Test, episode, and programme sensitivities of screening for colorectal cancer as a public health policy in Finland: experimental design
Test, episode, and programme sensitivities of screening for colorectal cancer as a public health policy in Finland: experimental design
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DOI：
10.1136/bmj.a2261
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发表时间：
2008-11-20
影响因子：
105.7
通讯作者：
Hakama, Matti
中科院分区：
文献类型：
--
作者：
Malila, Nea;Oivanen, Tiina;Hakama, Matti
目的报告粪便潜血试验的敏感性、筛查次数、结肠直肠癌的筛查计划以及在新的公共卫生政策的实施阶段应用随机设计的好处。设计在目标人群中使用个体水平随机化的公共卫生评估中纳入的实验设计。2004年设置了芬兰431个城市中的161个-6.参与者106000名成年人随机分配到筛选组或对照组。筛查组共有52998名年龄在60- 64岁的成年人接受了粪便潜血检测试剂盒。主要结果指标通过发病率方法估计的检测、发作和程序敏感性，并对选择性就诊和过度诊断进行了校正。（70.8%），女性（78.1%）明显优于男性（63.3%）。在对照组中，男性的癌症发病率略高于女性（103比93/100 000人年），而间隔期癌症的发病率则不同（42比49/100 000人年）。粪便潜血试验的敏感性为54.6%。在检测结果呈阳性的患者中，仅检测到少数间隔癌症，因此51.3%的发作灵敏度接近检测灵敏度。在人群水平上，该项目的敏感性为37.5%。结论虽然相对较低，但在芬兰，粪便潜血试验筛查结直肠癌的敏感性是足够的。实验设计是评价这种筛查方案的先决条件，因为预防死亡的有效性可能很小，否则结果可能仍然是不确定的。因此，应在公共卫生计划中启动使用任何主要检测方式进行结直肠癌筛查，并在实施阶段对目标人群进行随机化。
Objectives To report the sensitivities of the faecal occult blood test, screening episode, and screening programme for colorectal cancer and the benefits of applying a randomised design at the implementation phase of a new public health policy.Design Experimental design incorporated in public health evaluation using randomisation at individual level in the target population.Setting 161 of the 431 Finnish municipalities in 2004- 6.Participants 106 000 adults randomised to screening or control arms. In total, 52 998 adults aged 60- 64 in the screening arm received faecal occult blood test kits.Main outcome measures Test, episode, and programme sensitivities estimated by the incidence method and corrected for selective attendance and overdiagnosis.Results The response for screening was high overall ( 70.8%), and significantly better in women ( 78.1%) than in men ( 63.3%). The incidence of cancer in the controls was somewhat higher in men than in women ( 103 v 93 per 100 000 person years), which was not true for interval cancers ( 42 v 49per 100 000 person years). The sensitivity of the faecal occult blood test was 54.6%. Only a few interval cancers were detected among those with positive test results, hence the episode sensitivity of 51.3% was close to the test sensitivity. At the population level the sensitivity of the programme was 37.5%.Conclusions Although relatively low, the sensitivity of screening for colorectal cancer with the faecal occult blood test in Finland was adequate. An experimental design is a prerequisite for evaluation of such a screening programme because the effectiveness of preventing deaths is likely to be small and results may otherwise remain inconclusive. Thus, screening for colorectal cancer using any primary test modality should be launched in a public health programme with randomisation of the target population at the implementation phase.