Clark Gavin Rc, Godfrey Thomas, Purdie Calum, Strachan Judith, Carey Francis A, Fraser Callum G, Steele Robert Jc
Centre for Research into Cancer Prevention and Screening, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK.
Public Health Scotland, Edinburgh, UK.
J Med Screen. 2024 Mar;31(1):21-27. doi: 10.1177/09691413231188252. Epub 2023 Jul 19.
To compare interval cancer proportions (ICP) in the faecal immunochemical test (FIT)-based Scottish Bowel Screening Programme (SBoSP) with the former guaiac faecal occult blood test (gFOBT)-based SBoSP and investigate associations between interval cancer (IC) and faecal haemoglobin concentration (f-Hb) threshold, sex, age, deprivation, site, and stage.
The ICP data from first year of the FIT-based SBoSP and the penultimate year of the gFOBT-based SBoSP were compared in a prospective cohort design.
With FIT, 801 colorectal cancers (CRCs) were screen detected (SDC), 802 were in non-participants, 548 were ICs, 39 were colonoscopy missed and 72 were diagnosed after incomplete screening; with gFOBT: 540, 904, 556, 45, and 13, respectively. FIT had a significantly higher proportion of SDC compared to IC than gFOBT. For FIT and gFOBT, ICP was significantly higher in women than men. As f-Hb threshold increased, ICP increased and, for any f-Hb threshold for men, a lower threshold was required for comparable ICP in women. In Scotland, the current threshold of ≥80 µg Hb/g faeces would have to be lowered to ≥40 µg Hb/g faeces for women to achieve sex equality for ICP. In the FIT-based SBoSP, there were four times as many stage I SDC than IC. This was reversed in advanced stages, with twice as many stage IV CRC diagnosed as IC versus SDC.
Reducing the numbers of IC requires lowering the f-Hb threshold. Using different f-Hb thresholds for women and men could eliminate the sex disparity, but with additional colonoscopy.
比较基于粪便免疫化学检测（FIT）的苏格兰肠道筛查计划（SBoSP）与之前基于愈创木脂粪便潜血试验（gFOBT）的SBoSP中的间期癌比例（ICP），并研究间期癌（IC）与粪便血红蛋白浓度（f-Hb）阈值、性别、年龄、贫困程度、部位和分期之间的关联。
采用前瞻性队列设计，比较基于FIT的SBoSP第一年和基于gFOBT的SBoSP倒数第二年的ICP数据。
使用FIT时，筛查发现（SDC）801例结直肠癌（CRC），非参与者中有802例，IC有548例，结肠镜检查漏诊39例，不完全筛查后诊断出72例；使用gFOBT时，分别为540例、904例、556例、45例和13例。与gFOBT相比，FIT的SDC比例显著高于IC。对于FIT和gFOBT，女性的ICP显著高于男性。随着f-Hb阈值的增加，ICP增加，对于男性的任何f-Hb阈值，女性需要更低的阈值才能达到可比的ICP。在苏格兰，要实现ICP的性别平等，目前≥80μg Hb/g粪便的阈值必须降低到女性≥40μg Hb/g粪便。在基于FIT的SBoSP中，I期SDC的数量是IC的四倍。在晚期则相反，IV期CRC诊断为IC的数量是SDC的两倍。
减少IC数量需要降低f-Hb阈值。对男性和女性使用不同的f-Hb阈值可以消除性别差异，但需要增加结肠镜检查。
