45至50岁患者的结直肠癌筛查完成情况及筛查率：一项观察性研究

Colorectal Cancer Screening Completion and Yield in Patients Aged 45 to 50 Years : An Observational Study.

作者信息

Levin Theodore R, Jensen Christopher D, Udaltsova Natalia, Burnett-Hartman Andrea A, Kamineni Aruna, Chao Chun R, Schottinger Joanne E, Ghai Nirupa R, Pocobelli Gaia, White Larissa L, Oliver Malia, Chowdhry Hina, Hixon Brian P, Badalov Jessica M, Goldberg Shauna R, Bradford Susan C, Quesenberry Charles P, Lee Jeffrey K

机构信息

Division of Research, Kaiser Permanente Northern California, Oakland, California, and Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California (T.R.L.).

Division of Research, Kaiser Permanente Northern California, Oakland, California (C.D.J., N.U., J.M.B., C.P.Q., J.K.L.).

出版信息

Ann Intern Med. 2024 Dec;177(12):1621-1629. doi: 10.7326/M24-0743. Epub 2024 Oct 22.

DOI:10.7326/M24-0743

PMID:39531396

Abstract

BACKGROUND

Guidelines now recommend initiating colorectal cancer (CRC) screening at age 45 years rather than 50 years, but little is known about screening completion and yield among people aged 45 to 49 years.

OBJECTIVE

To evaluate fecal immunochemical test (FIT) completion and yield in patients aged 45 to 49 versus 50 years.

DESIGN

Retrospective cohort study.

SETTING

Kaiser Permanente Northern California, Washington, and Colorado.

PATIENTS

Those distributed a FIT kit during January to September 2022.

MEASUREMENTS

FIT completion within 3 months, FIT positivity, receipt of colonoscopy within 3 months after a positive FIT result, and colonoscopy yield.

RESULTS

A total of 267 732 FIT kits were distributed: 213 928 (79.9%) to patients aged 45 to 49 years, and 53 804 (20.1%) to those aged 50 years. Overall, FIT completion was slightly higher in patients aged 45 to 49 years (38.9% vs. 37.5%; adjusted risk ratio [aRR], 1.05 [95% CI, 1.04 to 1.06]), although at Colorado, those aged 45 to 49 years were substantially less likely to complete a FIT (30.7% vs. 40.2%; aRR, 0.77 [CI, 0.73 to 0.80]). Overall, FIT positivity was lower in patients aged 45 to 49 years (3.6% vs. 4.0%; aRR, 0.91 [CI, 0.84 to 0.98]), and receipt of colonoscopy after a positive FIT result was similar between groups (64.9% vs. 67.4%; aRR, 1.00 [CI, 0.94 to 1.05]). Adenoma detection was lower in the younger group (58.8% vs. 67.7%; aRR, 0.88 [CI, 0.83 to 0.95]). Yields were similar for adenoma with advanced histology (13.2% vs. 15.9%; aRR, 0.86 [CI, 0.69 to 1.07]), polyp with high-grade dysplasia (3.4% vs. 5.1%; aRR, 0.68 [CI, 0.44 to 1.04]), sessile serrated lesion (10.3% vs. 11.7%; aRR, 0.92 [CI, 0.71 to 1.21]), and CRC (2.8% vs. 2.7%; aRR, 1.10 [CI, 0.62 to 1.96]).

LIMITATION

The small number of neoplasia events contributed to wide CIs.

CONCLUSION

Similar FIT completion and yield rates in people aged 45 to 50 years support initiation of CRC screening at age 45 years.

PRIMARY FUNDING SOURCE

Kaiser Permanente Sidney R. Garfield Memorial Fund.

摘要

背景

目前的指南建议在45岁而非50岁开始进行结直肠癌（CRC）筛查，但对于45至49岁人群的筛查完成情况和筛查收益知之甚少。

目的

评估45至49岁患者与50岁患者粪便免疫化学检测（FIT）的完成情况和收益。

设计

回顾性队列研究。

地点

北加利福尼亚、华盛顿和科罗拉多州的凯撒医疗集团。

患者

2022年1月至9月期间分发了FIT检测试剂盒的人群。

测量指标

3个月内FIT完成情况、FIT阳性率、FIT结果呈阳性后3个月内接受结肠镜检查情况以及结肠镜检查收益。

结果

共分发了267732份FIT检测试剂盒：213928份（79.9%）给45至49岁的患者，53804份（20.1%）给50岁的患者。总体而言，45至49岁患者的FIT完成率略高（38.9%对37.5%；调整风险比[aRR]，1.05[95%CI，1.04至1.06]），尽管在科罗拉多州，45至49岁的患者完成FIT的可能性大幅降低（30.7%对40.2%；aRR，0.77[CI，0.73至0.80]）。总体而言，45至49岁患者的FIT阳性率较低（3.6%对4.0%；aRR，0.91[CI，0.84至0.98]），FIT结果呈阳性后两组接受结肠镜检查的情况相似（64.9%对67.4%；aRR，1.00[CI，0.94至1.05]）。较年轻组的腺瘤检出率较低（58.8%对67.7%；aRR，0.88[CI，0.83至0.95]）。高级别组织学腺瘤（13.2%对15.9%；aRR，0.86[CI，0.69至1.07]）、高级别异型增生息肉（3.4%对5.1%；aRR，0.68[CI，0.44至1.04]）、无蒂锯齿状病变（10.3%对11.7%；aRR，0.92[CI，0.71至1.21]）和结直肠癌（2.8%对2.7%；aRR，1.10[CI，0.62至1.96]）的收益相似。