的，连续筛查轮次的参与率有所提高，超过70%的符合条件的受试者在三轮筛查中至少参加了一次。三轮筛查中筛查出的AN下降与重复FIT筛查导致AN患病率降低相符。这些发现为FIT筛查的有效性提供了有力证据，并强调了对多轮筛查进行持续研究的重要性。
