Real-Time Monitoring of Results During First Year of Dutch Colorectal Cancer Screening Program and Optimization by Altering Fecal Immunochemical Test Cut-Off Levels
Real-Time Monitoring of Results During First Year of Dutch Colorectal Cancer Screening Program and Optimization by Altering Fecal Immunochemical Test Cut-Off Levels
复制标题
DOI：
10.1053/j.gastro.2016.11.022
复制
发表时间：
2017-03-01
期刊：
影响因子：
29.4
通讯作者：
Lansdorp-Vogelaar, Iris
中科院分区：
文献类型：
--
作者：
Toes-Zoutendijk, Esther;van Leerdam, Monique E.;Lansdorp-Vogelaar, Iris
背景与目的：经过仔细的试点研究和规划，荷兰于2014年启动了国家结直肠癌（CRC）筛查计划，每两年进行一次粪便免疫化学检测（FIT）。开发了一个国家实时监测信息系统，以便及时进行评价。从该筛查项目的第一年收集数据，以确定计划和监测对最佳筛查项目性能的重要性。方法：采用正交设计法CRC筛查项目的国家信息系统记录了2014年发出的邀请、FIT试剂盒返回和结肠镜检查的数量。每周、每季度和每年测定经性别调整的参与率、阳性检测结果数量和晚期肿瘤的阳性预测值（PPV）。结果：2014年，共有741，914人被邀请参加FIT;其中，529，056人（71.3%; 95%CI，71.2%-71.4%）参加了FIT。项目实施几个月后，实时监测显示参与率和阳性检测结果（10.6%; 95% CI，10.5%-10.8%）高于预测值，PPV（42.1%; 95% CI，41.3%-42.9%）低于基于试点研究的预测值。为了减少不必要的结肠镜检查的负担并减轻结肠镜检查的能力，到2014年中期，阳性FIT结果的截止水平从15 μ g Hb/g粪便增加到47 μ g Hb/g粪便。该调整将阳性检测结果的百分比降低至6.7%（95% CI，6.6%-6.8%），并将PPV增加至49.1%（95% CI，48.3%-49.9%）。荷兰筛查项目的第一年共检测出2483例癌症和12,030例晚期腺瘤。结论：密切监测荷兰国家CRC筛查计划的实施情况，可以即时调整FIT截止水平，以优化计划绩效。
BACKGROUND & AIMS: After careful pilot studies and planning, the national screening program for colorectal cancer (CRC), with biennial fecal immunochemical tests (FITs), was initiated in The Netherlands in 2014. A national information system for real-time monitoring was developed to allow for timely evaluation. Data were collected from the first year of this screening program to determine the importance of planning and monitoring for optimal screening program performance. METHODS: The national information system of the CRC screening program kept track of the number of invitations sent in 2014, FIT kits returned, and colonoscopies performed. Age-adjusted rates of participation, the number of positive test results, and positive predictive values (PPVs) for advanced neoplasia were determined weekly, quarterly, and yearly. RESULTS: In 2014, there were 741,914 persons invited for FIT; of these, 529,056 (71.3%; 95% CI, 71.2%-71.4%) participated. A few months into the program, real-time monitoring showed that rates of participation and positive test results (10.6%; 95% CI, 10.5%-10.8%) were higher than predicted and the PPV was lower (42.1%; 95% CI, 41.3%-42.9%) than predicted based on pilot studies. To reduce the burden of unnecessary colonoscopies and alleviate colonoscopy capacity, the cut-off level for a positive FIT result was increased from 15 to 47 mu g Hb/g feces halfway through 2014. This adjustment decreased the percentage of positive test results to 6.7% (95% CI, 6.6%-6.8%) and increased the PPV to 49.1% (95% CI, 48.3%-49.9%). In total, the first year of the Dutch screening program resulted in the detection of 2483 cancers and 12,030 advanced adenomas. CONCLUSIONS: Close monitoring of the implementation of the Dutch national CRC screening program allowed for instant adjustment of the FIT cut-off levels to optimize program performance.