Bujanda Luis, Sarasqueta Cristina, Castells Antoni, Pellisé María, Cubiella Joaquín, Gil Inés, Cosme Angel, Arana-Arri Eunate, Mar Izaskun, Idigoras Isabel, Portillo Isabel
aDepartment of Gastroenterology, Hospital Donostia, Instituto Biodonostia, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), Universidad del País Vasco (UPV/EHU) bHospital Universitario Donostia, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), San Sebastián cDepartment of Gastroenterology, Hospital Clínic, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), IDIBAPS, University of Barcelona, Barcelona dServicio de Aparato Digestivo, Complexo Hospitalario Universitario de Ourense, Ourense eHospital Universitario de Cruces, Baracaldo fPrograma de Cribado de Cáncer Colorrectal, Servicio Vasco de Salud, País Vasco, Spain.
Eur J Gastroenterol Hepatol. 2015 Jul;27(7):813-8. doi: 10.1097/MEG.0000000000000366.
The faecal immunochemical test is one of the tests recommended by scientific societies for colorectal cancer (CRC) screening in average-risk populations. Our aim was to evaluate the characteristics of CRC detected in a second round of screening after negative results in a first round.
We studied patients in whom CRC was detected in a screening programme. This programme included asymptomatic individuals between 50 and 69 years old and offered tests every 2 years. A total of 363,792 individuals were invited to participate in the first round of faecal immunochemical test screening and 100,135 individuals in the second round after a first negative result. The screening strategy consisted of faecal testing of a single sample using an automated semiquantitative kit, with a cut-off of 20 μg haemoglobin (Hb)/g faeces.
The rate of positive results was 6.9% (16,467/238,647) in the first round and 4.8% (3359/69,193) in the second round (P < 0.0005). Overall, 860 (0.36%) cases of CRC were detected in the first round and 100 (0.14%) in the second round (P < 0.005). The location of the cancer was proximal in 12.5 and 24% of cases detected in the first and second rounds, respectively (P = 0.008). Hb concentrations were higher in the first round (211 vs. 109 μg Hb/g faeces in the second round; P = 0.002). Multivariate analysis confirmed that, in the second round, CRC diagnosed was more often proximal (hazard ratio vs. first round, 2.4; 95% confidence interval, 1.3-4.4; P = 0.003) and the concentration of Hb/g faeces was lower (hazard ratio vs. first round, 2.1; 95% confidence interval, 1.3-3.5; P = 0.003).
The CRC detection rate is lower in the second round of screening. Further, in the second round, CRC detected is more often in a proximal location and Hb concentrations are lower.
粪便免疫化学检测是科学协会推荐用于平均风险人群结直肠癌（CRC）筛查的检测方法之一。我们的目的是评估在第一轮筛查结果为阴性后的第二轮筛查中检测到的CRC的特征。
我们研究了在筛查项目中检测到CRC的患者。该项目包括50至69岁的无症状个体，每2年进行一次检测。共有363,792人被邀请参加第一轮粪便免疫化学检测筛查，100,135人在第一轮结果为阴性后参加第二轮筛查。筛查策略包括使用自动化半定量试剂盒对单个样本进行粪便检测，临界值为20μg血红蛋白（Hb）/g粪便。
第一轮阳性率为6.9%（16,467/238,647），第二轮为4.8%（3359/69,193）（P<0.0005）。总体而言，第一轮检测到860例（0.36%）CRC，第二轮检测到100例（0.14%）（P<0.005）。在第一轮和第二轮检测到的病例中，癌症位于近端的分别为12.5%和24%（P=0.008）。第一轮的Hb浓度更高（第二轮为211μg Hb/g粪便，第一轮为109μg Hb/g粪便；P=0.002）。多变量分析证实，在第二轮中，诊断出的CRC更常位于近端（与第一轮相比，风险比为2.4；95%置信区间为1.3 - 4.4；P=0.003），且每克粪便中的Hb浓度更低（与第一轮相比，风险比为2.1；95%置信区间为1.3 - 3.5；P=0.003）。
第二轮筛查中CRC的检出率较低。此外，在第二轮中，检测到的CRC更常位于近端，且Hb浓度较低。
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