Barré S, Leleu H, Vimont A, Kaufmanis A, Gendre I, Taleb S, De Bels F
Institut national du cancer, Boulogne-Billancourt, France.
Public Health Expertise, Paris, France.
Rev Epidemiol Sante Publique. 2020 Jun;68(3):171-177. doi: 10.1016/j.respe.2020.04.053. Epub 2020 May 13.
Colorectal cancer is the third most common cancer and the second most deadly in France. A Cochrane meta-analysis has confirmed the benefits of colorectal cancer screening. A nationwide colorectal screening program was set up in France in 2009 for medium-risk, asymptomatic people aged 50 to 74 years. It has been based, since 2015, on the Fecal Immunochemical Test. The participation rate for 2016-2017 was 34%, which is lower than the European objectives. The objective of this study was to evaluate the impact of the program at the current participation rate and at rates of 45% and 65%.
The epidemiological impact of the program was estimated from the results of an individual simulation model adapted from the Microsimulation Screening Analysis Colon model, calibrated and transposed to the French context. An initial analysis was conducted to estimate the individual impact of screening and a second for the entire eligible population, at various participation rates.
The test is associated with a lifetime reduction in the risk of colorectal cancer of 24% for men and 21% for women, and a reduction in the risk of death from colorectal cancer of 51% and 43% respectively. At the current level of participation, the program reduces incidence by 5% and mortality by 14% compared to no organized screening. The impact would be reduced by an additional 3% and 8% for participation rates of 45% and 65% respectively. Similarly, mortality would decrease by an additional 8% and 22%.
These results confirm that in a population at medium risk for colorectal cancer, the organised programme is an effective strategy for reducing its incidence. They also confirm that the achievement of European objectives remains a key issue for improving the effectiveness of organized screening. An evolution of immunological test delivery modalities could help to achieve these participation objectives.
在法国，结直肠癌是第三大常见癌症，也是第二大致死癌症。一项Cochrane荟萃分析证实了结直肠癌筛查的益处。2009年，法国为50至74岁的中度风险无症状人群设立了全国性结直肠癌筛查项目。自2015年起，该项目基于粪便免疫化学检测。2016 - 2017年的参与率为34%，低于欧洲目标。本研究的目的是评估该项目在当前参与率以及45%和65%参与率下的影响。
该项目的流行病学影响是通过一个根据微模拟筛查分析结肠模型改编的个体模拟模型的结果来估计的，该模型已校准并应用于法国的情况。进行了初步分析以估计筛查的个体影响，并在不同参与率下对整个符合条件的人群进行了第二次分析。
该检测与男性一生中患结直肠癌风险降低24%、女性降低21%相关，结直肠癌死亡风险分别降低51%和43%。与无组织筛查相比，在当前参与水平下，该项目使发病率降低5%，死亡率降低14%。参与率分别为45%和65%时，影响将分别再降低3%和8%。同样，死亡率将分别再降低8%和22%。
这些结果证实，在结直肠癌中度风险人群中，有组织的项目是降低其发病率的有效策略。它们还证实，实现欧洲目标仍然是提高有组织筛查有效性的关键问题。免疫检测交付方式的改进可能有助于实现这些参与目标。
