The effect of using fecal testing after a negative sigmoidoscopy on the risk of death from colorectal cancer.

Autor: Doubeni CA; Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, MN, USA.; Department of Family Medicine, Mayo Clinic, Rochester, MN, USA., Corley DA; Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA., Jensen CD; Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA., Schottinger JE; Kaiser Permanente Southern California, Pasadena, CA, USA., Lee JK; Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA., Ghai NR; Kaiser Permanente Southern California, Pasadena, CA, USA., Levin TR; Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA., Zhao WK; Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA., Saia CA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA., Wainwright JV; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA., Mehta SJ; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA., Selby K; Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland., Doria-Rose VP; Healthcare Assessment Research Branch in the Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA., Zauber AG; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA., Fletcher RH; Department of Population Medicine, Harvard Medical School, Boston, MA, USA., Weiss NS; Department of Epidemiology, University of Washington, Seattle, WA, USA.
Jazyk: angličtina
Zdroj: Journal of medical screening [J Med Screen] 2021 Jun; Vol. 28 (2), pp. 140-147. Date of Electronic Publication: 2020 May 21.
DOI: 10.1177/0969141320921427
Abstrakt: Objective: To examine whether receiving a fecal occult blood test after a negative sigmoidoscopy reduced mortality from colorectal cancer.
Methods: We used a nested case-control design with incidence-density matching in historical cohorts of 1,877,740 50-90-year-old persons during 2006-2012, in an integrated health-system setting. We selected 1758 average risk patients who died from colorectal cancer and 3503 matched colorectal cancer-free persons. Colorectal cancer-specific death was ascertained from cancer and mortality registries. Screening histories were determined from electronic and chart-audit clinical data in the 5- to 10-year period prior to the reference date. We evaluated receipt of subsequent fecal occult blood test within five years of the reference date among patients with negative sigmoidoscopy two to six years before the reference date.
Results: Of the 5261 patients, 831 patients (204 colorectal cancer deaths/627 controls) had either negative sigmoidoscopy only ( n  = 592) or negative sigmoidoscopy with subsequent screening fecal occult blood test ( n  = 239). Fifty-six (27.5%) of the 204 patients dying of colorectal cancer and 183 (29.2%) of the 627 colorectal cancer-free patients received fecal occult blood test following a negative sigmoidoscopy. Conditional regressions found no significant association between fecal occult blood test receipt and colorectal cancer death risk, overall (adjusted odds ratio = 0.93, confidence interval: 0.65-1.33), or for right (odds ratio = 1.02, confidence interval: 0.65-1.60) or left-colon/rectum (odds ratio = 0.77, confidence interval: 0.39-1.52) cancers. Similar results were obtained in sensitivity analyses with alternative exposure ascertainment windows or timing of fecal occult blood test.
Conclusions: Our results suggest that receipt of at least one fecal occult blood test during the several years after a negative sigmoidoscopy did not substantially reduce mortality from colorectal cancer.
Databáze: MEDLINE
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