Public Health Scotland, Edinburgh, UK.
Centre for Research into Cancer Prevention and Screening, University of Dundee, Dundee, UK.
Eur J Public Health. 2023 Apr 1;33(2):331-335. doi: 10.1093/eurpub/ckad029.
Colorectal cancer (CRC) screening using faecal tests reduces disease-specific mortality. To investigate mortality and its association with sex, rates in women and men, and in different age ranges, were examined, before and after screening began in Scotland.
From 1990-99, no structured screening existed. Three pilots ran from 2000 to 2007 and subsequent full roll-out completed in 2009. Crude mortality rates for 1990-2020 were calculated relative to Scottish population estimates, and age-sex standardized rates calculated for all, pre-screening (<50 years), screening (5-74 years) and post-screening (>74 years) age ranges.
CRC mortality declined from 1990 to 2020, but not linearly, and differed between sexes. In women, 1990-99 showed a steady decline [average annual percentage change (AAPC): -2.1%, 95% confidence interval (CI): -2.8% to -1.4%], but a less marked decline after 2000 (AAPC: -0.7%, 95% CI: -0.9% to -0.4%). In men, no clear decline was seen from 1990 to 1999 (AAPC: -0.4%, 95% CI: -1.1% to 0.4%), but mortality declined from 2000 to 2020 (AAPC: -1.7%, 95% CI: -1.9% to -1.5%). This pattern was exaggerated in the screening age ranges. For 2000-20, the overall reduction in mortality was less in women and in the screening age range. In the post-screening age range, reductions were smaller, but an increase was seen in the pre-screening age range, greater in women.
CRC mortality fell during 1990-2020, but the decline differed markedly between sexes, indicating a larger beneficial effect of screening on CRC mortality in men compared to women: use of different thresholds for the sexes might lead to equality.
粪便检测用于结直肠癌（CRC）筛查可降低特定疾病死亡率。为了研究死亡率及其与性别、女性和男性中的死亡率以及不同年龄范围的关系，我们在苏格兰开始筛查之前和之后对这些数据进行了检查。
1990-99 年，尚无结构化筛查。2000-2007 年进行了三项试验，随后于 2009 年全面铺开。计算了 1990-2020 年的粗死亡率，与苏格兰人口估计值相关，并计算了所有人群（<50 岁）、筛查（5-74 岁）和筛查后（>74 岁）年龄组的年龄性别标准化率。
CRC 死亡率从 1990 年下降到 2020 年，但并非线性下降，而且男女之间存在差异。在女性中，1990-99 年死亡率呈稳步下降趋势[平均年变化百分比（AAPC）：-2.1%，95%置信区间（CI）：-2.8%至-1.4%]，但 2000 年后下降幅度较小（AAPC：-0.7%，95% CI：-0.9%至-0.4%）。在男性中，1990-1999 年死亡率没有明显下降（AAPC：-0.4%，95% CI：-1.1%至 0.4%），但 2000 年至 2020 年死亡率下降（AAPC：-1.7%，95% CI：-1.9%至-1.5%）。这种模式在筛查年龄范围内更为明显。对于 2000-20 年，女性和筛查年龄范围内的死亡率总体下降幅度较小。在筛查后年龄范围内，降幅较小，但筛查前年龄范围内的死亡率有所上升，女性的增幅更大。
1990-2020 年期间，CRC 死亡率下降，但男女之间的下降幅度差异显著，表明筛查对男性 CRC 死亡率的益处明显大于女性：对男女使用不同的阈值可能会导致平等。
