Pham Lily A, Clark Paul J, Macdonald Graeme A, Thomas James A, Dalais Christine, Fonda Annie, Kendall Bradley J, Thrift Aaron P
Faculty of Medicine, University of Queensland, Brisbane, Australia.
Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia.
EClinicalMedicine. 2024 May 25;73:102666. doi: 10.1016/j.eclinm.2024.102666. eCollection 2024 Jul.
First Nations populations have poorer colorectal cancer (CRC) survival compared to non-First Nations populations. Whilst First Nations populations across the world are distinct, shared experiences of discrimination and oppression contribute to persistent health inequities. CRC screening improves survival, however screening rates in First Nations populations are poorly described. This study seeks to define participation rates in CRC screening in First Nations populations worldwide.
A systematic literature search was conducted of PubMed, Embase, Cochrane Library, CINAHL, MEDLINE, grey literature, national registries and ClinicalTrials.gov. All sources were searched from their inception date to 18 February 2024. Studies were included if they reported CRC screening rates in adult (≥18 years) First Nations populations. We aimed to undertake a meta-analysis if there were sufficient data. Quality of papers were assessed using the Joanna Briggs Institute (JBI) appraisal tool. The study was registered with PROSPERO, CRD42020210181.
The literature search identified 1723 potentially eligible published studies. After review, 57 studies were included, 50 from the United States (US), with the remaining studies from Australia, Aotearoa New Zealand (NZ), Canada, Dominica and Guatemala. Additionally, eleven non-indexed reports from national programs in Australia and NZ were included. There were insufficient data to undertake meta-analysis, therefore a systematic review and narrative synthesis were conducted. CRC screening definitions varied, and included stool-based screening, sigmoidoscopy and colonoscopy. US First Nations screening rates ranged between 4.0 and 79.2%, Australia reported 10.6-35.2%, NZ 18.4-49%, Canada 22.4-53.4%, Guatemala 2.2% and Dominica 4.2%. Fifty-five studies were assessed as moderate or high quality and two as low quality.
Our findings suggested that there is wide variation in CRC screening participation rates across First Nations populations. Screening data are lacking in direct comparator groups and longitudinal outcomes. Disaggregation of screening data are required to better understand and address First Nations CRC outcome inequities.
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与非原住民相比，原住民的结直肠癌（CRC）生存率更低。尽管世界各地的原住民群体各不相同，但共同的歧视和压迫经历导致了持续存在的健康不平等。CRC筛查可提高生存率，然而，原住民群体的筛查率却鲜有描述。本研究旨在确定全球原住民群体中CRC筛查的参与率。
对PubMed、Embase、Cochrane图书馆、CINAHL、MEDLINE、灰色文献、国家登记处和ClinicalTrials.gov进行了系统的文献检索。所有来源均从其创建日期检索至2024年2月18日。如果研究报告了成年（≥18岁）原住民群体的CRC筛查率，则纳入研究。如果有足够的数据，我们旨在进行荟萃分析。使用乔安娜·布里格斯研究所（JBI）评估工具评估论文质量。该研究已在PROSPERO注册，注册号为CRD42020210181。
文献检索确定了1723项潜在符合条件的已发表研究。经过审查，纳入了57项研究，其中50项来自美国，其余研究来自澳大利亚、新西兰、加拿大、多米尼克和危地马拉。此外，还纳入了来自澳大利亚和新西兰国家项目的11份非索引报告。没有足够的数据进行荟萃分析，因此进行了系统评价和叙述性综合分析。CRC筛查的定义各不相同，包括基于粪便的筛查、乙状结肠镜检查和结肠镜检查。美国原住民的筛查率在4.0%至79.2%之间，澳大利亚报告为10.6%-35.2%，新西兰为18.4%-49%，加拿大为22.4%-53.4%，危地马拉为2.2%，多米尼克为4.2%。55项研究被评估为中等或高质量，两项为低质量。
我们的研究结果表明，原住民群体的CRC筛查参与率差异很大。缺乏直接对照群体和纵向结果的筛查数据。需要对筛查数据进行分类，以更好地理解和解决原住民CRC结果的不平等问题。
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