Background & Aims

Randomized trials have shown that biennial fecal occult blood test (FOBT) screening reduces mortality from colorectal cancer (CRC), but not overall mortality. Differences in benefit for men vs women, and by age, are unknown. We sought to evaluate long-term reduction in all-cause and CRC-specific mortality in men and women who comply with offered screening, and in different age groups, using individual participant data from 2 large randomized trials of biennial FOBT screening, compared with an intention to treat analysis.

Methods

We updated the CRC and all-cause mortality from the Danish CRC screening trial (n = 61,933) through 30 years of follow up and pooled individual participant data with individual 30-year follow-up data from the Minnesota Colon Cancer Control trial (n = 46,551). We compared the biennial screening groups to usual care (controls) in individuals 50–80 years old using Kaplan Meier estimates of relative risks and risk differences, adjusted for study differences in age, sex, and compliance.

Results

Through 30 years of follow up, there were 33,478 (71.9%) and 33,479 (72.2%) total deaths and 1023 (2.2%) and 1146 (2.5%) CRC deaths in the biennial screening (n = 46,553) and control groups (n = 46,358), respectively. Among compliers, biennial FOBT screening significantly reduced CRC mortality by 16% (relative risk [RR], 0.84; 95% CI, 0.74–0.96) and all-cause mortality by 2% (RR, 0.98; 95% CI, 0.97–0.99). Among compliers, the reduction in CRC mortality was larger for men (RR, 0.75; 95% CI, 0.62–0.90) than women (RR, 0.91; 95% CI, 0.75–1.09). The largest reduction in CRC mortality was in compliant men 60–69 years old (RR, 0.59; 95% CI, 0.42–0.81) and women 70 years and older (RR, 0.53; 95% CI, 0.30–0.94).

Conclusions

Long-term CRC mortality outcomes of screening among compliers using biennial FOBT are sustained, with a statistically significant reduction in all-cause mortality. The reduction in CRC mortality is greater in men than women—the benefit in women lags that of men by about 10 years.

中文翻译：

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筛查依从性对长期降低全因和结直肠癌死亡率的影响

背景与目标

随机试验表明，两年一次的粪便潜血试验 (FOBT) 筛查可降低结直肠癌 (CRC) 的死亡率，但不会降低总体死亡率。男性与女性的获益差异以及年龄差异尚不清楚。我们试图使用来自两年一次 FOBT 筛查的 2 项大型随机试验的个体参与者数据，与接受筛查的男性和女性在不同年龄组中长期降低全因死亡率和 CRC 特异性死亡率的情况进行比较。意向治疗分析。

方法

我们更新了丹麦 CRC 筛查试验（n = 61,933）到 30 年随访的 CRC 和全因死亡率，并将个体参与者数据与来自明尼苏达结肠癌控制试验（n = 46,551）。我们使用 Kaplan Meier 估计的相对风险和风险差异比较了 50-80 岁个体的两年一次筛查组与常规护理（对照组），并根据研究中的年龄、性别和依从性差异进行了调整。

结果

通过 30 年的随访，在两年一次的筛查（n = 46,553）和对照组（n = 46,358），分别。在符合者中，两年一次的 FOBT 筛查显着降低了 16% 的 CRC 死亡率（相对风险 [RR]，0.84；95% CI，0.74-0.96）和 2% 的全因死亡率（RR，0.98；95% CI，0.97-0.99） ）。在符合者中，男性结直肠癌死亡率的降低幅度（RR，0.75；95% CI，0.62–0.90）大于女性（RR，0.91；95% CI，0.75–1.09）。CRC 死亡率降低最大的是 60-69 岁男性（RR，0.59；95% CI，0.42-0.81）和 70 岁及以上女性（RR，0.53；95% CI，0.30-0.94）。

结论

使用两年一次的 FOBT 筛查的符合者的长期 CRC 死亡率结果是持续的，全因死亡率在统计学上显着降低。男性结直肠癌死亡率的降低幅度大于女性——女性的获益比男性低约 10 年。