Background: Whether colorectal cancer (CRC) screening with a fecal immunochemical test (FIT) reduces mortality remains unclear. In South Korea, CRC screening with a FIT for individuals aged ≥ 50 years has been part of the Korean National Cancer Screening Program (KNCSP) since 2004. The aim of this study was to evaluate the effectiveness of the KNCSP in reducing CRC-specific mortality. Methods: We conducted a nested case-control study using cohort-based data derived from the KNCSP database. The cohort included 5,944,540 colorectal cancer-free individuals aged ≥ 50 years as of 2004. Individuals who died after CRC diagnosis were defined as cases (n= 29,992) and their sociodemographic characteristics were matched to those of the selected controls. The effects of screening exposure, frequency, and time interval on CRC-specific mortality were analyzed according to age group. Conditional logistic regression analysis was performed. Results: Compared with individuals who had never been screened, those who had ever been screened showed an OR of 0.74 (95% CI, 0.71–0.76) for CRC-specific mortality. CRC-specific mortality decreased as the number of screenings increased. Similar results were observed for those aged 50–79 years; however, the results for those aged 75–79 years were not statistically significant. Moreover, those aged ≥ 80 years had the opposite results. Conclusions: CRC mass screening using FIT is effective for individuals aged 50–74 years; therefore, this study suggests that countries considering introducing national CRC screening implement FIT for those within this age range.
背景：粪便免疫化学检测（FIT）用于结直肠癌（CRC）筛查是否能降低死亡率尚不明确。自2004年起，韩国国家癌症筛查计划（KNCSP）已将针对50岁及以上人群的FIT结直肠癌筛查纳入其中。本研究旨在评估KNCSP在降低结直肠癌特异性死亡率方面的有效性。方法：我们利用KNCSP数据库中的队列数据开展了一项巢式病例对照研究。该队列纳入了截至2004年时年龄≥50岁、未患结直肠癌的5,944,540名个体。将确诊结直肠癌后死亡的个体定义为病例组（n=29,992），并依据社会人口学特征匹配相应的对照组。研究按年龄组分析了筛查参与情况、筛查频率及筛查间隔时间对结直肠癌特异性死亡率的影响，并采用条件逻辑回归进行分析。结果：与从未接受筛查的个体相比，曾接受过筛查的个体结直肠癌特异性死亡率的比值比（OR）为0.74（95%置信区间0.71–0.76）。随着筛查次数增加，结直肠癌特异性死亡率呈下降趋势。50-79岁人群呈现相似规律，但75-79岁人群的结果无统计学显著性。而年龄≥80岁人群的结果则呈现相反趋势。结论：采用FIT进行结直肠癌大规模筛查对50-74岁人群具有显著效果；因此，本研究建议考虑推行国家结直肠癌筛查计划的国家针对该年龄段人群实施FIT筛查。
肿瘤(癌症)患者之家