Offering people a choice for colorectal cancer screening
Offering people a choice for colorectal cancer screening
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DOI：
10.1136/gutjnl-2011-301013
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发表时间：
2013-05-01
期刊：
影响因子：
24.5
通讯作者：
Segnan, Nereo
中科院分区：
文献类型：
--
作者：
Senore, Carlo;Ederle, Andrea;Segnan, Nereo
目的评估提供免疫化学粪便潜血试验（FIT）的非应答者的人口覆盖率和诊断率的一个灵活的乙状结肠镜检查（FS）invitation.Design在人群为基础的结直肠癌（CRC）筛查计划进行的队列研究。在该方案中，邀请58岁（都灵; 43 748名受试者）或60岁（维罗纳; 19 970名受试者）的合格男女，并由其全科医生签署个人信函，接受FS。肠道准备仅限于在家中自行进行单次灌肠。在FS时检测到一个远端息肉>5 mm（都灵>= 10 mm）或至少一个腺瘤（都灵一个晚期腺瘤或两个以上腺瘤）的受试者被转诊进行结肠镜检查。邀请不响应接受FS邀请的人进行FIT（OC-传感器; Eiken，Tokyo，Japan;单样本，临界值100 ng/ml）。出勤率和肿瘤产量进行了分析，在四个连续的出生cohols.Results整体参与率为FS的邀请是39.3%，在维罗纳和29.9%，都灵。在FS邀请的合格无应答者中，19.3%（95% CI 18.9%至19.7%）接受了FIT。因此，维罗纳和都灵接受FS或FIT筛查的人数比例分别为55.2%和39.3%，两个中心均无性别差异。FIT检测到了筛查时诊断的所有晚期腺瘤的8.3%和所有CRC的20.4%。结论顺序提供FS和FIT的策略是一种可行且有效的方法。不参加FS的人的FIT增加了晚期腺瘤和CRC的筛查摄取和检测。
Objectives To assess the population coverage and diagnostic yield of offering an immunochemical faecal occult blood test (FIT) to non-responders to a flexible sigmoidoscopy (FS) invitation.Design A cohort study conducted in a population-based colorectal cancer (CRC) screening programme. In this programme, eligible men and women aged 58 (Turin; 43 748 subjects) or 60 (Verona; 19 970 subjects) are invited, with a personal letter signed by their general practitioner, to undergo an FS. Bowel preparation is limited to a single enema self-administered at home. Subjects in whom one distal polyp >5 mm (>= 10 mm in Turin) or at least one adenoma (one advanced adenoma or more than two adenomas in Turin) is detected at FS are referred for colonoscopy. People who do not respond to the invitation to undergo an FS are invited to have an FIT (OC-Sensor; Eiken, Tokyo, Japan; single sample, cutoff 100 ng/ml). Attendance rate and neoplasia yield were analysed in four consecutive birth cohorts.Results Overall participation rate for the FS invitation was 39.3% in Verona and 29.9% in Turin. Of the eligible non-responders to the FS invitation, 19.3% (95% CI 18.9% to 19.7%) underwent an FIT. As a result, the proportion of people undergoing screening by FS or FIT was 55.2% in Verona and 39.3% in Turin, with no gender differences in either centre. FIT detected 8.3% of all advanced adenomas and 20.4% of all CRCs diagnosed at screening.Conclusions A strategy involving the sequential offer of FS and FIT is a feasible and efficient approach. FIT in people not attending for FS increases screening uptake and detection of advanced adenomas and CRCs.