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

Abstract

ObjectiveTo 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.DesignA 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.ResultsFIT 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).ConclusionA 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.

Mitigating the impact of COVID-19 on colorectal cancer screening: Organized service screening perspectives from the Asia-Pacific region

“…Given the similar disease burden and the way screening services are offered (by FIT screening) in Asian programs, we used empirical data obtained from the Taiwanese CRC Screening Program to estimate the impact of the COVID-19 pandemic on the effectiveness of CRC screening if the pandemic persists or remains poorly controlled ( Onyoh et al, 2019 ). We simulated a cohort of 300,000 subjects with 100 replications based on a five-state stage-based natural history model of CRC (including one CRC-free state and four CRC states stratified by stage [early (stage 0 and I) vs. advanced stages (stage II and above)] and symptoms (asymptomatic vs. symptomatic phases) and the subsequent prognostic model with the parameters based on the empirical data from the Taiwanese program to project the effect of FIT screening on CRC mortality ( Chiu et al, 2015 ; Chiu et al, 2021 ). We first used a hypothetical cohort without any intervention to simulate or project the expected number of advanced-stage CRCs at diagnosis, and then we changed the screening rate and the colonoscopy rate from the prepandemic rates to the pandemic rates during a 12-year follow-up to estimate CRC deaths.…”

“…In the Asia-Pacific region, many countries or regions with high CRC incidence have launched population-based CRC screening programs in the past two decades ( Schreuders et al, 2015 ). (See Table 1 ) The effectiveness of FIT screening in reducing CRC mortality and/or incidence has been reported not only in Western countries but also in Asia ( Chiu et al, 2015 ; Giorgi Rossi et al, 2015 ; Zorzi et al, 2015 ; Chiu et al, 2021 ). Japan was the first country in this region to launch a FIT-based population screening, as early as 1992, followed by Korea, Taiwan, and Australia in 2000's, and later by New Zealand in 2017 and Hong Kong in 2020 (rolling out from 2016 to 2019 and full program from 2020 on) ( Shim et al, 2010 ; Saito, 2006 ; Bowel screening, n.d. ; Eligibility of Colorectal Cancer Screening Programme updated, n.d. ).…”

“…There are also several ongoing pilot studies in China, Thailand, and Malaysia ( Sarakarn et al, 2017 ; Li et al, 2018 ). All the existing programs in Asia-Pacific ( Chiu et al, 2021 ) countries use FIT as the primary screening method, but with different age ranges and interscreen intervals ( Onyoh et al, 2019 ).

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Colorectal cancer incidence and mortality: the current status, temporal trends and their attributable risk factors in 60 countries in 2000–2019

“…Population-based screening by fecal immunochemical test also showed significant reduction of both incidence of advanced-stage CRC and deaths from CRC. [ 30 ] Particularly, the introduction of population-based screening in developed countries over the past two decades contributed to the decreasing CRC incidence and mortality in these regions. [ 31 ] Taking the United States as an example, CRC screening recommendations were first released in 1997, [ 32 ] and the uptake rate of screening with any recommended test increased from 38% in 2000 to 66% in 2018.…”

Modelling the impacts of COVID-19 pandemic on the quality of population-based colorectal cancer screening

“…The parameters used for building up the screening process from referral rate until confirmatory diagnosis and for the construction of the disease natural history model can refer to the literature or be estimated from the routine data on population-based screening in each country and region. Note that the framework and methodology can also be modified and extended to other kinds of evidence-based population-based screening for CRC, including sigmoidoscopy and colonoscopy ( Hardcastle et al, 1996 ; Kronborg et al, 1996 ; Mandel et al, 1993 ; Berry et al, 1997 ; Rasmussen et al, 1999 ; Segnan et al, 2005 , Segnan et al, 2011 ; Verne et al, 1998 ; Kaminski et al, 2015 ; Chiu et al, 2015 , Chiu et al, 2021 ).…”