Effectiveness of fecal immunochemical testing in reducing colorectal cancer mortality from the One Million Taiwanese Screening Program

Han Mo Chiu, Sam Li Sheng Chen, Amy Ming Fang Yen, Sherry Yueh Hsia Chiu, Jean Ching Yuan Fann, Yi Chia Lee, Shin Liang Pan, Ming Shiang Wu, Chao Sheng Liao, Hsiu Hsi Chen, Shin Lan Koong, Shu Ti Chiou

Research output: Contribution to journalArticle

66 Citations (Scopus)

Abstract

BACKGROUND: The effectiveness of fecal immunochemical testing (FIT) in reducing colorectal cancer (CRC) mortality has not yet been fully assessed in a large, population-based service screening program. METHODS: A prospective cohort study of the follow-up of approximately 5 million Taiwanese from 2004 to 2009 was conducted to compare CRC mortality for an exposed (screened) group and an unexposed (unscreened) group in a population-based CRC screening service targeting community residents of Taiwan who were 50 to 69 years old. Given clinical capacity, this nationwide screening program was first rolled out in 2004. In all, 1,160,895 eligible subjects who were 50 to 69 years old (ie, 21.4% of the 5,417,699 subjects of the underlying population) participated in the biennial nationwide screening program by 2009. RESULTS: The actual effectiveness in reducing CRC mortality attributed to the FIT screening was 62% (relative rate for the screened group vs the unscreened group, 0.38; 95% confidence interval, 0.35-0.42) with a maximum follow-up of 6 years. The 21.4% coverage of the population receiving FIT led to a significant 10% reduction in CRC mortality (relative rate, 0.90; 95% confidence interval, 0.84-0.95) after adjustments for a self-selection bias. CONCLUSIONS: This large, prospective Taiwanese cohort undergoing population-based FIT screening for CRC had the statistical power to demonstrate a significant CRC mortality reduction, although the follow-up time was short. Although such findings are informative for health decision makers, continued follow-up of this large cohort will be required to estimate the long-term impact of FIT screening if the covered population is expanded.

Original languageEnglish
Pages (from-to)3221-3229
Number of pages9
JournalCancer
Volume121
Issue number18
DOIs
Publication statusPublished - Sep 1 2015

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Colorectal Neoplasms
Mortality
Population
Confidence Intervals
Selection Bias
Taiwan
Early Detection of Cancer
Cohort Studies
Prospective Studies
Health

Keywords

  • colorectal cancer
  • fecal immunochemical testing
  • mortality reduction
  • population-based screening

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Effectiveness of fecal immunochemical testing in reducing colorectal cancer mortality from the One Million Taiwanese Screening Program. / Chiu, Han Mo; Chen, Sam Li Sheng; Yen, Amy Ming Fang; Chiu, Sherry Yueh Hsia; Fann, Jean Ching Yuan; Lee, Yi Chia; Pan, Shin Liang; Wu, Ming Shiang; Liao, Chao Sheng; Chen, Hsiu Hsi; Koong, Shin Lan; Chiou, Shu Ti.

In: Cancer, Vol. 121, No. 18, 01.09.2015, p. 3221-3229.

Research output: Contribution to journalArticle

Chiu, HM, Chen, SLS, Yen, AMF, Chiu, SYH, Fann, JCY, Lee, YC, Pan, SL, Wu, MS, Liao, CS, Chen, HH, Koong, SL & Chiou, ST 2015, 'Effectiveness of fecal immunochemical testing in reducing colorectal cancer mortality from the One Million Taiwanese Screening Program', Cancer, vol. 121, no. 18, pp. 3221-3229. https://doi.org/10.1002/cncr.29462
Chiu, Han Mo ; Chen, Sam Li Sheng ; Yen, Amy Ming Fang ; Chiu, Sherry Yueh Hsia ; Fann, Jean Ching Yuan ; Lee, Yi Chia ; Pan, Shin Liang ; Wu, Ming Shiang ; Liao, Chao Sheng ; Chen, Hsiu Hsi ; Koong, Shin Lan ; Chiou, Shu Ti. / Effectiveness of fecal immunochemical testing in reducing colorectal cancer mortality from the One Million Taiwanese Screening Program. In: Cancer. 2015 ; Vol. 121, No. 18. pp. 3221-3229.
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abstract = "BACKGROUND: The effectiveness of fecal immunochemical testing (FIT) in reducing colorectal cancer (CRC) mortality has not yet been fully assessed in a large, population-based service screening program. METHODS: A prospective cohort study of the follow-up of approximately 5 million Taiwanese from 2004 to 2009 was conducted to compare CRC mortality for an exposed (screened) group and an unexposed (unscreened) group in a population-based CRC screening service targeting community residents of Taiwan who were 50 to 69 years old. Given clinical capacity, this nationwide screening program was first rolled out in 2004. In all, 1,160,895 eligible subjects who were 50 to 69 years old (ie, 21.4{\%} of the 5,417,699 subjects of the underlying population) participated in the biennial nationwide screening program by 2009. RESULTS: The actual effectiveness in reducing CRC mortality attributed to the FIT screening was 62{\%} (relative rate for the screened group vs the unscreened group, 0.38; 95{\%} confidence interval, 0.35-0.42) with a maximum follow-up of 6 years. The 21.4{\%} coverage of the population receiving FIT led to a significant 10{\%} reduction in CRC mortality (relative rate, 0.90; 95{\%} confidence interval, 0.84-0.95) after adjustments for a self-selection bias. CONCLUSIONS: This large, prospective Taiwanese cohort undergoing population-based FIT screening for CRC had the statistical power to demonstrate a significant CRC mortality reduction, although the follow-up time was short. Although such findings are informative for health decision makers, continued follow-up of this large cohort will be required to estimate the long-term impact of FIT screening if the covered population is expanded.",
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T1 - Effectiveness of fecal immunochemical testing in reducing colorectal cancer mortality from the One Million Taiwanese Screening Program

