Participation in a population-based screening for colorectal cancer using the faecal immunochemical test decreases mortality in 5 years

Abstract

Background The steady increase in colorectal cancer (CRC) could be reversed through timely secondary prevention (screening) as a main strategy. The aims of this study were to determine the main features of CRC, survival rate and related factors for different types of identified CRCs in a population-based screening programme using the faecal immunochemical test (FIT). Materials and methods The CRCs in the susceptible population to be screened between 2009 and 2014 were identified and classified into four groups: (a) nonscreening-detected CRC (diagnosed before first screening invitation and nonparticipants), (b) screening-detected CRC, (c) interval cancer (IC) FIT (diagnosed between screening rounds after a negative FIT) and (d) IC colonoscopy (diagnosed before the colonoscopy surveillance, which is recommended after the screening colonoscopy). Patient demographics and epidemiological characteristics, tumour characteristics and survival were compared between the four groups. Results 5909 individuals were diagnosed with a CRC. The median follow-up of survival was 4.6 years (range: 0–9 years). The study highlights a significant difference (P<0.0001) in the 5-year survival in the screening-detected CRC group compared with those who had nonscreening-detected CRCs (90.1 vs. 66.7%). Although ICs are not desirable events, the 5-year survival rate is significantly higher with respect to nonparticipants (P<0.0001) (76.3 vs. 60.5%), this being the group with the lowest survival rate. Conclusion The significantly higher 5-year survival rate of 23.4% of the participants in the screening programme suggests that incidence and mortality rates of CRC will decrease in the near future for participants in screening programmes. A high participation rate is essential to achieve health benefits, irrespective of the type of participation.

Colorectal Cancer Survival in 50- to 69-Year-Olds after Introducing the Faecal Immunochemical Test

“…Additionally, rates of participation in these programmes and of malignant lesions also vary with socioeconomic status [3,[21][22][23][24]. For these reasons, to improve the performance of screening programmes, it is essential to increase participation rates, especially among men and individuals from lower socioeconomic groups, as has been observed in previous studies [25][26][27].…”

Factors Related to Non-participation in the Basque Country Colorectal Cancer Screening Programme

“…Regarding sex, data show consistently lower levels of participation in men than in women (5), even though advanced adenoma and CRC detection rates are higher in men (8)(9)(10)(11). Moreover, the benefits of participation increase in men showing a pronounced decrease in mortality (4.3% in men vs. 1.9% in women) (1,3).…”

Use of Antiplatelet Agents Decreases the Positive Predictive Value of Fecal Immunochemical Tests for Colorectal Cancer but Does Not Affect Their Sensitivity

“…The fecal immunochemical test (FIT) is the most commonly used non-invasive screening tool for colorectal cancer (CRC) worldwide, and it has been adopted as a populationbased CRC screening program in many Western and Asian countries [1][2][3][4][5][6]. To increase the utility of the FIT, it is necessary to improve its accuracy in the detection of CRC.…”