University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, 8930, Randers NØ, Denmark.
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
BMC Gastroenterol. 2022 May 20;22(1):256. doi: 10.1186/s12876-022-02331-9.
Guidelines on colorectal cancer (CRC) screening recommend screening of average-risk adults only. In addition, screening of individuals with active inflammatory bowel disease (IBD) might result in too many false-positive cases. However, the organisers of CRC screening programmes are often uninformed of whom to exclude due to an elevated CRC risk or active IBD. It is therefore unknown how often high-risk individuals (i.e. individuals with a previous diagnosis of CRC or polyps associated with hereditary CRC syndromes and certain patient groups with a diagnosis of inflammatory bowel disease (IBD) or multiple polyps) and individuals with active IBD participate in CRC screening following invitation.
We used data from the first two years of the Danish CRC screening programme (2014-2015). Information on invitations, participations and FIT test results were obtained from the national screening database, while information on previous CRC, hereditary CRC syndromes, IBD or multiple polyps diagnoses were obtained from the Danish Cancer Registry and the Danish Patient Register. Screening participation rates and FIT-positive rates were calculated and compared for high-risk invitees, invitees having IBD and an average risk group of remaining invitees not diagnosed with colorectal polyps in 10 years preceding the invitation.
When invited to CRC screening, 28-48% of high-risk residents (N: 29; 316; 5584) and 55% of residents with IBD (N: 2217; 6927) chose to participate. The participation rate was significantly higher (67%) among residents without previous colorectal disease, i.e. the average risk group (N = 585,624). In this average group 6.7% of the participants had a positive FIT test. The proportion of positive FIT results was higher among all disease groups (7.7-14.8%), though not statistically significant for participants with prior CRC diagnosis and participants with high-risk IBD.
When high-risk residents and residents with IBD receive an invitation to CRC screening, many participate despite being recommended not to. The screening program was not intended for these groups and further research is needed as several of these groups have a higher rate of positive screening result than the average risk population.
结直肠癌（CRC）筛查指南建议仅对一般风险的成年人进行筛查。此外，对活动性炎症性肠病（IBD）患者进行筛查可能会导致过多的假阳性病例。然而，CRC 筛查计划的组织者通常由于 CRC 风险升高或活动性 IBD 而不知道应排除哪些人。因此，目前尚不清楚有多少高风险个体（即既往诊断为 CRC 或与遗传性 CRC 综合征相关的息肉，以及诊断为炎症性肠病（IBD）或多发性息肉的某些患者群体）和活动性 IBD 患者会在接到邀请后参加 CRC 筛查。
我们使用了丹麦 CRC 筛查计划头两年（2014-2015 年）的数据。邀请、参与和 FIT 检测结果的信息来自全国筛查数据库，而既往 CRC、遗传性 CRC 综合征、IBD 或多发性息肉诊断的信息则来自丹麦癌症登记处和丹麦患者登记处。对于高风险受邀者、患有 IBD 的受邀者以及在受邀前 10 年内未被诊断为结直肠息肉的剩余受邀者的平均风险组，我们计算并比较了筛查参与率和 FIT 阳性率。
当被邀请参加 CRC 筛查时，28-48%的高风险居民（N：29；316；5584）和 55%的 IBD 居民（N：2217；6927）选择参与。在没有既往结直肠疾病的居民（即平均风险组，N=585624）中，参与率显著更高（67%）。在这个平均组中，有 6.7%的参与者 FIT 检测呈阳性。所有疾病组的阳性 FIT 结果比例都较高（7.7-14.8%），但对于既往 CRC 诊断的参与者和高风险 IBD 的参与者来说，这一比例没有统计学意义。
当高风险居民和 IBD 居民收到 CRC 筛查邀请时，尽管他们被建议不要参与，但仍有许多人参与。该筛查计划并非针对这些人群，需要进一步研究，因为这些人群中的阳性筛查结果比例高于一般风险人群。