AU - Chiu, Han Mo

AU - Chen, Sam Li Sheng

AU - Yen, Amy Ming Fang

AU - Chiu, Sherry Yueh Hsia

AU - Fann, Jean Ching Yuan

AU - Lee, Yi Chia

AU - Pan, Shin Liang

AU - Wu, Ming Shiang

AU - Liao, Chao Sheng

AU - Chen, Hsiu Hsi

AU - Koong, Shin Lan

AU - Chiou, Shu Ti

PY - 2015/9/1

Y1 - 2015/9/1

N2 - BACKGROUND: The effectiveness of fecal immunochemical testing (FIT) in reducing colorectal cancer (CRC) mortality has not yet been fully assessed in a large, population-based service screening program. METHODS: A prospective cohort study of the follow-up of approximately 5 million Taiwanese from 2004 to 2009 was conducted to compare CRC mortality for an exposed (screened) group and an unexposed (unscreened) group in a population-based CRC screening service targeting community residents of Taiwan who were 50 to 69 years old. Given clinical capacity, this nationwide screening program was first rolled out in 2004. In all, 1,160,895 eligible subjects who were 50 to 69 years old (ie, 21.4% of the 5,417,699 subjects of the underlying population) participated in the biennial nationwide screening program by 2009. RESULTS: The actual effectiveness in reducing CRC mortality attributed to the FIT screening was 62% (relative rate for the screened group vs the unscreened group, 0.38; 95% confidence interval, 0.35-0.42) with a maximum follow-up of 6 years. The 21.4% coverage of the population receiving FIT led to a significant 10% reduction in CRC mortality (relative rate, 0.90; 95% confidence interval, 0.84-0.95) after adjustments for a self-selection bias. CONCLUSIONS: This large, prospective Taiwanese cohort undergoing population-based FIT screening for CRC had the statistical power to demonstrate a significant CRC mortality reduction, although the follow-up time was short. Although such findings are informative for health decision makers, continued follow-up of this large cohort will be required to estimate the long-term impact of FIT screening if the covered population is expanded.

AB - BACKGROUND: The effectiveness of fecal immunochemical testing (FIT) in reducing colorectal cancer (CRC) mortality has not yet been fully assessed in a large, population-based service screening program. METHODS: A prospective cohort study of the follow-up of approximately 5 million Taiwanese from 2004 to 2009 was conducted to compare CRC mortality for an exposed (screened) group and an unexposed (unscreened) group in a population-based CRC screening service targeting community residents of Taiwan who were 50 to 69 years old. Given clinical capacity, this nationwide screening program was first rolled out in 2004. In all, 1,160,895 eligible subjects who were 50 to 69 years old (ie, 21.4% of the 5,417,699 subjects of the underlying population) participated in the biennial nationwide screening program by 2009. RESULTS: The actual effectiveness in reducing CRC mortality attributed to the FIT screening was 62% (relative rate for the screened group vs the unscreened group, 0.38; 95% confidence interval, 0.35-0.42) with a maximum follow-up of 6 years. The 21.4% coverage of the population receiving FIT led to a significant 10% reduction in CRC mortality (relative rate, 0.90; 95% confidence interval, 0.84-0.95) after adjustments for a self-selection bias. CONCLUSIONS: This large, prospective Taiwanese cohort undergoing population-based FIT screening for CRC had the statistical power to demonstrate a significant CRC mortality reduction, although the follow-up time was short. Although such findings are informative for health decision makers, continued follow-up of this large cohort will be required to estimate the long-term impact of FIT screening if the covered population is expanded.

KW - colorectal cancer

KW - fecal immunochemical testing

KW - mortality reduction

KW - population-based screening

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