Lee Hyeon Ji, Lee Kyeongmin, Kim Byung Chang, Jun Jae Kwan, Choi Kui Son, Suh Mina
National Cancer Control Institute, National Cancer Center, Goyang 10408, Republic of Korea.
Department of Cancer Control and Policy, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang 10408, Republic of Korea.
Cancers (Basel). 2024 Dec 23;16(24):4278. doi: 10.3390/cancers16244278.
Whether colorectal cancer (CRC) screening with a fecal immunochemical test (FIT) reduces mortality remains unclear. In South Korea, CRC screening with a FIT for individuals aged ≥ 50 years has been part of the Korean National Cancer Screening Program (KNCSP) since 2004. The aim of this study was to evaluate the effectiveness of the KNCSP in reducing CRC-specific mortality.
We conducted a nested case-control study using cohort-based data derived from the KNCSP database. The cohort included 5,944,540 colorectal cancer-free individuals aged ≥ 50 years as of 2004. Individuals who died after CRC diagnosis were defined as cases ( = 29,992) and their sociodemographic characteristics were matched to those of the selected controls. The effects of screening exposure, frequency, and time interval on CRC-specific mortality were analyzed according to age group. Conditional logistic regression analysis was performed.
Compared with individuals who had never been screened, those who had ever been screened showed an OR of 0.74 (95% CI, 0.71-0.76) for CRC-specific mortality. CRC-specific mortality decreased as the number of screenings increased. Similar results were observed for those aged 50-79 years; however, the results for those aged 75-79 years were not statistically significant. Moreover, those aged ≥ 80 years had the opposite results.
CRC mass screening using FIT is effective for individuals aged 50-74 years; therefore, this study suggests that countries considering introducing national CRC screening implement FIT for those within this age range.
粪便免疫化学检测（FIT）用于结直肠癌（CRC）筛查是否能降低死亡率尚不清楚。在韩国，自2004年起，针对年龄≥50岁人群的FIT CRC筛查已成为韩国国家癌症筛查计划（KNCSP）的一部分。本研究旨在评估KNCSP在降低CRC特异性死亡率方面的有效性。
我们使用来自KNCSP数据库的队列数据进行了一项巢式病例对照研究。该队列包括截至2004年年龄≥50岁的5,944,540名无结直肠癌个体。CRC诊断后死亡的个体被定义为病例（n = 29,992），并将其社会人口统计学特征与所选对照进行匹配。根据年龄组分析筛查暴露、频率和时间间隔对CRC特异性死亡率的影响。进行了条件逻辑回归分析。
与从未接受过筛查的个体相比，曾经接受过筛查的个体CRC特异性死亡率的比值比（OR）为0.74（95%置信区间，0.71 - 0.76）。CRC特异性死亡率随着筛查次数的增加而降低。50 - 79岁人群也观察到了类似结果；然而，75 - 79岁人群的结果无统计学意义。此外，≥80岁人群的结果相反。
使用FIT进行CRC群体筛查对50 - 74岁个体有效；因此，本研究表明，考虑引入国家CRC筛查的国家应对该年龄范围内的人群实施FIT筛查。
