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. 2021 Dec;70(12):2321-2329.
doi: 10.1136/gutjnl-2020-322545. Epub 2021 Jan 25.

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

Han-Mo Chiu  1 , Grace Hsiao-Hsuan Jen  2 , Ying-Wei Wang  3 , Jean Ching-Yuan Fann  4 , Chen-Yang Hsu  2 , Ya-Chung Jeng  5 , Amy Ming-Fang Yen  5 , Sherry Yueh-Hsia Chiu  6 , Sam Li-Sheng Chen  5 , Wen-Feng Hsu  1   2 , Yi-Chia Lee  1 , Ming-Shiang Wu  1 , Chien-Yuan Wu  3 , Yann-Yuh Jou  3 , Tony Hsiu-Hsi Chen  7
Affiliations

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

Han-Mo Chiu et al. Gut. 2021 Dec.

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.

Keywords: cancer epidemiology; cancer prevention; colorectal cancer screening.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form (http://www.icmje.org/coi_disclosure.pdf) and declare no support from any organisation for the submitted work, no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years and no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1
Cascade of screening indicators from the uptake of screening until the final confirmatory diagnosis with complete colonoscopy to reach the cecum for subjects invited to a population-based service screening programme for CRC. CRC, colorectal cancer; FIT, faecal immunochemical test.
Figure 2
Figure 2
Schematic of the prospective cohort with the staggered entry to attend the first screen for the eligible population aged 50–69 years.
See this image and copyright information in PMC

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