Positive impact of a faecal-based screening programme on colorectal cancer mortality risk

• Published in: PloS one 2021-06, Vol.16 (6), p.e0253369-e0253369
• Main Authors: Ibáñez-Sanz, Gemma, Milà, Núria, Vidal, Carmen, Rocamora, Judith, Moreno, Víctor, Sanz-Pamplona, Rebeca, Garcia, Montse
• Format: Article
• Language: English
• Subjects: Aged; Biology and Life Sciences; Biomedical research; Blood; Blood tests; Cancer; Colonoscopy; Colorectal cancer; Colorectal carcinoma; Colorectal Neoplasms - diagnosis; Colorectal Neoplasms - mortality; Data analysis; Diagnosis; Early Detection of Cancer - methods; Early Detection of Cancer - statistics & numerical data; Epidemiology; Evaluation; Female; Health risks; Hospitals; Humans; Male; Medical diagnosis; Medical research; Medical screening; Medicine and Health Sciences; Middle Aged; Mortality; Mortality risk; Multivariate analysis; Neoplasm Staging; Occult Blood; Oncology; Participation; Patient Acceptance of Health Care; Public health; Retrospective Studies; Risk Assessment - statistics & numerical data; Spain; Testing; Tumors
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0253369

The effectiveness of colorectal cancer (CRC) screening programs is directly related to participation and the number of interval CRCs. The objective was to analyse specific-mortality in a cohort of individuals invited to a CRC screening program according to type of CRC diagnosis (screen-detected cancers, interval cancers, and cancers among the non-uptake group). Retrospective cohort that included invitees aged 50-69 years of a CRC screening program (target population of 85,000 people) in Catalonia (Spain) from 2000-2015 with mortality follow-up until 2020. A screen-detected CRC was a cancer diagnosed after a positive faecal occult blood test (guaiac or immunochemical); an interval cancer was a cancer diagnosed after a negative test result and before the next invitation to the program (≤24 months); a non-uptake cancer was a cancer in subjects who declined screening. A total of 624 people were diagnosed with CRC (n = 265 screen-detected, n = 103 interval cancers, n = 256 non-uptake). In the multivariate analysis, we observed a 74% increase in mortality rate in the group with interval CRC compared to screen-detected CRC adjusted for age, sex, location and stage (HR: 1.74%, 95% CI:1.08-2.82, P = 0.02). These differences were found even when we restricted for advanced-cancers participants. In the stratified analysis for type of faecal occult blood test, a lower mortality rate was only observed among FIT screen-detected CRCs. CRC screening with the FIT was associated with a significant reduction in CRC mortality.