Abstract
Purpose
To compare two strategies for colorectal cancer screening: one-time colonoscopy versus fecal immunochemical testing (FIT) (and colonoscopy for positive) every 2 years, in order to determine which strategy provides the highest participation and detection rates in groups of sex and age.
Methods
This analysis was performed with data from the first screening round within the COLONPREV study, a population-based, multicenter, nationwide trial carried out in Spain. Several logistic regression models were applied to identify the influence of the screening test on participation rates and detection of proximal and distal neoplasms, as well to identify the influence of age and sex: women aged 50–59 years, women aged 60–69 years, men aged 50–59 years, and men aged 60–69 years.
Results
Participation was higher in women than in men, especially among women aged 50–59 years (25.91 % for colonoscopy and 35.81 % for FIT). Crossover from colonoscopy to FIT was higher among women than men, especially among those aged 60–69 years (30.37 %). In general, detection of any neoplasm and advanced adenoma was higher with colonoscopy than with FIT, but no significant differences were found between the two strategies for colorectal cancer detection. Detection of advanced adenoma in both arms was lower in women [specifically in women aged 50–59 years (OR 0.31; 95 % CI 0.25–0.38) than in men aged 60–69 years]. Women aged 50–59 years in the colonoscopy arm had a higher probability of detection of advanced adenoma (OR 4.49; 95 % CI 3.18–6.35), as well as of detection of neoplasms in proximal and distal locations (proximal OR 19.34; 95 % CI 12.07–31.00; distal OR 11.04; 95 % CI 8.13–15.01) than women of the same age in the FIT arm. These differences were also observed in the remaining groups but to a lesser extent.
Conclusion
Women were more likely to participate in a FIT-based strategy, especially those aged 50–59 years. The likelihood of detection of any neoplasm was higher in the colonoscopy arm for all the population groups studied, especially in women aged 50–59 years. Distinct population groups should be informed of the benefits of each screening strategy so that they may take informed decisions.
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References
Levin B, Lieberman DA, McFarland B, Andrews KS, Brooks D, Bond J, Dash C, Giardiello FM, Glick S, Johnson D, Johnson CD, Levin TR, Pickhardt PJ, Rex DK, Smith RA, Thorson A, Winawer SJ, American Cancer Society Colorectal Cancer Advisory Group, US Multi-Society Task Force, American College of Radiology Colon Cancer Committee (2008) Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. Gastroenterology 134(5):1570–1595
Mandel JS, Church TR, Bond JH, Ederer F, Geisser MS, Mongin SJ, Snover DC, Schuman LM (2000) The effect of fecal occult-blood screening on the incidence of colorectal cancer. N Engl J Med 343(22):1603–1607
Hewitson P, Glasziou P, Watson E, Towler B, Irwig L (2008) Cochrane systematic review of colorectal cancer screening using the fecal occult blood test (hemoccult): an update. Am J Gastroenterol 103(6):1541–1549
Atkin WS, Edwards R, Kralj-Hans I, Wooldrage K, Hart AR, Northover JM, Parkin DM, Wardle J, Duffy SW, Cuzick J, UK Flexible Sigmoidoscopy Trial Investigators (2010) Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial. Lancet 375(9726):1624–1633
Parkin DM, Tappenden P, Olsen AH, Patnick J, Sasieni P (2008) Predicting the impact of the screening programme for colorectal cancer in the UK. J Med Screen 15(4):163–174
von Wagner C, Good A, Wright D, Rachet B, Obichere A, Bloom S, Wardle J (2009) Inequalities in colorectal cancer screening participation in the first round of the national screening programme in England. Br J Cancer 3(101 Suppl 2):S60–S63
Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM (2010) Estimates of worldwide burden of cancer in 2008: GLOBOCAN
Brasso K, Lynge E (2010) Determinants of participation in colorectal cancer screening with faecal occult blood testing. J Public Health (Oxf) 32(3):395–405
Wardle J, Miles A, Atkin W (2005) Gender differences in utilization of colorectal cancer screening. J Med Screen 12(1):20–27
