Centre for Cancer Detection, 8000 Bruges, Belgium.
Family Medicine and Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium.
Int J Environ Res Public Health. 2023 Jan 16;20(2):1654. doi: 10.3390/ijerph20021654.
The faecal immunochemical test (FIT) has been increasingly used for organised colorectal cancer (CRC) screening. We assessed the impact of a six-year existing FIT screening programme in Flanders (Belgium) on CRC incidence, mortality and survival. The Flemish CRC screening programme started in 2013, targeting individuals aged 50-74 years. Joinpoint regression was used to investigate trends of age-standardised CRC incidence and mortality among individuals aged 50-79 years (2004-2019). Their 5-year relative survival was calculated using the Ederer II method. We found that FIT screening significantly reduced CRC incidence, especially that of advanced-stage CRCs (69.8/100,000 in 2012 vs. 51.1/100,000 in 2019), with a greater impact in men. Mortality started to decline in men two years after organised screening implementation (annual reduction of 9.3% after 2015 vs. 2.2% before 2015). The 5-year relative survival was significantly higher in screen-detected (93.8%) and lower in FIT non-participant CRCs (61.9%) vs. FIT interval cancers and CRCs in never-invited cases (67.6% and 66.7%, respectively). Organised FIT screening in Flanders clearly reduced CRC incidence (especially advanced-stage) and mortality (in men, but not yet in women). Survival is significantly better in screen-detected cases vs. CRCs in unscreened people. Our findings support the implementation of FIT organised screening and the continued effort to increase uptake.
粪便免疫化学检测（FIT）已越来越多地用于结直肠癌（CRC）的有组织筛查。我们评估了在比利时佛兰德地区（Flanders）开展的六年 FIT 筛查计划对 CRC 发病率、死亡率和生存率的影响。佛兰德 CRC 筛查计划于 2013 年启动，目标人群为 50-74 岁人群。采用 Joinpoint 回归分析了 50-79 岁人群（2004-2019 年）CRC 发病率和死亡率的年龄标准化趋势。采用 Ederer II 法计算了 5 年相对生存率。我们发现，FIT 筛查显著降低了 CRC 的发病率，特别是晚期 CRC 的发病率（2012 年为 69.8/100,000，2019 年为 51.1/100,000），对男性的影响更大。在有组织筛查实施两年后，男性死亡率开始下降（2015 年后每年下降 9.3%，而 2015 年前每年下降 2.2%）。筛查发现的 CRC 的 5 年相对生存率明显更高（93.8%），而 FIT 非参与者的 CRC 的 5 年相对生存率明显更低（61.9%），FIT 间期癌症和未受邀人群的 CRC 的 5 年相对生存率分别为 67.6%和 66.7%。佛兰德地区有组织的 FIT 筛查明显降低了 CRC 的发病率（尤其是晚期）和死亡率（仅在男性中，尚未在女性中）。筛查发现的病例的生存率明显优于未筛查人群的 CRC。我们的研究结果支持实施 FIT 有组织筛查，并继续努力提高筛查参与率。
