Kaalby Lasse, Rasmussen Morten, Zimmermann-Nielsen Erik, Buijs Magdalena Maria, Baatrup Gunnar
Department of Surgery, Odense University Hospital, Odense, Denmark.
Department of Clinical Science, University of Southern Denmark, Odense, Denmark.
Clin Epidemiol. 2019 Jul 30;11:659-667. doi: 10.2147/CLEP.S206873. eCollection 2019.
The aim of this study was to investigate the effect of response time from the Fecal Immunochemical Test (FIT) based screening invitation to the conclusive screening Optical Colonoscopy (OC) on the risk of detecting colorectal cancer (CRC), advanced stage disease and precursor lesions.
We used a cross-sectional study design and included all 62,554 screening participants registered in the Danish Colorectal Cancer Screening Database who tested FIT-positive between March 2014 and December 2016. The main exposure was response time, measured as the time from initial invitation to the conclusive OC. Our main outcomes were the probability of being diagnosed with CRC, advanced stage disease or precursor lesions.
Of the 62,554 FIT-positive participants, 53,171 (85%) received an OC and were eligible for analysis (median age 63.7 years, 56% men). In this group, 3,639 cancers were registered, 2,890 of which were registered with a defined stage of disease (79%), and 1,042 (36%) of these were advanced stage (UICC III & IV). In addition, 17,732 high-risk and 10,605 low-risk adenomas were identified. Compared to participants receiving the conclusive examination within 30 days, those receiving the examination more than 90 days after initial invitation were 3.49 times more likely to be diagnosed with any CRC (OR 3.49 [95% CI, 3.13-3.89]) and 2.10 times more likely to have advanced stage disease (OR 2.10 [95% CI, 1.73-2.56]). Those waiting for the longest were also more likely to have one or more high-risk adenomas (OR 1.59 [95% CI, 1.50-1.68]).
Increased screening response time was associated with a higher probability of detecting high-risk adenomas, any stage CRC and advanced stage cancer. More research is needed to explain what causes these associations.
本研究旨在调查从基于粪便免疫化学检测（FIT）的筛查邀请到最终筛查光学结肠镜检查（OC）的响应时间对检测结直肠癌（CRC）、晚期疾病和前驱病变风险的影响。
我们采用横断面研究设计，纳入了丹麦结直肠癌筛查数据库中2014年3月至2016年12月期间FIT检测呈阳性的所有62554名筛查参与者。主要暴露因素为响应时间，定义为从初次邀请到最终OC检查的时间。我们的主要结局是被诊断为CRC、晚期疾病或前驱病变的概率。
在62554名FIT检测呈阳性的参与者中，53171名（85%）接受了OC检查并符合分析条件（中位年龄63.7岁，56%为男性）。在该组中，登记了3639例癌症，其中2890例有明确的疾病分期（79%），其中1042例（36%）为晚期（国际抗癌联盟III期和IV期）。此外，还发现了17732例高危腺瘤和10605例低危腺瘤。与在30天内接受最终检查的参与者相比，在初次邀请后90天以上接受检查的参与者被诊断为任何CRC的可能性高3.49倍（比值比3.49 [95%可信区间，3.13 - 3.89]），患晚期疾病的可能性高2.10倍（比值比2.10 [95%可信区间，1.73 - 2.56]）。等待时间最长的参与者也更有可能有一个或多个高危腺瘤（比值比1.59 [95%可信区间，1.50 - 1.68]）。
筛查响应时间延长与检测高危腺瘤、任何阶段CRC和晚期癌症的可能性增加相关。需要更多研究来解释这些关联的原因。
