The effect of fecal occult-blood screening on the incidence of colorectal cancer
The effect of fecal occult-blood screening on the incidence of colorectal cancer
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DOI：
10.1056/nejm200011303432203
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发表时间：
2000-11-30
影响因子：
158.5
通讯作者：
Schuman, LM
中科院分区：
文献类型：
--
作者：
Mandel, JS;Church, TR;Schuman, LM
背景：每年一次的粪便隐血检测和每两年一次的检测都可以显着降低结直肠癌的死亡率。然而，筛查对结直肠癌发病率的影响仍然不确定，尽管在许多人接受screening.Methods的诊断和切除癌前病变：我们已经遵循了18年的明尼苏达州结肠癌控制研究的参与者。在1975年至1978年期间，共有46，551人参加了研究，其中大多数年龄在50至80岁之间，并随机分配到年度筛查，两年一次的筛查或常规护理（对照组）。那些被分配到筛选组被要求准备和提交两个样本，从每三个连续的粪便愈创木基测试。那些在六个切片中至少有一个阳性切片的人被提供了包括结肠镜检查在内的诊断性检查。1976年至1982年进行了筛查，1986年至1992年再次进行筛查。研究参与者被随访了新诊断的结直肠癌病例和死亡病例。结果：在18年的随访期间，我们发现了1359例新的结直肠癌病例：417例在年度筛查组，435例在两年一次筛查组，507例在对照组。与对照组相比，筛查组中结直肠癌的累积发病率比值分别为0.80（95%置信区间，0.70至0.90）和0.83（95%置信区间，0.73至0.94），分别为每年一次筛查组和两年一次筛查组。对于这两个筛选组，阳性载玻片的数量与结直肠癌和腺瘤性息肉的阳性预测值至少1 cm in diameter.Conclusions：无论是每年或两年一次的粪便隐血检测显着降低结直肠癌的发病率。（N Engl J Med 2000;343：1603-7.）(C)2000年，马萨诸塞州医学会。
Background: Both annual testing for fecal occult blood and biennial testing significantly reduce mortality from colorectal cancer. However, the effect of screening on the incidence of colorectal cancer remains uncertain, despite the diagnosis and removal of precancerous lesions in many persons who undergo screening.Methods: We have followed the participants in the Minnesota Colon Cancer Control Study for 18 years. A total of 46,551 people, most of whom were 50 to 80 years old, were enrolled between 1975 and 1978 and randomly assigned to annual screening, biennial screening, or usual care (the control group). Those assigned to the screening groups were asked to prepare and submit two samples from each of three consecutive stools for guaiac-based testing. Those with at least one positive slide in the set of six were offered a diagnostic examination that included colonoscopy. Screening was conducted between 1976 and 1982 and again between 1986 and 1992. Study participants have been followed with respect to newly diagnosed cases of colorectal cancer and deaths. Follow-up has been more than 90 percent complete.Results: During the 18-year follow-up period, we identified 1359 new cases of colorectal cancer: 417 in the annual-screening group, 435 in the biennial-screening group, and 507 in the control group. The cumulative incidence ratios for colorectal cancer in the screening groups as compared with the control group were 0.80 (95 percent confidence interval, 0.70 to 0.90) and 0.83 (95 percent confidence interval, 0.73 to 0.94) for the annual-screening and biennial-screening groups, respectively. For both screening groups, the number of positive slides was associated with the positive predictive value both for colorectal cancer and for adenomatous polyps at least 1 cm in diameter.Conclusions: The use of either annual or biennial fecal occult-blood testing significantly reduces the incidence of colorectal cancer. (N Engl J Med 2000;343:1603-7.) (C) 2000, Massachusetts Medical Society.