Effectiveness of screening for colorectal cancer with a faecal occult-blood test, in Finland
Background Screening for colorectal cancer (CRC) with guaiac-based faecal occult-blood test (FOBT) has been reported to reduce CRC mortality in randomised trials in the 1990s, but not in routine screening, so far. In Finland, a large randomised study on biennial FOB screening for CRC was gradually n...
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| Language: | English |
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BMJ Publishing Group
2015-12-01
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| Series: | BMJ Open Gastroenterology |
| Online Access: | https://bmjopengastro.bmj.com/content/2/1/e000034.full |
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| author | J Pitkäniemi K Seppä M Hakama O Malminiemi T Palva M-S Vuoristo H Järvinen H Paimela P Pikkarainen A Anttila L Elovainio T Hakulinen S Karjalainen L Pylkkänen M Rautalahti T Sarkeala H Vertio N Malila |
| author_facet | J Pitkäniemi K Seppä M Hakama O Malminiemi T Palva M-S Vuoristo H Järvinen H Paimela P Pikkarainen A Anttila L Elovainio T Hakulinen S Karjalainen L Pylkkänen M Rautalahti T Sarkeala H Vertio N Malila |
| author_sort | J Pitkäniemi |
| collection | DOAJ |
| description | Background Screening for colorectal cancer (CRC) with guaiac-based faecal occult-blood test (FOBT) has been reported to reduce CRC mortality in randomised trials in the 1990s, but not in routine screening, so far. In Finland, a large randomised study on biennial FOB screening for CRC was gradually nested as part of the routine health services from 2004. We evaluate the effectiveness of screening as a public health policy in the largest population so far reported.Methods We randomly allocated (1:1) men and women aged 60–69 years to those invited for screening and those not invited (controls), between 2004 and 2012. This resulted in 180 210 subjects in the screening arm and 180 282 in the control arm. In 2012, the programme covered 43% of the target age population in Finland.Results The median follow-up time was 4.5 years (maximum 8.3 years), with a total of 1.6 million person-years. The CRC incidence rate ratio between the screening and control arm was 1.11 (95% CI 1.01 to 1.23). The mortality rate ratio from CRC between the screening and control arm was 1.04 (0.84 to 1.28), respectively. The CRC mortality risk ratio was 0.88 (0.66 to 1.16) and 1.33 (0.94 to 1.87) in males and females, respectively.Conclusions We did not find any effect in a randomised health services study of FOBT screening on CRC mortality. The substantial effect difference between males and females is inconsistent with the evidence from randomised clinical trials and with the recommendations of several international organisations. Even if our findings are still inconclusive, they highlight the importance of randomised evaluation when new health policies are implemented.Trial registration 002_2010_august. |
| format | Article |
| id | doaj-art-6681bc46a8be45cb9b5faf1e4cdab36b |
| institution | Kabale University |
| issn | 2054-4774 |
| language | English |
| publishDate | 2015-12-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Gastroenterology |
| spelling | doaj-art-6681bc46a8be45cb9b5faf1e4cdab36b2025-02-02T13:30:16ZengBMJ Publishing GroupBMJ Open Gastroenterology2054-47742015-12-012110.1136/bmjgast-2015-000034Effectiveness of screening for colorectal cancer with a faecal occult-blood test, in FinlandJ Pitkäniemi0K Seppä1M Hakama2O Malminiemi3T Palva4M-S Vuoristo5H Järvinen6H Paimela7P Pikkarainen8A Anttila9L Elovainio10T Hakulinen11S Karjalainen12L Pylkkänen13M Rautalahti14T Sarkeala15H Vertio16N Malila172Department of Public Health, University of Helsinki, Finland1Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland1Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland4Fimlab Laboratories, Tampere, Finland5Pirkanmaa Cancer Society, Tampere, Finland5Pirkanmaa Cancer Society, Tampere, Finland6Department of Gastroenterological Surgery, Helsinki University Hospital, Helsinki, Finland7Department of Gastrointestinal Surgery, University Hospital of Northern Norway, Narvik, Norway8Department of Medicine, Tampere University Hospital, Tampere, Finland1Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland1Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland1Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland9The Cancer Society of Finland, Helsinki, Finland9The Cancer Society of Finland, Helsinki, Finland10Finnish Medical Society Duodecim, Helsinki, Finland1Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland9The Cancer Society of Finland, Helsinki, Finland1Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, FinlandBackground Screening for colorectal cancer (CRC) with guaiac-based faecal occult-blood test (FOBT) has been reported to reduce CRC mortality in randomised trials in the 1990s, but not in routine screening, so far. In Finland, a large randomised study on biennial FOB screening for CRC was gradually nested as part of the routine health services from 2004. We evaluate the effectiveness of screening as a public health policy in the largest population so far reported.Methods We randomly allocated (1:1) men and women aged 60–69 years to those invited for screening and those not invited (controls), between 2004 and 2012. This resulted in 180 210 subjects in the screening arm and 180 282 in the control arm. In 2012, the programme covered 43% of the target age population in Finland.Results The median follow-up time was 4.5 years (maximum 8.3 years), with a total of 1.6 million person-years. The CRC incidence rate ratio between the screening and control arm was 1.11 (95% CI 1.01 to 1.23). The mortality rate ratio from CRC between the screening and control arm was 1.04 (0.84 to 1.28), respectively. The CRC mortality risk ratio was 0.88 (0.66 to 1.16) and 1.33 (0.94 to 1.87) in males and females, respectively.Conclusions We did not find any effect in a randomised health services study of FOBT screening on CRC mortality. The substantial effect difference between males and females is inconsistent with the evidence from randomised clinical trials and with the recommendations of several international organisations. Even if our findings are still inconclusive, they highlight the importance of randomised evaluation when new health policies are implemented.Trial registration 002_2010_august.https://bmjopengastro.bmj.com/content/2/1/e000034.full |
| spellingShingle | J Pitkäniemi K Seppä M Hakama O Malminiemi T Palva M-S Vuoristo H Järvinen H Paimela P Pikkarainen A Anttila L Elovainio T Hakulinen S Karjalainen L Pylkkänen M Rautalahti T Sarkeala H Vertio N Malila Effectiveness of screening for colorectal cancer with a faecal occult-blood test, in Finland BMJ Open Gastroenterology |
| title | Effectiveness of screening for colorectal cancer with a faecal occult-blood test, in Finland |
| title_full | Effectiveness of screening for colorectal cancer with a faecal occult-blood test, in Finland |
| title_fullStr | Effectiveness of screening for colorectal cancer with a faecal occult-blood test, in Finland |
| title_full_unstemmed | Effectiveness of screening for colorectal cancer with a faecal occult-blood test, in Finland |
| title_short | Effectiveness of screening for colorectal cancer with a faecal occult-blood test, in Finland |
| title_sort | effectiveness of screening for colorectal cancer with a faecal occult blood test in finland |
| url | https://bmjopengastro.bmj.com/content/2/1/e000034.full |
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