Centre for Research into Cancer Prevention and Screening, University of Dundee, Dundee, Dundee, Scotland, UK.
Public Health Scotland, Edinburgh, Scotland, UK.
J Med Screen. 2023 Dec;30(4):184-190. doi: 10.1177/09691413231175611. Epub 2023 May 25.
This study aimed to develop a risk-scoring model in the Scottish Bowel Screening Programme incorporating faecal haemoglobin concentration with other risk factors for colorectal cancer.
Data were collected for all individuals invited to participate in the Scottish Bowel Screening Programme between November 2017 and March 2018 including faecal haemoglobin concentration, age, sex, National Health Service Board, socioeconomic status, and screening history. Linkage with The Scottish Cancer Registry identified all screening participants diagnosed with colorectal cancer. Logistic regression was performed to identify which factors demonstrated significant association with colorectal cancer and could be used in the development of a risk-scoring model.
Of 232,076 screening participants, 427 had colorectal cancer: 286 diagnosed following a screening colonoscopy and 141 arising after a negative screening test result giving an interval cancer proportion of 33.0%. Only faecal haemoglobin concentration and age showed a statistically significant association with colorectal cancer. Interval cancer proportion increased with age and was higher in women (38.1%) than men (27.5%). If positivity in women were mirrored in men at each age quintile interval cancer proportion would still have remained higher in women (33.2%). Moreover, an additional 1201 colonoscopies would be required to detect 11 colorectal cancers.
Development of a risk scoring model using early data from the Scottish Bowel Screening Programme was not feasible due to most variables showing insignificant association with colorectal cancer. Tailoring the faecal haemoglobin concentration threshold according to age could help to diminish some of the disparity in interval cancer proportion between women and men. Strategies to achieve sex equality using faecal haemoglobin concentration thresholds depend considerably on which variable is selected for equivalency and this requires further exploration.
本研究旨在建立苏格兰结直肠筛查计划中的风险评分模型，将粪便血红蛋白浓度与结直肠癌的其他危险因素结合起来。
收集了 2017 年 11 月至 2018 年 3 月期间所有受邀参加苏格兰结直肠筛查计划的个体的数据，包括粪便血红蛋白浓度、年龄、性别、国民保健制度委员会、社会经济地位和筛查史。与苏格兰癌症登记处的链接确定了所有筛查参与者中被诊断为结直肠癌的患者。采用逻辑回归确定哪些因素与结直肠癌有显著关联，并可用于开发风险评分模型。
在 232076 名筛查参与者中，有 427 人患有结直肠癌：286 人在筛查结肠镜检查后确诊，141 人在阴性筛查结果后出现，间隔期癌症比例为 33.0%。只有粪便血红蛋白浓度和年龄与结直肠癌有统计学显著关联。间隔期癌症比例随年龄增长而增加，女性（38.1%）高于男性（27.5%）。如果女性的阳性率在每个年龄五分位数间隔期内都与男性相同，那么女性的间隔期癌症比例仍将高于男性（33.2%）。此外，还需要额外进行 1201 次结肠镜检查才能发现 11 例结直肠癌。
由于大多数变量与结直肠癌的关联不显著，因此使用苏格兰结直肠筛查计划的早期数据开发风险评分模型是不可行的。根据年龄调整粪便血红蛋白浓度阈值可能有助于减少女性和男性之间间隔期癌症比例的差异。使用粪便血红蛋白浓度阈值实现性别平等的策略在很大程度上取决于选择哪个变量作为等效性，这需要进一步探讨。
