Dataset Information

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

ABSTRACT:

Introduction

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).

Material and methods

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.

Results

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.

Conclusion

CRC screening with the FIT was associated with a significant reduction in CRC mortality.

SUBMITTER: Ibanez-Sanz G

PROVIDER: S-EPMC8244848 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BACKGROUND: Interval cancers are primary breast cancers diagnosed in women after a negative screening test and before the next screening invitation. Our aim was to evaluate risk factors for interval cancer and their subtypes and to compare the risk factors identified with those associated with incident screen-detected cancers. METHODS: We analyzed data from 645,764 women participating in the Spanish breast cancer screening program from 2000-2006 and followed-up until 2009. A total of 5,309 screen-detected and 1,653 interval cancers were diagnosed. Among the latter, 1,012 could be classified on the basis of findings in screening and diagnostic mammograms, consisting of 489 true interval cancers (48.2%), 235 false-negatives (23.2%), 172 minimal-signs (17.2%) and 114 occult tumors (11.3%). Information on the screening protocol and women's characteristics were obtained from the screening program registry. Cause-specific Cox regression models were used to estimate the hazard ratios (HR) of risks factors for interval cancer and incident screen-detected cancer. A multinomial regression model, using screen-detected tumors as a reference group, was used to assess the effect of breast density and other factors on the occurrence of interval cancer subtypes. RESULTS: A previous false-positive was the main risk factor for interval cancer (HR?=?2.71, 95%CI: 2.28-3.23); this risk was higher for false-negatives (HR?=?8.79, 95%CI: 6.24-12.40) than for true interval cancer (HR?=?2.26, 95%CI: 1.59-3.21). A family history of breast cancer was associated with true intervals (HR?=?2.11, 95%CI: 1.60-2.78), previous benign biopsy with a false-negatives (HR?=?1.83, 95%CI: 1.23-2.71). High breast density was mainly associated with occult tumors (RRR?=?4.92, 95%CI: 2.58-9.38), followed by true intervals (RRR?=?1.67, 95%CI: 1.18-2.36) and false-negatives (RRR?=?1.58, 95%CI: 1.00-2.49). CONCLUSION: The role of women's characteristics differs among interval cancer subtypes. This information could be useful to improve effectiveness of breast cancer screening programmes and to better classify subgroups of women with different risks of developing cancer.