University of British Columbia, Vancouver, Canada.
BC Cancer Agency, Vancouver, Canada.
J Gen Intern Med. 2020 Feb;35(2):444-448. doi: 10.1007/s11606-019-05399-4. Epub 2019 Dec 12.
Colorectal cancer (CRC) screening is an evidence-based strategy to reduce CRC-related mortality.
This study identifies physician and participant characteristics, as well as previous FIT values associated with premature FIT usage.
This is a retrospective review of all FITs ordered from January 1, 2016, until June 30, 2017. For each ordered FIT, the participant's chart was reviewed to identify if a previous FIT had occurred in the prior 21 months. A premature FIT was defined as an ordered test with a negative FIT in the preceding 21 months.
Screening participants were average risk for CRC, aged 50-74, and had a FIT ordered by their primary care provider in British Columbia, Canada.
The BC College of Physicians and Surgeons' database was used to identify the location of referring physician, date of graduation from medical school, and gender. The participant's age, gender, and value of previous FIT were recorded. Physician and participant variables and previous FIT value were examined with logistic regression to identify associations with premature FIT ordering.
In total, 385,375 FITs were ordered during this period with 116,727 representing participants returning following a previous negative FIT. In total, 35,148 (30.1%) returned early for screening. Men were more likely to return early than women (OR 1.14; 95% CI 1.11-1.17; p < 0.0001). Male physicians were more likely to order premature FITs (OR 1.15; 95% CI 1.06-1.24; p < 0.0001). A higher quantitative FIT value (ng/mL) of the previous FIT was also associated with early screening (OR 1.11; 95% CI 1.09-1.14; < 0.0001).
This study found that approximately 30% of FIT tests, ordered for CRC screening, were ordered before they were due. This may lead to wasted resources, unnecessary participant stress, and unwarranted patient risk.
结直肠癌（CRC）筛查是一种基于证据的策略，可以降低 CRC 相关死亡率。
本研究确定了与 FIT 提前使用相关的医生和参与者特征以及之前的 FIT 值。
这是对 2016 年 1 月 1 日至 2017 年 6 月 30 日期间所有 FIT 订单的回顾性分析。对于每个订购的 FIT，都会查阅参与者的图表，以确定在此前 21 个月内是否进行过先前的 FIT。提前进行 FIT 检测被定义为在前 21 个月内 FIT 检测结果为阴性但随后又进行 FIT 检测。
筛查参与者为 CRC 平均风险人群，年龄在 50-74 岁之间，由加拿大不列颠哥伦比亚省的初级保健医生开 FIT 检测。
使用不列颠哥伦比亚省医师和外科医生协会的数据库确定转诊医生的位置、医学院毕业日期和性别。记录参与者的年龄、性别和之前 FIT 的值。使用逻辑回归检查医生和参与者变量以及之前的 FIT 值，以确定与 FIT 提前检测相关的因素。
在此期间共进行了 385375 次 FIT 检测，其中 116727 次代表的是在前一次阴性 FIT 检测后返回的参与者。共有 35148 人（30.1%）提前进行了筛查。男性比女性更有可能提前返回（OR 1.14；95%CI 1.11-1.17；p<0.0001）。男性医生更有可能提前开 FIT 检测（OR 1.15；95%CI 1.06-1.24；p<0.0001）。之前 FIT 的定量值（ng/mL）越高，也与早期筛查相关（OR 1.11；95%CI 1.09-1.14；<0.0001）。
本研究发现，大约 30%的 CRC 筛查 FIT 检测在规定时间之前就已经进行。这可能导致资源浪费、不必要的参与者压力和不必要的患者风险。
