Long-Term Mortality after Screening for Colorectal Cancer
Long-Term Mortality after Screening for Colorectal Cancer
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DOI：
10.1056/nejmoa1300720
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发表时间：
2013-09-19
影响因子：
158.5
通讯作者：
Church, Timothy R.
中科院分区：
文献类型：
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作者：
Shaukat, Aasma;Mongin, Steven J.;Church, Timothy R.
背景在随机试验中，粪便隐血检测可降低结直肠癌的死亡率。然而，持续时间的好处是未知的，因为是特定的年龄和sex.MethodsIn明尼苏达州结肠癌控制研究，46,551名参与者，50至80岁，被随机分配到日常护理（控制）或每年或两年一次的粪便潜血试验筛查。筛查从1976年至1982年和1986年至1992年进行。我们使用国家死亡指数来获得参与者生命状态的最新信息，并确定2008年的死亡原因。结果通过30年的随访，33,020名参与者（70.9%）死亡。共有732例死亡归因于结直肠癌：每年筛查组11，072例死亡中的200例（1.8%），两年筛查组11，004例死亡中的237例（2.2%），对照组10，944例死亡中的295例（2.7%）。在30年的随访中，筛查降低了结直肠癌死亡率（每年筛查的相对风险为0.68; 95%可信区间[CI]为0.56 ~ 0.82;两年筛查的相对风险为0.78; 95% CI为0.65 ~ 0.93）。未观察到全因死亡率降低（每年筛查的相对风险为1.00; 95%CI为0.99 - 1.01;两年筛查的相对风险为0.99; 95%CI为0.98 - 1.01）。结直肠癌死亡率的减少是男性比女性在两年一次的筛查组（P=0.04的相互作用）。ConclusionsThe效果的筛查粪便潜血试验结直肠癌死亡率持续30年后，但不影响全因死亡率。结直肠癌死亡率的持续下降支持息肉切除术的效果。
BackgroundIn randomized trials, fecal occult-blood testing reduces mortality from colorectal cancer. However, the duration of the benefit is unknown, as are the effects specific to age and sex.MethodsIn the Minnesota Colon Cancer Control Study, 46,551 participants, 50 to 80 years of age, were randomly assigned to usual care (control) or to annual or biennial screening with fecal occult-blood testing. Screening was performed from 1976 through 1982 and from 1986 through 1992. We used the National Death Index to obtain updated information on the vital status of participants and to determine causes of death through 2008.ResultsThrough 30 years of follow-up, 33,020 participants (70.9%) died. A total of 732 deaths were attributed to colorectal cancer: 200 of the 11,072 deaths (1.8%) in the annual-screening group, 237 of the 11,004 deaths (2.2%) in the biennial-screening group, and 295 of the 10,944 deaths (2.7%) in the control group. Screening reduced colorectal-cancer mortality (relative risk with annual screening, 0.68; 95% confidence interval [CI], 0.56 to 0.82; relative risk with biennial screening, 0.78; 95% CI, 0.65 to 0.93) through 30 years of follow-up. No reduction was observed in all-cause mortality (relative risk with annual screening, 1.00; 95% CI, 0.99 to 1.01; relative risk with biennial screening, 0.99; 95% CI, 0.98 to 1.01). The reduction in colorectal-cancer mortality was larger for men than for women in the biennial-screening group (P=0.04 for interaction).ConclusionsThe effect of screening with fecal occult-blood testing on colorectal-cancer mortality persists after 30 years but does not influence all-cause mortality. The sustained reduction in colorectal-cancer mortality supports the effect of polypectomy.