Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Taiwan Cancer Registry, Taipei, Taiwan.
Am J Prev Med. 2024 Sep;67(3):339-349. doi: 10.1016/j.amepre.2024.04.012. Epub 2024 Apr 30.
Colorectal cancer (CRC) remains a significant public health concern. This study aims to provide a comprehensive understanding of the effectiveness of fecal immunochemical test (FIT) screening on CRC incidence and mortality, leveraging the scale of over 1.5 million randomly selected Taiwanese and more than 11.7 million person-years of follow-up.
This prospective cohort study merges data from 3 robust Taiwanese health databases: the CRC screening program, cancer registration, and death registration databases. Incidence and mortality rates of CRC were calculated based on age, sex, urbanization, and past screening status. Cox proportional hazard models were used to assess the association between screening statuses and CRC incidence or mortality, adjusting for age, sex, and urbanization levels. Statistical analysis of the data was conducted in 2021-2022.
FIT screening was associated with a 33% reduction in CRC incidence and a 47% reduction in mortality. The study identified a dose-response relationship between the fecal hemoglobin concentration (f-HbC) levels and CRC risk. Participants with consistent FIT-negative results had significantly reduced CRC incidence and mortality risks, while those with one or more positive FIT results faced increased risks. Notably, compliance with follow-up examinations after a positive FIT significantly lowered mortality risk.
This large-scale study validates the efficacy of FIT screening in reducing CRC incidence and mortality. It offers a nuanced understanding of how various screening statuses impact CRC risks, thus providing valuable insights for public health strategies aimed at CRC prevention.
结直肠癌（CRC）仍然是一个重大的公共卫生问题。本研究旨在通过利用超过 150 万随机选择的台湾人和超过 1170 万人年的随访数据，全面了解粪便免疫化学测试（FIT）筛查对 CRC 发病率和死亡率的有效性。
这是一项前瞻性队列研究，合并了来自 3 个强大的台湾健康数据库的数据：CRC 筛查计划、癌症登记和死亡登记数据库。CRC 的发病率和死亡率按年龄、性别、城市化程度和既往筛查状况计算。使用 Cox 比例风险模型来评估筛查状况与 CRC 发病率或死亡率之间的关联，同时调整年龄、性别和城市化水平。数据分析于 2021-2022 年进行。
FIT 筛查与 CRC 发病率降低 33%和死亡率降低 47%相关。该研究确定了粪便血红蛋白浓度（f-HbC）水平与 CRC 风险之间的剂量反应关系。FIT 结果持续阴性的参与者 CRC 发病率和死亡率风险显著降低，而有一次或多次阳性 FIT 结果的参与者则面临更高的风险。值得注意的是，阳性 FIT 后进行随访检查的依从性显著降低了死亡率风险。
这项大规模研究验证了 FIT 筛查在降低 CRC 发病率和死亡率方面的有效性。它提供了关于不同筛查状况如何影响 CRC 风险的细致理解，从而为旨在预防 CRC 的公共卫生策略提供了有价值的见解。
