Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Prince of Wales Clinical School, University of New South Wales Sydney, NSW, Australia.
Int J Epidemiol. 2019 Apr 1;48(2):549-558. doi: 10.1093/ije/dyy271.
In 2006, the Bowel Cancer Screening Programme (BCSP) in England began offering biennial faecal occult blood testing (FOBt) at ages 60-69 years. Although FOBt is aimed at detecting colorectal neoplasms, other conditions can affect the result. In a large UK prospective study, we examined associations, both before and after screening, between FOBt positivity and 10 conditions that are often associated with gastrointestinal bleeding.
By electronically linking BCSP and Million Women Study records, we identified 604 495 women without previous colorectal cancer who participated in their first routine FOBt screening between 2006 and 2012. Regression models, using linked national hospital admission records, yielded adjusted relative risks (RRs) in FOBt-positive versus FOBt-negative women for colorectal cancer, adenoma, diverticular disease, inflammatory bowel disease, haemorrhoids, upper gastrointestinal cancer, oesophagitis, peptic ulcer, anaemia and other haematological disorders.
RRs in FOBt-positive versus FOBt-negative women were 201.3 (95% CI 173.8-233.2) for colorectal cancer and 197.9 (95% CI 180.6-216.8) for adenoma within 12 months after screening and 3.49 (95% CI 2.31-5.26) and 4.88 (95% CI 3.80-6.26), respectively, 12-24 months after screening; P < 0.001 for all RRs. In the 12 months after screening, the RR for inflammatory bowel disease was 26.3 (95% CI 19.9-34.7), and ranged between 2 and 5 for the upper gastrointestinal or haematological disorders. The RRs of being diagnosed with any of the eight conditions other than colorectal neoplasms before screening, and in the 12-24 months after screening, were 1.81 (95% CI 1.81-2.01) and 1.92 (95% CI 1.66-2.13), respectively.
Whereas FOBt positivity is associated with a substantially increased risk of colorectal neoplasms after screening, eight other gastrointestinal and haematological conditions are also associated with FOBt positivity, both before and after screening.
2006 年，英国的大肠癌筛查计划（BCSP）开始为 60-69 岁的人群提供每两年一次的粪便潜血检测（FOBt）。尽管 FOBt 旨在检测结直肠肿瘤，但其他疾病也会影响检测结果。在一项英国大型前瞻性研究中，我们在筛查前后都研究了 FOBt 阳性与十种常与胃肠道出血相关的疾病之间的关系。
通过电子链接 BCSP 和百万女性研究的记录，我们确定了 604495 名没有结直肠癌既往史的女性，她们在 2006 年至 2012 年期间参加了第一次常规 FOBt 筛查。使用链接的国家住院记录，回归模型得出了 FOBt 阳性与 FOBt 阴性女性之间的结直肠癌、腺瘤、憩室疾病、炎症性肠病、痔疮、上消化道癌症、食管炎、消化性溃疡、贫血和其他血液疾病的校正相对风险（RR）。
在筛查后 12 个月内，FOBt 阳性与 FOBt 阴性女性的结直肠癌 RR 为 201.3（95%CI 173.8-233.2），腺瘤 RR 为 197.9（95%CI 180.6-216.8）；分别在筛查后 12-24 个月内，RR 为 3.49（95%CI 2.31-5.26）和 4.88（95%CI 3.80-6.26）；所有 RR 的 P 值均<0.001。在筛查后 12 个月内，炎症性肠病的 RR 为 26.3（95%CI 19.9-34.7），而上消化道或血液疾病的 RR 范围在 2-5 之间。在筛查前和筛查后 12-24 个月内，被诊断为除结直肠肿瘤以外的八种疾病的 RR 分别为 1.81（95%CI 1.81-2.01）和 1.92（95%CI 1.66-2.13）。
虽然 FOBt 阳性与筛查后的结直肠肿瘤风险显著增加有关，但其他八种胃肠道和血液疾病也与 FOBt 阳性有关，这种关联既存在于筛查前，也存在于筛查后。
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