PO.PS01.09 · 人群科学
在45岁开始FIT筛查的有效性：与50—54岁成人检出率的比较
Effectiveness of initiating FIT screening at age 45: Comparative yield with adults aged 50-54 years
作者与单位 Authors & Affiliations
摘要 Abstract
中文摘要
背景与目的：过去二十年间，早发性结直肠癌（CRC）的发病率在多个高收入国家有所上升。为应对这一趋势，美国预防服务工作组（United States Preventative Services Task Force）基于微观模拟模型的估算，建议将CRC筛查的起始年龄从50岁降至45岁。然而，关于不同人群筛查检出率的真实世界证据仍然有限。
方法：自2020年起，在一个CRC高发地区（中国浙江省）实施了一项基于人群的CRC筛查项目。该项目主要针对50—74岁人群，但也纳入了40—49岁人群。筛查采用双样本粪便免疫化学检测（FIT），对任一样本检测阳性者提供结肠镜检查。我们比较了45—49岁与50—54岁参与者的筛查结果，包括：（1）FIT阳性率（阈值为每克粪便20 μg血红蛋白）；（2）结肠镜完成率；以及（3）肿瘤的阳性预测值（PPV，即在FIT阳性且有可用结肠镜检查者中检出的病例）。进展期肿瘤包括CRC、进展期腺瘤和进展期锯齿状病变。将标准化均数差大于0.1的变量（包括性别、水果摄入量和参与年份）纳入倾向评分模型，用于两个年龄组间的1:1匹配。采用泊松混合效应模型估计风险比（RR）。
结果：经倾向评分匹配后，选取了89 446名45—49岁受试者和89 446名50—54岁受试者，他们均完成了FIT检测，基线特征相当。45—49岁组的FIT阳性率为10.61%，低于50—54岁组的11.02%（RR，0.96；95% CI，0.94—0.99），结肠镜依从性相似（46.75% vs 47.43%；RR，0.99；95% CI，0.95—1.03）。与50—54岁组相比，45—49岁组任何腺瘤（15.82% vs 19.91%；RR，0.79；95% CI，0.72—0.88）和进展期肿瘤（6.06% vs 8.25%；RR，0.73；95% CI，0.63—0.86）的PPV显著更低。在45—49岁组的亚组分析中，吸烟、BMI ≥28 kg/m²、频繁饮酒、有腺瘤个人史或CRC家族史的参与者的进展期肿瘤PPV超过了50—54岁组观察到的水平。
结论：45—49岁人群的结肠镜依从性与50—54岁人群相当，但腺瘤和进展期肿瘤的检出率较低。年轻且具有危险因素的个体检出率较高，凸显了风险分层策略的潜力。这些发现提供了特定人群的证据，可为关于最佳筛查起始年龄的持续讨论提供参考，但仍需进一步的纵向研究、成本效益评估和项目评估。
查看英文原文 English abstract
Background and aim: Over the past two decades, the incidence of early-onset colorectal cancer (CRC) has risen in several high-income countries. To address this trend, the United States Preventative Services Task Force recommended lowering the starting age for CRC screening from 50 to 45 years based on estimates from microsimulation models. However, real-world evidence on the screening yield across diverse populations remains limited.
Methods: A population-based CRC screening program has been implemented since 2020 in a region with high CRC incidence (Zhejiang Province, China). The program primarily targeted individuals aged 50-74 years but also included those aged 40-49 years. Screening consisted of two-sample fecal immunochemical testing (FIT), with colonoscopy offered to individuals testing positive on either sample. We compared screening outcomes between participants aged 45-49 years and 50-54 years, including: (1) FIT positivity (threshold of 20 μg hemoglobin per gram of feces); (2) colonoscopy completion; and (3) positive predictive values (PPV, cases detected among those with a positive FIT and available colonoscopy) for neoplasia. Advanced neoplasia included CRC, advanced adenoma and advanced serrated lesion. Variables with standardized mean differences greater than 0.1, including sex, fruit intake, and year of participation, were included in the propensity score model for 1:1 matching between age groups. Risk ratios (RRs) were estimated using a Poisson mixed-effects model.
Results: After propensity score matching, 89 446 subjects aged 45-49 and 89446 subjects aged 50-54 who completed the FIT test were selected, with comparable baseline characteristics. The FIT positivity in the 45-49 age group was 10.61%, which was lower than 11.02% in the 50-54 age group (RR, 0.96; 95% CI, 0.94-0.99), with similar colonoscopy adherence (46.75% vs 47.43%; RR, 0.99; 95% CI, 0.95-1.03). Compared with the 50-54 age group, the 45-49 age group had significantly lower PPVs for any adenoma (15.82% vs 19.91%; RR, 0.79; 95% CI, 0.72-0.88) and advanced neoplasia (6.06% vs 8.25%; RR, 0.73; 95% CI, 0.63-0.86).In subgroup analyses of 45-49 age group, the PPVs for advanced neoplasia among participants with smoking, BMI ≥28 kg/m 2 , frequent alcohol drinking, personal history of adenoma or a family history of CRC exceeded that observed in the 50-54 age group.
Conclusions: Individuals aged 45-49 years had comparable colonoscopy adherence to those aged 50-54 years but a lower yield for adenomas and advanced neoplasia. Higher yields among younger individuals with risk factors highlight the potential of risk-stratified approaches. These findings contribute population-specific evidence to inform ongoing discussions on optimal screening initiation age, but further longitudinal, cost-effectiveness, and programmatic evaluations are warranted.
利益披露 Disclosure
L. Wang, None..
C. Zhu, None..
Y. Qiu, None..
W. Wu, None..
D. Hang, None..
N. Li, None..
P. Basu, None..
L. Du, None.