英格兰国家肠癌筛查计划中筛查间隔和粪便免疫化学检测阈值变化的影响：FIT 试点研究结果。
Impact of changes to the interscreening interval and faecal immunochemical test threshold in the national bowel cancer screening programme in England: results from the FIT pilot study.
机构信息
Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK.
出版信息
Br J Cancer. 2022 Nov;127(8):1525-1533. doi: 10.1038/s41416-022-01919-y. Epub 2022 Aug 17.
INTRODUCTION
The NHS Bowel Cancer Screening Programme (BCSP) faces endoscopy capacity challenges from the COVID-19 pandemic and plans to lower the screening starting age. This may necessitate modifying the interscreening interval or threshold.
METHODS
We analysed data from the English Faecal Immunochemical Testing (FIT) pilot, comprising 27,238 individuals aged 59-75, screened for colorectal cancer (CRC) using FIT. We estimated screening sensitivity to CRC, adenomas, advanced adenomas (AA) and mean sojourn time of each pathology by faecal haemoglobin (f-Hb) thresholds, then predicted the detection of these abnormalities by interscreening interval and f-Hb threshold.
RESULTS
Current 2-yearly screening with a f-Hb threshold of 120 μg/g was estimated to generate 16,092 colonoscopies, prevent 186 CRCs, detect 1142 CRCs, 7086 adenomas and 4259 AAs per 100,000 screened over 15 years. A higher threshold at 180 μg/g would reduce required colonoscopies to 11,500, prevent 131 CRCs, detect 1077 CRCs, 4961 adenomas and 3184 AAs. A longer interscreening interval of 3 years would reduce required colonoscopies to 10,283, prevent 126 and detect 909 CRCs, 4796 adenomas and 2986 AAs.
CONCLUSION
Increasing the f-Hb threshold was estimated to be more efficient than increasing the interscreening interval regarding overall colonoscopies per screen-benefited cancer. Increasing the interval was more efficient regarding colonoscopies per cancer prevented.
简介
NHS 肠癌筛查计划（BCSP）面临着 COVID-19 大流行带来的内镜检查能力挑战，并计划降低筛查起始年龄。这可能需要修改筛查间隔或阈值。
方法
我们分析了来自英格兰粪便免疫化学检测（FIT）试点的数据，该试点纳入了 27238 名年龄在 59-75 岁之间的个体，使用 FIT 筛查结直肠癌（CRC）。我们通过粪便血红蛋白（f-Hb）阈值估计了 CRC、腺瘤、高级别腺瘤（AA）的筛查敏感性和每种病理的平均居留时间，然后预测了通过筛查间隔和 f-Hb 阈值检测这些异常的情况。
结果
目前每 2 年进行一次筛查，f-Hb 阈值为 120μg/g，预计在 15 年内每 10 万人筛查中可进行 16092 次结肠镜检查，预防 186 例 CRC，检出 1142 例 CRC、7086 例腺瘤和 4259 例 AA。将阈值提高到 180μg/g 可将所需结肠镜检查减少到 11500 次，预防 131 例 CRC，检出 1077 例 CRC、4961 例腺瘤和 3184 例 AA。筛查间隔延长至 3 年，将所需结肠镜检查减少到 10283 次，预防 126 例，检出 909 例 CRC、4796 例腺瘤和 2986 例 AA。
结论
与增加筛查间隔相比，增加 f-Hb 阈值估计在每筛查获益癌症的结肠镜检查数量方面更有效。增加间隔在预防的癌症每例结肠镜检查数量方面更有效。
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