Telford Jennifer, Gentile Laura, Gondara Lovedeep, McGahan Colleen, Coldman Andrew
Department of Medicine (Telford) and School of Population and Public Health (Coldman), University of British Columbia; Departments of Population Oncology (Telford, Gentile, Gondara, McGahan) and Cancer Control Research (Coldman), British Columbia Cancer Agency, Vancouver, BC.
CMAJ Open. 2016 Nov 4;4(4):E668-E673. doi: 10.9778/cmajo.20160047. eCollection 2016 Oct-Dec.
British Columbia undertook a colorectal cancer screening pilot program in 3 communities. Our objective was to assess the performance of 2-specimen fecal immunochemical testing in the detection of colorectal neoplasms in this population-based screening program.
A prospective cohort of asymptomatic, average-risk people aged 50 to 74 years completed 2 quantitative fecal immunochemical tests every 2 years, with follow-up colonoscopy if the result of either test was positive. Participant demographics, fecal immunochemical test results, colonoscopy quality indicators and pathology results were recorded. Non-screen-detected colorectal cancer that developed in program participants was identified through review of data from the BC Cancer Registry.
A total of 16 234 people completed a first round of fecal immunochemical testing, with a positivity rate of 8.6%; 5378 (86.0% of eligible participants) completed a second round before the end of the pilot program, with a positivity rate of 6.7%. Of the 1756 who had a positive test result, 1555 (88.6%) underwent colonoscopy. The detection rate of colorectal cancer was 3.5 per 1000 participants. The positive predictive value of the fecal immunochemical test was 4.9% (95% confidence interval [CI] 3.8%-6.0%) for colorectal cancer, 35.0% (95% CI 32.5%-37.2%) for high-risk polyps and 62.0% (95% CI 59.6%-64.4%) for all neoplasms. The number needed to screen was 283 to detect 1 cancer, 40 to detect 1 high-risk polyp and 22 to detect any neoplasm.
Screening every 2 years with a 2-specimen fecal immunochemical test surpassed the current benchmark for colorectal cancer detection in population-based screening. This study has implications for other jurisdictions planning colorectal cancer screening programs.
不列颠哥伦比亚省在3个社区开展了一项结直肠癌筛查试点项目。我们的目的是评估在这个基于人群的筛查项目中，两次粪便免疫化学检测在结直肠肿瘤检测中的表现。
一个由年龄在50至74岁、无症状、平均风险人群组成的前瞻性队列，每2年完成两次定量粪便免疫化学检测，如果任何一次检测结果为阳性，则进行后续结肠镜检查。记录参与者的人口统计学信息、粪便免疫化学检测结果、结肠镜检查质量指标和病理结果。通过查阅不列颠哥伦比亚癌症登记处的数据，确定项目参与者中未通过筛查发现的结直肠癌。
共有16234人完成了第一轮粪便免疫化学检测，阳性率为8.6%；5378人（占符合条件参与者的86.0%）在试点项目结束前完成了第二轮检测，阳性率为6.7%。在1756名检测结果为阳性的人中，1555人（88.6%）接受了结肠镜检查。结直肠癌的检出率为每1000名参与者中有3.5例。粪便免疫化学检测对结直肠癌的阳性预测值为4.9%（95%置信区间[CI] 3.8%-6.0%），对高危息肉为35.0%（95% CI 32.5%-37.2%），对所有肿瘤为62.0%（95% CI 59.6%-64.4%）。筛查出1例癌症所需的人数为283人，筛查出1例高危息肉所需的人数为40人，筛查出任何肿瘤所需的人数为22人。
每2年进行一次两次粪便免疫化学检测的筛查，在基于人群的筛查中超过了目前结直肠癌检测的基准。这项研究对其他计划开展结直肠癌筛查项目的司法管辖区具有启示意义。
