Kronborg O, Fenger C, Olsen J, Bech K, Søndergaard O
Dept. of Surgical Gastroenterology, Odense University Hospital, Denmark.
Scand J Gastroenterol. 1989 Jun;24(5):599-606. doi: 10.3109/00365528909093096.
Two screenings with Hemoccult-II were performed in a randomized study, allocating 30,970 persons to screening and 30,968 as controls in a population of 140,000 between 45 and 74 years old on the island of Funen, Denmark. The test was completed in 20,672 initially and in 18,779 of these during rescreening 2 years later. Positive H-II tests were found in 215 and 159 persons during the two screenings, respectively. A total colonoscopy was performed in 187 and 144, and cancer was detected in 37 and 13 and adenomata in 86 and 76, respectively. Interval cancers had developed in 40 persons at the end of the second screening, and 39 non-responders had developed cancer. Cancer was diagnosed in 115 controls and an adenoma in 100 during the same period. Interval cancers presented as rectal cancers more frequently than those detected by screening. Early cancers were more frequent in the screening group, and, accordingly, more patients had curative and also less extensive surgery, with a low postoperative mortality. The total number of deaths from colorectal cancer was 37 in the screening group, including interval cancers and cancers in non-responders and persons who developed cancer before they could be invited, which suggests a reduction in mortality of 27% (51 deaths among controls, compared with 37). The reduction is as yet not statistically significant, and final evaluation must await at least one more screening, ending in 1990, and a follow-up of some years. Removal of more large adenomas during screening makes it possible that the incidence of cancer will decrease.
在丹麦菲英岛140,000名45至74岁人群中进行的一项随机研究中，采用隐血检测-II进行了两轮筛查，将30,970人分配至筛查组，30,968人作为对照组。最初有20,672人完成检测，两年后复查时其中18,779人完成检测。两轮筛查中分别有215人和159人隐血检测-II结果呈阳性。分别对187人和144人进行了全结肠镜检查，检测到37例癌症和13例癌症，以及86例腺瘤和76例腺瘤。在第二次筛查结束时，有40人发生了间期癌，39名未参与者患了癌症。同期在115名对照组中诊断出癌症，100名对照组中诊断出腺瘤。间期癌表现为直肠癌的频率高于筛查发现的癌症。早期癌症在筛查组中更为常见，因此，更多患者接受了根治性手术且手术范围较小，术后死亡率较低。筛查组中结直肠癌死亡总数为37例，包括间期癌、未参与者中的癌症以及在被邀请前就已患癌的人，这表明死亡率降低了27%（对照组中有51人死亡，而筛查组为37人）。这种降低在统计学上尚不显著，最终评估必须等待至少一轮于1990年结束的筛查以及数年的随访。在筛查期间切除更多大腺瘤可能会使癌症发病率降低。
