Long-term effectiveness of faecal immunochemical test screening for proximal and distal colorectal cancers

Han Mo Chiu, Grace Hsiao Hsuan Jen, Ying Wei Wang, Jean Ching Yuan Fann, Chen Yang Hsu, Ya Chung Jeng, Amy Ming Fang Yen, Sherry Yueh Hsia Chiu, Sam Li Sheng Chen, Wen Feng Hsu, Yi Chia Lee, Ming Shiang Wu, Chien Yuan Wu, Yann Yuh Jou, Tony Hsiu His Chen

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

Objective: To measure the effects of faecal immunochemical test (FIT) for colorectal cancer (CRC) screening on overall and site-specific long-term effectiveness of population-based organised service screening. Design: A prospective cohort study of Taiwanese nationwide biennial FIT screening was performed. A total of 5 417 699 eligible subjects were invited to attend screening from 2004 through 2009 and were followed up until 2014. We estimated the adjusted relative rates (aRRs) on the effectiveness of reducing advanced-stage CRC (stage II+) and CRC death by Bayesian Poisson regression models with the full adjustment for a cascade of self-selection factors (including the screening rate and the colonoscopy rate) and the completeness of colonoscopy together with demographic features. Results: FIT screening (exposed vs unexposed) reduced the incidence of advanced-stage CRC (48.4 vs 75.7 per 100 000) and mortality (20.3 vs 41.3 per 100 000). Statistically significant reductions of both incidence of advanced-stage CRCs (aRR=0.66, 95% CI 0.63 to 0.70) and deaths from CRC (aRR=0.60, 95% CI 0.57 to 0.64) were noted. FIT screening was more effective in reducing distal advanced-stage CRCs (aRR=0.61, 95% CI 0.58 to 0.64) and CRC mortality (aRR=0.56, 95% CI 0.53 to 0.69) than proximal advanced CRCs (aRR=0.84, 95% CI 0.77 to 0.92) and CRC mortality (aRR=0.72, 95% CI 0.66 to 0.80). Conclusion: A large-scale population-based biennial FIT screening demonstrates 34% significant reduction of advanced-stage CRCs and 40% reduction of death from CRC with larger long-term effectiveness in the distal colon than the proximal colon. Our findings provide a strong and consistent evidence-based policy for supporting a sustainable population-based FIT organised service screening worldwide. The disparity of site-specific long-term effectiveness also provides an insight into the remedy for lower effectiveness of FIT screening in the proximal colon.

Original languageEnglish
Article number322545
JournalGut
DOIs
Publication statusAccepted/In press - 2021

Keywords

  • cancer epidemiology
  • cancer prevention
  • colorectal cancer screening

ASJC Scopus subject areas

  • Gastroenterology

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