Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany.
Br J Cancer. 2020 Mar;122(7):1109-1117. doi: 10.1038/s41416-020-0754-5. Epub 2020 Feb 18.
Faecal immunochemical tests (FITs) have replaced guaiac-based faecal occult blood test (gFOBTs) in several colorectal cancer (CRC) screening programmes. We aimed to evaluate the benefits of this transition based on the Wallonia-Brussels-organised CRC screening programme.
A total of 1,569,868 individuals aged 50-74 years, who were invited to screening during 2009-2017, were studied by linking their screening records with insurance, pathology and cancer data in the Belgian Cancer Registry. We compared neoplasm detection rates and positive predictive values (PPVs) of gFOBT and FIT at 15 µg haemoglobin per gram cut-off in screen-naive individuals. We furthermore examined the incidence rates of interval cancer in gFOBT- and FIT-based screening programme.
Advanced neoplasms were detected less frequently by gFOBT (0.8%) than by FIT (1.3%), with a difference of 0.5% (P < 0.01). PPVs were lower for gFOBT (15.1%) than for FIT (21.7%) for advanced neoplasms (difference 6.6%, P < 0.01). Compared to participants with negative gFOBT, those with negative FIT were 77% less likely to develop interval cancer (incidence rate ratio 0.23, 95% confidence interval 0.16-0.33).
Our study demonstrated that in an organised CRC screening programme, replacing gFOBT with FIT improved neoplasm detection rate and substantially reduced interval cancer incidence.
粪便免疫化学检测（FIT）已在多个结直肠癌（CRC）筛查计划中取代了愈创木脂粪便潜血检测（gFOBT）。我们旨在根据瓦隆-布鲁塞尔组织的 CRC 筛查计划评估这种转变的益处。
共有 1569868 名年龄在 50-74 岁之间的个体在 2009-2017 年期间受邀参加筛查，通过将他们的筛查记录与比利时癌症登记处的保险、病理学和癌症数据相链接进行研究。我们比较了 gFOBT 和 FIT 在 15µg 血红蛋白/克截止值下在筛查初筛个体中的肿瘤检出率和阳性预测值（PPV）。此外，我们还检查了 gFOBT 和 FIT 为基础的筛查计划中间隔期癌症的发病率。
高级别肿瘤通过 gFOBT（0.8%）的检出率低于 FIT（1.3%），差异为 0.5%（P<0.01）。对于高级别肿瘤，gFOBT 的 PPV（15.1%）低于 FIT（21.7%），差异为 6.6%（P<0.01）。与 gFOBT 阴性的参与者相比，FIT 阴性的参与者发生间隔期癌症的风险低 77%（发病率比 0.23，95%置信区间 0.16-0.33）。
我们的研究表明，在有组织的 CRC 筛查计划中，用 FIT 替代 gFOBT 提高了肿瘤检出率，并大大降低了间隔期癌症的发病率。
