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Pitkäniemi J, Seppä K, Hakama M, et al. Effectiveness of screening for colorectal cancer with a faecal occult-blood test, in Finland. BMJ Open Gastroenterol. 2015;2(1):e000034doi: 10.1136/bmjgast-2015-000034.
Pitkäniemi, J., Seppä, K., Hakama, M., Malminiemi, O., Palva, T., Vuoristo, M. S., Järvinen, H., Paimela, H., Pikkarainen, P., Anttila, A., Elovainio, L., Hakulinen, T., Karjalainen, S., Pylkkänen, L., Rautalahti, M., Sarkeala, T., Vertio, H., & Malila, N. (2015). Effectiveness of screening for colorectal cancer with a faecal occult-blood test, in Finland. BMJ open gastroenterology, 2(1), e000034. https://doi.org/10.1136/bmjgast-2015-000034
Pitkäniemi, J, et al. "Effectiveness of screening for colorectal cancer with a faecal occult-blood test, in Finland." BMJ open gastroenterology vol. 2,1 (2015): e000034. doi: https://doi.org/10.1136/bmjgast-2015-000034
Pitkäniemi J, Seppä K, Hakama M, Malminiemi O, Palva T, Vuoristo MS, Järvinen H, Paimela H, Pikkarainen P, Anttila A, Elovainio L, Hakulinen T, Karjalainen S, Pylkkänen L, Rautalahti M, Sarkeala T, Vertio H, Malila N. Effectiveness of screening for colorectal cancer with a faecal occult-blood test, in Finland. BMJ Open Gastroenterol. 2015 Jun 08;2(1):e000034. doi: 10.1136/bmjgast-2015-000034. eCollection 2015. PMID: 26462283; PMCID: PMC4599169.
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BMJ Open Gastroenterol. 2015 Jun 08;2(1):e000034. doi: 10.1136/bmjgast-2015-000034. eCollection 2015.

Effectiveness of screening for colorectal cancer with a faecal occult-blood test, in Finland.

BMJ open gastroenterology

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

Affiliations

  1. Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research , Helsinki , Finland ; Department of Public Health , University of Helsinki , Finland.
  2. Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research , Helsinki , Finland.
  3. Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research , Helsinki , Finland ; School of Health Sciences, University of Tampere , Tampere , Finland.
  4. Fimlab Laboratories , Tampere , Finland.
  5. Pirkanmaa Cancer Society , Tampere , Finland.
  6. Department of Gastroenterological Surgery , Helsinki University Hospital , Helsinki , Finland.
  7. Department of Gastrointestinal Surgery , University Hospital of Northern Norway , Narvik , Norway.
  8. Department of Medicine, Tampere University Hospital , Tampere , Finland.
  9. The Cancer Society of Finland , Helsinki , Finland.
  10. Finnish Medical Society Duodecim , Helsinki , Finland.

PMID: 26462283 PMCID: PMC4599169 DOI: 10.1136/bmjgast-2015-000034

Abstract

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.

Keywords: CANCER PREVENTION; COLORECTAL CANCER SCREENING; SCREENING

References

  1. Lancet. 2015 Mar 14;385(9972):977-1010 - PubMed
  2. Gut. 2012 Jul;61(7):1036-40 - PubMed
  3. Lancet. 1996 Nov 30;348(9040):1472-7 - PubMed
  4. N Engl J Med. 2013 Sep 19;369(12):1106-14 - PubMed
  5. Biometrics. 2011 Mar;67(1):39-49 - PubMed
  6. Stat Med. 2002 Aug 15;21(15):2175-97 - PubMed
  7. BMJ. 2008 Nov 20;337:a2261 - PubMed
  8. Gut. 2002 Jan;50(1):29-32 - PubMed
  9. Br J Cancer. 2013 Jun 11;108(11):2205-40 - PubMed
  10. Acta Oncol. 1994;33(4):365-9 - PubMed
  11. Lancet. 1996 Nov 30;348(9040):1467-71 - PubMed
  12. Z Gastroenterol. 2008 Apr;46 Suppl 1:S25-8 - PubMed
  13. Lancet Oncol. 2014 Jan;15(1):23-34 - PubMed
  14. Acta Oncol. 2010 Jun;49(5):725-36 - PubMed
  15. JAMA. 2014 Aug 13;312(6):606-15 - PubMed
  16. Br J Surg. 2008 Aug;95(8):1029-36 - PubMed
  17. J Med Screen. 2013 Mar;20(1):33-8 - PubMed
  18. Cell. 1990 Jun 1;61(5):759-67 - PubMed
  19. Int J Cancer. 2012 Dec 15;131(12):2898-902 - PubMed
  20. Lancet. 2014 Apr 26;383(9927):1490-502 - PubMed
  21. J Med Screen. 2013;20(3):125-48 - PubMed
  22. Eur J Cancer Prev. 1993 May;2(3):221-7 - PubMed
  23. J Med Screen. 2011;18(1):18-23 - PubMed
  24. Gut. 2015 Feb;64(2):282-91 - PubMed
  25. J Med Screen. 2010;17 (4):204-10 - PubMed
  26. Gastroenterology. 2004 Jun;126(7):1674-80 - PubMed
  27. Curr Oncol. 2015 Apr;22(2):e41-50 - PubMed
  28. J Med Screen. 2005;12(1):28-32 - PubMed
  29. Gut. 2010 Jan;59(1):62-8 - PubMed
  30. Br J Surg. 2010 Oct;97(10):1567-71 - PubMed
  31. N Engl J Med. 2014 Aug 28;371(9):799-807 - PubMed
  32. N Engl J Med. 1993 May 13;328(19):1365-71 - PubMed

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