Department of Gastroenterology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; Colonoscopy Unit of the Colorectal Surgical Division, Department of Gastroenterology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
Department of Gastroenterology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
Clin Gastroenterol Hepatol. 2024 Aug;22(8):1719-1727.e1. doi: 10.1016/j.cgh.2024.01.033. Epub 2024 Feb 9.
BACKGROUND & AIMS: Organized colorectal cancer (CRC) screening is not widely practiced in Latin America and the results of regional studies may help overcome barriers for implementation of national screening programs. We aimed to describe the implementation and findings of a fecal immunochemical test (FIT)-based program in Brazil.
In a prospective population-based study, asymptomatic individuals (50-75 years old) from Sao Paulo city were invited to undergo FIT for CRC screening. Participants with positive FIT (≥10 μg Hb/g feces) were referred for colonoscopy. Subjects were classified into groups according to the presence of CRC, precursor lesions, and other benign findings, possibly related to bleeding.
Of a total of 9881 subjects, 7.8% had positive FIT and colonoscopy compliance was 68.9% (n = 535). Boston scale was considered adequate in 99% and cecal intubation rate was 99.4%. CRC was diagnosed in 5.9% of the cases, adenoma in 63.2%, advanced adenoma in 31.4%, and advanced neoplasia in 33.0%. Age was positively associated with CRC (P = .03). Higher FIT concentrations were associated with increased detection of CRC (P < .008), advanced adenoma (P < .001), and advanced neoplasia (P < .001).
Implementation of a FIT-based CRC screening program was feasible in a low-resource setting, and there was a high yield for neoplasia in individuals with a positive FIT. This approach could be used as a model to plan and disseminate organized CRC screening more broadly in Brazil and Latin America.
在拉丁美洲，结直肠癌（CRC）的有组织筛查并未广泛开展，区域性研究的结果可能有助于克服实施国家筛查计划的障碍。本研究旨在描述巴西基于粪便免疫化学检测（FIT）的筛查项目的实施情况和结果。
在一项前瞻性的基于人群的研究中，邀请来自圣保罗市的无症状个体（50-75 岁）进行 CRC 筛查用 FIT。FIT 阳性（≥10 μg Hb/g 粪便）的参与者被转诊行结肠镜检查。根据是否存在 CRC、癌前病变和其他可能与出血相关的良性发现，将受试者分为不同组别。
在总共 9881 名受试者中，7.8%的 FIT 检测结果为阳性，结肠镜检查的依从率为 68.9%（n=535）。Boston 评分被认为是足够的占 99%，盲肠插管率为 99.4%。5.9%的病例诊断为 CRC，63.2%为腺瘤，31.4%为高级别腺瘤，33.0%为高级别肿瘤。年龄与 CRC 呈正相关（P=0.03）。较高的 FIT 浓度与 CRC（P<0.008）、高级别腺瘤（P<0.001）和高级别肿瘤（P<0.001）的检出率增加相关。
在资源有限的环境下，实施基于 FIT 的 CRC 筛查计划是可行的，并且在 FIT 阳性的个体中，肿瘤的检出率较高。这种方法可作为在巴西和拉丁美洲更广泛地计划和推广有组织 CRC 筛查的模型。
