Impact of colorectal cancer screening participation in remote northern Canada:A retrospective cohort study

查看全文 作　　者：Heather A [1,2]Smith;Andrew D [2]Scarffe;Nicole [3]Brunet;Cait [4]Champion;Kami [5]Kandola;Alisha [6]Tessier;Robin [7]Boushey;Craig [8]Kuziemsky 机构地区：[1]Department of Surgery,University of Ottawa,Ottawa K1Y4E9,Ontario,Canada;[2]Telfer School of Management,University of Ottawa,Ottawa K1N6N5,Ontario,Canada;[3]Faculty of Medicine,University of Ottawa,Ottawa K1Y4E9,Ontario,Canada;[4]Department of Surgery,Northern Ontario School of Medicine,Sudbury P3E2C6,Ontario,Canada;[5]Department of Health and Social Services,Government of the Northwest Territories,Yellowknife X1A1P5,Northwest Territories,Canada;[6]Department of Surgery,Stanton Territorial Health Authority,Yellowknife X1A0H1,Northwest Territories,Canada;[7]Division of General Surgery,University of Ottawa,Ottawa K1H 8L6,Ontario,Canada;[8]Office of Research Services,MacEwan University,Edmonton T5J4S2,Alberta,Canada 出　　处：《World Journal of Gastroenterology》索引2020年第26卷第48期,共12页 基　　金：This study was approved by the Aurora College Research Ethics Committee,protocol No.20190404. 摘　　要：BACKGROUND Screening provides earlier colorectal cancer(CRC)detection and improves outcomes.It remains poorly understood if these benefits are realized with screening guidelines in remote northern populations of Canada where CRC rates are nearly twice the national average and access to colonoscopy is limited.AIM To evaluate the participation and impact of CRC screening guidelines in a remote northern population.METHODS This retrospective cohort study included residents of the Northwest Territories,a northern region of Canada,age 50-74 who underwent CRC screening by a fecal immunohistochemical test(FIT)between January 1,2014 to March 30,2019.To assess impact,individuals with a screen-detected CRC were compared to clinically-detected CRC cases for stage and location of CRC between 2014-2016.To assess participation,we conducted subgroup analyses of FIT positive individuals exploring the relationships between signs and symptoms of CRC at the time of screening,wait-times for colonoscopy,and screening outcomes.Two sample Welch t-test was used for normally distributed continuous variables,Mann-Whitney-Wilcoxon Tests for data without normal distribution,and Chi-square goodness of fit test for categorical variables.A P value of<0.05 was considered to be statistically significant.RESULTS 6817 fecal tests were completed,meaning an annual average screening rate of 25.04%,843(12.37%)were positive,629 individuals underwent a follow-up colonoscopy,of which,24.48%had advanced neoplasia(AN),5.41%had CRC.There were no significant differences in stage,pathology,or location between screen-detected cancers and clinically-detected cancers.In assessing participation and screening outcomes,we observed 49.51%of individuals referred for colonoscopy after FIT were ineligible for CRC screening,most often due to signs and symptoms of CRC.Individuals were more likely to have AN if they had signs and symptoms of cancer at the time of screening,waited over 180 d for colonoscopy,or were indigenous[respectively,estimated RR 1.1895%CI of RR(0.89-1.59)];RR 1.523(CI:1.035,2.240);RR 1.722(CI:1.165,2.547)].CONCLUSION Screening did not facilitate early cancer detection but facilitated higher than anticipated AN detection.Signs and symptoms of CRC at screening,and long colonoscopy wait-times appear contributory. 关 键 词：GASTROENTEROLOGY Rural health services Public health Colorectal neoplasms Early detection of cancer Northwest Territories