Ola Idris, Cardoso Rafael, Hoffmeister Michael, Brenner Hermann
Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120, Heidelberg, Germany.
Medical Faculty Heidelberg, University of Heidelberg, 69120, Heidelberg, Germany.
Eur J Epidemiol. 2025 Jun 17. doi: 10.1007/s10654-025-01247-4.
Despite increasing implementation of colorectal cancer (CRC) screening programs in Europe, utilization of screening tests has varied significantly over the years. We examined recent trends in the utilization of colonoscopy and fecal occult blood test (FOBT), the primary tests recommended for CRC screening, across European countries with various screening programs. Population-based data from the second and third waves of the European Health Interview Survey (EHIS) were analyzed to determine changes in utilization of fecal occult blood test within the preceding 2 years or colonoscopy within the preceding 10 years among people aged 50-74 years between 2013-2015 and 2018-2020. Absolute percentage changes (APC) in screening test use were calculated in each country and subgroup meta-analyses were conducted using random effects models to estimate the pooled APCs and their 95% confidence intervals across different categories of screening offers. A total of 234,251 respondents across 28 European countries were included in the analysis. The increase in use of either test was highest among countries which fully rolled out nationwide organized screening programs with fecal tests between 2013-2015 and 2018-2020 (increases ranging from 19.1% units in Belgium to 46.3% units in The Netherlands) and was lowest among countries with opportunistic offering of fecal test, colonoscopy or flexible sigmoidoscopy (from - 3% units in Germany to + 12.2% units in Slovakia). Changes in screening programs were strongly associated with higher rates of utilization of colonoscopy and fecal occult blood test across all screening offers. Our findings highlight that well-organized and dynamic population screening strategies can rapidly and sustainably increase utilization of CRC screening tests in Europe.
尽管欧洲结直肠癌（CRC）筛查项目的实施越来越多，但多年来筛查测试的利用率差异很大。我们研究了结肠镜检查和粪便潜血试验（FOBT）这两种CRC筛查推荐的主要测试在欧洲各国不同筛查项目中的近期使用趋势。分析了欧洲健康访谈调查（EHIS）第二波和第三波基于人群的数据，以确定2013 - 2015年至2018 - 2020年期间50 - 74岁人群在前两年内粪便潜血试验或前十年内结肠镜检查的使用变化。计算每个国家筛查测试使用的绝对百分比变化（APC），并使用随机效应模型进行亚组荟萃分析，以估计不同筛查类别中汇总的APC及其95%置信区间。分析纳入了28个欧洲国家的234,251名受访者。在2013 - 2015年至2018 - 2020年期间全面开展全国性有组织粪便检测筛查项目的国家中，两种测试的使用增加幅度最大（比利时增加19.1个百分点至荷兰增加46.3个百分点），而在机会性提供粪便检测、结肠镜检查或乙状结肠镜检查的国家中增加幅度最小（从德国的 - 3个百分点到斯洛伐克的 + 12.2个百分点）。筛查项目的变化与所有筛查项目中结肠镜检查和粪便潜血试验的更高利用率密切相关。我们的研究结果强调，组织良好且动态的人群筛查策略可以迅速且可持续地提高欧洲CRC筛查测试的利用率。