Javanparast S, Ward P, Young G, Wilson C, Carter S, Misan G, Cole S, Jiwa M, Tsourtos G, Martini A, Gill T, Baratiny G, Matt MA (2010) How equitable are colorectal cancer screening programs which include FOBTs? A review of qualitative and quantitative studies. Prev Med 50(4):165–172
Hassan C, Giorgi Rossi P, Camilloni L, Rex DK, Jimenez-Cendales B, Ferroni E, Borgia P, Zullo A, Guasticchi G, HTA Group (2012) Meta-analysis: adherence to colorectal cancer screening and the detection rate for advanced neoplasia, according to the type of screening test. Aliment Pharmacol Ther 36(10):929–940
Hol L, van Leerdam ME, van Ballegooijen M, van Vuuren AJ, van Dekken H, Reijerink JC, van der Togt AC, Habbema JD, Kuipers EJ (2010) Screening for colorectal cancer: randomised trial comparing guaiac-based and immunochemical faecal occult blood testing and flexible sigmoidoscopy. Gut 59(1):62–68
Segnan N, Senore C, Andreoni B, Azzoni A, Bisanti L, Cardelli A, Castiglione G, Crosta C, Ederle A, Fantin A, Ferrari A, Fracchia M, Ferrero F, Gasperoni S, Recchia S, Risio M, Rubeca T, Saracco G, Zappa M, SCORE3 Working Group-Italy (2007) Comparing attendance and detection rate of colonoscopy with sigmoidoscopy and FIT for colorectal cancer screening. Gastroenterology 132(7):2304–2312
Lieberman D (2009) Colon cancer screening and surveillance controversies. Curr Opin Gastroenterol 25(5):422–427
Nishihara R, Wu K, Lochhead P, Morikawa T, Liao X, Qian ZR, Inamura K, Kim SA, Kuchiba A, Yamauchi M, Imamura Y, Willett WC, Rosner BA, Fuchs CS, Giovannucci E, Ogino S, Chan AT (2013) Long-term colorectal-cancer incidence and mortality after lower endoscopy. N Engl J Med 369(12):1095–1105
Quintero E, Castells A, Bujanda L, Cubiella J, Salas D, Lanas Á, Andreu M, Carballo F, Morillas JD, Hernández C, Jover R, Montalvo I, Arenas J, Laredo E, Hernández V, Iglesias F, Cid E, Zubizarreta R, Sala T, Ponce M, Andrés M, Teruel G, Peris A, Roncales MP, Polo-Tomás M, Bessa X, Ferrer-Armengou O, Grau J, Serradesanferm A, Ono A, Cruzado J, Pérez-Riquelme F, Alonso-Abreu I, de la Vega-Prieto M, Reyes-Melian JM, Cacho G, Díaz-Tasende J, Herreros-de-Tejada A, Poves C, Santander C, González-Navarro A, COLONPREV Study Investigators (2012) Colonoscopy versus fecal immunochemical testing in colorectal-cancer screening. N Engl J Med 366(8):697–706
Jover R, Herráiz M, Alarcón O, Brullet E, Bujanda L, Bustamante M, Campo R, Carreño R, Castells A, Cubiella J, García-Iglesias P, Hervás AJ, Menchén P, Ono A, Panadés A, Parra-Blanco A, Pellisé M, Ponce M, Quintero E, Reñé JM, Sánchez del Río A, Seoane A, Serradesanferm A, Soriano Izquierdo A, Vázquez Sequeiros E, Spanish Society of Gastroenterology, Spanish Society of Gastrointestinal Endoscopy Working Group (2012) Clinical practice guidelines: quality of colonoscopy in colorectal cancer screening. Endoscopy 44(4):444–451
Pox CP, Altenhofen L, Brenner H, Theilmeier A, Von Stillfried D, Schmiegel W (2012) Efficacy of a nationwide screening colonoscopy program for colorectal cancer. Gastroenterology 142(7):1460–1467
Wong MC, John GK, Hirai HW, Lam TY, Luk AK, Ching JY, Ng SS, Chan FK, Griffiths SM, Sung JJ (2012) Changes in the choice of colorectal cancer screening tests in primary care settings from 7,845 prospectively collected surveys. Cancer Causes Control 23(9):1541–1548
Senore C, Ederle A, Benazzato L, Arrigoni A, Silvani M, Fantin A, Fracchia M, Armaroli P, Segnan N (2013) Offering people a choice for colorectal cancer screening. Gut 62(5):735–740
Heitman SJ, Ronksley PE, Hilsden RJ, Manns BJ, Rostom A, Hemmelgarn BR (2009) Prevalence of adenomas and colorectal cancer in average risk individuals: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 7(12):1272–1278
Lieberman DA, Weiss DG, Harford WV, Ahnen DJ, Provenzale D, Sontag SJ, Schnell TG, Chejfec G, Campbell DR, Kidao J, Bond JH, Nelson DB, Triadafilopoulos G, Ramirez FC, Collins JF, Johnston TK, McQuaid KR, Garewal H, Sampliner RE, Esquivel R, Robertson D (2007) Five-year colon surveillance after screening colonoscopy. Gastroenterology 133(4):1077–1085
Imperiale TF, Glowinski EA, Lin-Cooper C, Ransohoff DF (2012) Tailoring colorectal cancer screening by considering risk of advanced proximal neoplasia. Am J Med 125(12):1181–1187
