Routine screening with fecal occult blood testing reduces CRC mortality by 14%
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Key takeaways:
- After a maximum follow-up of 14 years, the mean screening participation rate was 63.3%.
- Those who underwent early screening had reduced risk for colorectal cancer mortality and excess mortality.
Participation in early, routine screening for colorectal cancer using fecal occult blood testing was associated with a 14% reduction in CRC mortality in a cohort of nearly 380,000 individuals in Sweden, according to data.
“There is a lack of observational studies evaluating the association of CRC mortality with routine screening programs using FOBT,” Johannes Blom, MD, PhD, of the department of clinical science and education at Karolinska Institute, and colleagues wrote in JAMA Network Open. “In 2008, the region of Stockholm-Gotland, encompassing approximately 25% of the Swedish population, initiated a CRC screening program.
“Influenced by experiences from Finland, the program gradually invited men and women aged 60 to 69 years to undergo biennial guaiac-based FOBT. If results were positive, a referral for colonoscopy was undertaken.”
In a prospective cohort study, Blom and colleagues evaluated cancer-specific mortality among 379,448 Swedish individuals (51% women; born 1938-1954) who were invited to participate in early (2008-2012) or late (2013-2015) routine CRC screening with fecal occult blood testing (FOBT), or who received no invitation to screen. Of those, 203,670 individuals were in the exposure group (early invitation) and 175,778 were in the control group, comprised of 60,162 individuals (34.2%) who were not invited to screen and 115,616 (65.8%) who were invited to participate in at least one screening round (late invitation).
After a maximum follow-up of 14 years, the mean screening participation rate was 63.3%. There were 834 CRC deaths in 2,190,589 person-years in the exposure group vs. 889 deaths in 2,249,939 person-years in the control group. Although women had a “significantly lower” CRC mortality compared with men (RR = 0.67; 95% CI, 0.61-0.74), there was no significant interaction between group and sex (RR = 0.94; 95% CI, 0.78-1.14).
Further, results showed that those who underwent early CRC screening had reduced risk for CRC mortality in both unadjusted (RR = 0.96; 95% CI, 0.88-1.06) and adjusted (RR = 0.86; 95% CI, 0.78-0.95) analyses, as well as reduced risk for excess mortality before and after adjustment for follow-up year and attained age (RR = 0.94; 95% CI, 0.86-1.03 and RR = 0.84; 95% CI, 0.75-0.93, respectively).
“This cohort study evaluating invitation to routine FOBT screening in Sweden found a 14% reduction in CRC mortality after 14 years of follow-up,” Blom and colleagues concluded. “Dilution of the estimated effectiveness is expected due to some later screening in the control group and some CRC deaths occurring among individuals who received a diagnosis years after invitations to screening had ended.”
They continued: “Our results have an important public health implication in suggesting that organized population-based CRC screening with FOBT has the potential to save lives worldwide.”
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