Cardoso Rafael, Guo Feng, Heisser Thomas, Hoffmeister Michael, Brenner Hermann
Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany.
Medical Faculty Heidelberg, University of Heidelberg, 69120 Heidelberg, Germany.
Cancers (Basel). 2020 May 29;12(6):1409. doi: 10.3390/cancers12061409.
In the past two decades, an extensive rollout of colorectal cancer (CRC) screening programmes has been initiated in European countries with a large heterogeneity of screening offers. Using data from a population-based cross-sectional survey conducted between 2013 and 2016 in all European Union countries, we analysed the utilisation of faecal tests and colonoscopy among people aged 50-74 years and the factors associated with uptake by type of screening offer. We observed the highest utilisation of either test for countries with fully rolled out organised programmes with faecal tests (ranging from 29.7% in Croatia to 66.7% in the UK) and countries offering both faecal tests and colonoscopy (from 22.7% in Greece to 70.9% in Germany). Utilisation was very low for countries with no programme (from 6.3% in Romania to 30.5% in Norway). Younger age (50-54 years), longer time since last consultation with a doctor and a lifestyle score associated with increased CRC risk were significantly associated with lower test use, a pattern observed across all types of screening offers. Our results suggest that more countries should implement organised programmes with faecal immunochemical tests, in combination with alternative endoscopy offers where resources allow. Furthermore, there is a large potential for increasing screening use in Europe by better reaching the younger eligible individuals, those who have not been to the doctor recently and those at increased risk for CRC.
在过去二十年中，欧洲国家已广泛开展结直肠癌（CRC）筛查项目，筛查服务存在很大差异。利用2013年至2016年在所有欧盟国家进行的一项基于人群的横断面调查数据，我们分析了50至74岁人群中粪便检测和结肠镜检查的使用情况，以及与不同筛查服务类型的接受率相关的因素。我们观察到，对于全面推行有组织的粪便检测项目的国家（从克罗地亚的29.7%到英国的66.7%）以及同时提供粪便检测和结肠镜检查的国家（从希腊的22.7%到德国的70.9%），这两种检测的使用率最高。对于没有项目的国家，使用率非常低（从罗马尼亚的6.3%到挪威的30.5%）。年龄较小（50至54岁）、距离上次看医生时间较长以及与CRC风险增加相关的生活方式评分与较低的检测使用率显著相关，这一模式在所有类型的筛查服务中都有观察到。我们的结果表明，更多国家应实施有组织的粪便免疫化学检测项目，并在资源允许的情况下结合其他内镜检查服务。此外，通过更好地覆盖年轻的符合条件个体、近期未看过医生的个体以及CRC风险增加的个体，欧洲在提高筛查使用率方面有很大潜力。