Crotta S, Segnan N, Paganin S, Dagnes B, Rosset R, Senore C (2012) High rate of advanced adenoma detection in 4 rounds of colorectal cancer screening with the fecal immunochemical test. Clin Gastroenterol Hepatol 10(6):633–638
European guidelines for quality assurance in colorectal cancer screening and diagnosis (2011). Brussels: European Commission. IOP Publishing Physics Web. http://bookshop.europa.eu/is-bin/INTERSHOP.enfinity/WFS/EU-Bookshop-Site/en_GB/-/EUR/ViewPublication-Start?PublicationKey=ND3210390. Accessed 14 Jan 2014
Acknowledgments
This work was supported by grants from the Asociación Española contra el Cáncer (Fundación Científica and Junta de Barcelona), Instituto de Salud Carlos III (PI08/90717), FEDER funds, Ministerio de Economía y Competividad (SAF2010-19273), and the Agència de Gestió d’Ajuts Universitaris i de Recerca (2009SGR849). CIBERehd is funded by the Instituto de Salud Carlos III. In the Basque Country, the study received additional support with grants from Obra Social de Kutxa, Diputación Foral de Gipuzkoa (DFG 07/5), Departamento de Sanidad del Gobierno Vasco, EITB-Maratoia (BIO 07/CA/19), and Acción Transversal contra el Cáncer del CIBERehd (2008). In Galicia, this work was supported by Dirección Xeral de Innovación e Xestión da Saúde Pública, Conselleria de Sanidade, Xunta de Galicia. Eiken Chemical Co., Ltd., Japan, and its Spanish representatives, Palex Medical and Biogen Diagnóstica, donated supplies and technology used for FIT, but they were not involved in the design of the study or in the analysis or interpretation of the results.
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For the COLONPREV Study Investigators.
Appendix: Investigators of COLONPREV study
Appendix: Investigators of COLONPREV study
Aragón: Angel Lanas (local coordinator), Francisca Gonzalez-Rubio, Alberto Moya-Calvo, Mónica Polo-Tomas, Maria Pilar Roncales, Pilar Sebastian-Martínez,María Ángeles Valencia-Doblas, Nieves Valero-Capilla (Department of Gastroenterology, University of Zaragoza, IIS Aragón, CIBERehd, Salud).
Basque Country: Luis Bujanda (local coordinator), María E. Alkiza, Jone Altzibar, Pilar Amiano, Juan Arenas, Edurne Artiñano, Angel Cosme, Isabel Egitegi, Kepa Elorriaga, Jose L. Elósegui, José M. Enriquez-Navascués, Cristina Erce, Inés Gil, María A. Gutiérrez-Stampa, Marta Herreros, Elizabeth Hijona, Mariluz Jaúregui, Eva Laredo, Roberto Martínez, Maria J. Mitxelena, Isabel Montalvo, Carlos Placer, Isabel Portillo (Department of Gastroenterology, Donostia Hospital, CIBERehd, University of Basque Country, Department of Gastroenterology, Instituto Oncológico, Obra Social Kutxa, and Department of Gastroenterology, Policlinica Gipuzkoa, CIBERehd, the Department of Gastroenterology, Lasarte-Oria Health Center, Osakidetza-Basque Health Service, Guipúzcoa).
Canarias: Enrique Quintero (national and local coordinator), Onofre Alarcón, Inmaculada Alonso-Abreu, Marta Carrillo-Palau, Mariola de la Vega-Prieto, María Luisa Díez-Fuentes, Antonio Gimeno-García, Yanira González-Méndez, Manuel Hernández-Guerra, Renata Linertová, David Nicolás-Perez, Juana María Reyes-Melián (Department of Gastroenterology, Hospital Universitario de Canarias, and Colorectal Cancer Screening Program of Servicio Canario de la Salud Comunidad de Canarias).
Cataluña: Montserrat Andreu (local coordinator), Cristina Álvarez, Josep M. Augé, Francesc Balaguer, Mercè Barau, Xavier Bessa, Felipe Bory, Andrea Burón, Antoni Castells (national coordinator), Xavier Castells, Mercè Comas, Míriam Cuatrecasas, Maria Estrada, Olga Ferrer, Imma Garrell, Jaume Grau, Rafael Guayta, Cristina Hernández, María López-Cerón, Francesc Macià, Leticia Moreira, Teresa Ocaña, Maria Pellisé, Mercè Piracés, Sandra Polbach, Marc Puigvehí, Cristina Rodríguez, Maria Sala, Agustín Seoane, Anna Serradesanferm, Judith Sivilla (Department of Gastroenterology, Hospital Clínic, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d’Ivestigacions Biomediques August Pi i Sunyer, the Department of Gastroenterology, Parc de Salut Mar, Institut Municipal d’Investigació Mèdica (IMIM), Pompeu Fabra University, Department of Epidemiology and Evaluation, Parc de Salut Mar, IMIM, and Unitat d’Avaluació, Suport i Preventiva, Hospital Clínic).
