Juul Jakob Søgaard, Andersen Berit, Laurberg Søren, Carlsen Anders Helles, Olesen Frede, Vedsted Peter
a Research Unit for General Practice & Section for General Medical Practice, Department of Public Health , Aarhus University , Bartholins Allé 2 , Aarhus C , 8000 , Denmark.
b Research Centre for Cancer Diagnosis in Primary Care, Department of Public Health , Aarhus University , Bartholins Allé 2 , Aarhus C , 8000 , Denmark.
Scand J Prim Health Care. 2018 Sep;36(3):281-290. doi: 10.1080/02813432.2018.1487378. Epub 2018 Jun 22.
To investigate the diagnostic activity in general practice and the cumulative incidence of colorectal cancer (CRC) in individuals invited to the Danish national screening programme for CRC.
A historical population-based cohort study.
The Danish CRC screening programme and general practice.
The 376,198 individuals invited to the Danish CRC screening programme from 1 March to 31 December 2014.
The diagnostic activity (consultations and haemoglobin measures) in general practice in the year preceding the screening invitation and the cumulated incidence of CRC in the year following the screening invitation.
Screening participants had significantly higher diagnostic activity than non-participants. Individuals with a positive faecal immunochemical test (FIT) had higher diagnostic activity compared to individuals with a negative FIT, and a small increase in the months leading up to the invitation. Individuals with a screen-detected CRC had lower diagnostic activity than individuals with no CRC. In total, 308 (25.3%) of CRCs diagnosed in the invited population were diagnosed outside the screening programme. Non-participants with CRC more often had low socio-economic status, high comorbidity and stage IV CRC than participants with CRC.
There was a tendency that participants and those with a positive FIT had a higher diagnostic activity the year before the screening. This was not seen for those with CRC detected through screening. CRC must still be diagnosed in general practice in the invited population and non-participants are of special interest as they have higher risk of late stage CRC. Key Points Current awareness:Individuals with colorectal cancer (CRC) in screening may be symptomatic and CRC may still occur outside screening in the invited population. Most important points:The majority of individuals with CRC in screening cannot be expected to be diagnosed on symptomatic presentation in general practice GPs have to be aware that CRC still occurs outside screening in the invited population Non-participants with CRC are often deprived and have late stage CRC.
调查丹麦全国结直肠癌（CRC）筛查计划所邀请个体在全科医疗中的诊断活动以及CRC的累积发病率。
一项基于历史人群的队列研究。
丹麦CRC筛查计划及全科医疗。
2014年3月1日至12月31日被邀请参加丹麦CRC筛查计划的376,198名个体。
筛查邀请前一年全科医疗中的诊断活动（会诊和血红蛋白检测）以及筛查邀请后一年CRC的累积发病率。
筛查参与者的诊断活动显著高于非参与者。粪便免疫化学检测（FIT）呈阳性的个体与FIT呈阴性的个体相比，诊断活动更高，且在邀请前几个月有小幅增加。筛查发现患有CRC的个体的诊断活动低于未患CRC的个体。在受邀人群中诊断出的CRC病例中，共有308例（25.3%）是在筛查计划之外诊断出来的。患有CRC的非参与者比患有CRC的参与者更常具有低社会经济地位、高合并症和IV期CRC。
有迹象表明，参与者和FIT呈阳性者在筛查前一年的诊断活动较高。通过筛查发现患有CRC的个体则未出现这种情况。在受邀人群中，CRC仍须在全科医疗中进行诊断，非参与者特别值得关注，因为他们患晚期CRC的风险更高。要点 当前认识：筛查中的结直肠癌（CRC）个体可能有症状，且受邀人群中CRC仍可能在筛查之外发生。最重要的要点：不能期望筛查中大多数患有CRC的个体在全科医疗中因出现症状而被诊断出来 全科医生必须意识到，受邀人群中CRC仍在筛查之外发生 患有CRC的非参与者往往处于不利地位且患有晚期CRC。