Galicia: Joaquín Cubiella (local coordinator), Ma Belén Aguado, Susana Aldecoa, Raquel Almazán, Ana Alonso, Inés Castro, Estela Cid, Lucía Cid, Joan Clofent, Ma Luisa de Castro, Pamela Estévez, Ana Belén Fernández, Ma Dolores González, Simoneta González, Ma Carmen González-Mao, Vicent Hernández, Begoña Iglesias, Felipe Iglesias, Pilar Iglesias, Ángeles López-Martínez, Ramiro Macenlle, Alfonso Martínez, David Martínez, Carlos Menéndez, Carmen Méndez, José Antonio Hermo, Isabel Pérez, Carmen Portasany, Mar Rionda, Concepción Rivera, Benito Rodríguez, Rosa Rodríguez, Manuel Rubio, María Isolina Santiago, Miriam Vázquez, José Ángel Vázquez, Pablo Vega, Ma Carmen Vidal, Raquel Zubizarreta. (Department of Gastroenterology, Complexo Hospitalario Universitario de Ourense, Department of Gastroenterology, Complexo Hospitalario Universitario de Vigo, Dirección Xeral de Innovación e Xestión da Saúde Pública, Conselleria de Sanidade, Xunta de Galicia).
Madrid: Juan Diego Morillas (local coordinator), Luís Abreu, Francisco Javier Amador, Manuel Arroyo, Fernando Bandrés, Margarita Barba, José Manuel Blanco, Guillermo Cacho, José Cantero, Juan Carrasco, Beatriz Carrascosa,Gregorio Castellano, Francisco Colina, María Chaparro, Manuel Díaz-Rubio, José Díaz-Tasende, José Miguel Esteban, Conrado Fernández, Servando Fernández-Díez, Marta Fernández-Gil, Juan Ferrándiz, Alejandro Franco, Gabriela García-Álvarez, Aurelio Garrido, Sofía Garrido, Javier P. Gisbert, Mariano Gómez-Haba, Inés Gómez-Molíns, Andrés González-Navarro, María José González, Belén Herranz, Pilar Herránz, Alberto Herreros, Rosario Iglesias, Sonia Izquierdo, Carlos López, María Aranzazu López-Rubio, Alicia Marín, José Carlos Marín, María Carmen Martín, José Luis Martínez, Raquel Martínez, Carmen Moliner, José Manuel Moreno, Ricardo Moreno, Amelia Nogueiras, María Teresa Pérez, Rafael Píriz, Carmen Plaza, Elena Polentinos, Carmen Povés, Pedro Ruíz, Inmaculada Salces, Francisco Sánchez-Ceballos, Cecilio Santander, Rocío Sastre, Vicente Valentín (Department of Gastroenterology, Hospital Clínico San Carlos, Department of Gastroenterology, Hospital Fundación Alcorcón, Department of Gastroenterology, Hospital 12 de Octubre, Department of Gastroenterology, Hospital de la Princesa, Instituto de Investigación Sanitaria Princesa, and CIBERehd, Department of Gastroenterology, Hospital Puerta de Hierro, Majadahonda and the Regional Office for Oncology Coordination, Consejería de Sanidad).
Murcia: Fernando Carballo (local coordinator), Miriam Alajarín, Fernando Alberca, Juan Bermejo, Joaquín Carrillo, José Cruzado, Purificación López, Mariano Martínez, María Dolores Navarro, Akiko Ono, Soledad Parra, Francisco Pérez-Riquelme, Pedro Riquelme-Tenza (Department of Gastroenterology. Hospital Universitario Virgen de la Arrixaca, Institute of Bio-health Research of Murcia (IMIB), Colorectal Cancer Prevention Program of the Región de Murcia, Servicio Murciano de Salud and Colorectal Cancer Prevention Program of the Región de Murcia, Dirección General de Salud Pública, Consejería de Sanidad y Política Social).
Valencia: Dolores Salas (local coordinator), Mercedes Andrés, Consuelo Calvo, Montserrat Jimenez, Elena Pérez, Antonio Peris, Marta Ponce, Rodrigo Jover, Teresa Sala, Gloria Teruel, Josefa Ibañez (Colorectal Cancer Screening Program, General Directorate Public Health, Centre for Public Health Research (CSISP), FISABIO, Department of Gastroenterology, Hospital Universitario La Fe, Department of Gastroenterology, Consorcio Hospitalario de Castellón and the Gastroenterology Unit, Hospital General Universitario de Alicante).
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Salas, D., Vanaclocha, M., Ibáñez, J. et al. Participation and detection rates by age and sex for colonoscopy versus fecal immunochemical testing in colorectal cancer screening. Cancer Causes Control 25, 985–997 (2014). https://doi.org/10.1007/s10552-014-0398-y
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DOI: https://doi.org/10.1007/s10552-014-0398-y