Abstract
| Original language | English |
|---|---|
| Pages (from-to) | 60-67 |
| Number of pages | 8 |
| Journal | European Journal of Cancer |
| Volume | 178 |
| DOIs | |
| Publication status | Published - 1 Jan 2023 |
Keywords
- Colorectal cancer
- Colorectal cancer screening
- Faecal immunochemical testing
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In: European Journal of Cancer, Vol. 178, 01.01.2023, p. 60-67.
Research output: Contribution to journal › Article › Academic › peer-review
TY - JOUR
T1 - Advanced-stage CRC incidence patterns following the phased implementation of the CRC screening programme in the Netherlands
AU - Breekveldt, Emilie C. H.
AU - Toes-Zoutendijk, Esther
AU - Spaander, Manon C. W.
AU - van de Schootbrugge-Vandermeer, Hilliene J.
AU - van Vuuren, Anneke J.
AU - van Kemenade, Folkert J.
AU - Ramakers, Christian R. B.
AU - Dekker, Evelien
AU - Nagtegaal, Iris D.
AU - van Leerdam, Monique E.
AU - Lansdorp-Vogelaar, Iris
N1 - Funding Information: In the period 2014–2019, an increase in advanced-stage CRC incidence was observed for all invitation cohorts first invited for screening, followed by a decrease below expected incidence, following the pattern of the phased implementation. The cumulative advanced-stage CRC incidence in invitation cohorts invited for screening multiple times was lower than expected based on trends from the pre-screening era. These findings support a causal relationship between the introduction of the Dutch screening programme and a decrease in advanced-stage CRC incidence.We observed significant differences between cumulative advanced-stage CRC incidence and expected cumulative advanced-stage CRC incidence in the period 2010–2019 in the 2014–2016 invitation cohorts. This difference was not observed yet for the 2017 and 2018 invitation cohorts. In the 2019 invitation cohort, we actually observed a slightly higher cumulative advanced-stage CRC incidence than the expected cumulative advanced-stage CRC incidence. This pattern across all birth cohorts supports the hypothesis that screening is the main cause of changes in the cumulative advanced-stage CRC incidence. Indeed, first screening promotes the diagnosis of CRC, resulting in an initial peak in (advanced-stage) CRC incidence. This is exactly what we observe in the 2019 cohort, which was invited only once. After that first screening, time and repeated screening is needed to compensate for the peak in (advanced-stage) CRC incidence. Therefore, we do not see a statistically significant difference in the 2017 and 2018 invitation cohorts, but we do see a statistically significant difference in the earlier cohorts, which were invited for screening more often and longer ago. Interestingly, in men, the cumulative advanced-stage CRC incidence was significantly lower than the expected advanced-stage CRC incidence in the 2014–2016 invitation cohorts, whereas in women, only in the 2014 and 2015 invitation cohorts a significant difference was observed between the observed and expected cumulative advanced-stage CRC incidence. This could indicate that screening has a greater protective effect on the advanced-stage CRC incidence in men than in women. A major strength of this study is the availability of detailed data from a large national cancer registry, which allowed us to conduct analyses by birth cohort. Second, when assessing changes in trends of surrogate quality indicators, the fact that CRC survival has significantly improved in recent years due to advances in surgical oncological treatment, should also be taken into account. Modification of (treatment) guidelines usually is quite time-consuming, hence using this surrogate quality indicator (i.e. advanced-stage CRC incidence patterns over time) is more reliable, as time effects are less influential. The main limitation of this study is the introduction of bias due to the ecological design. It is inevitable that randomised controlled trials (RCTs) are considered higher level evidence than (retrospective) cohort studies. Since RCTs on the efficacy of FIT-based screening are lacking and unlikely to be initiated in the future, we must rely on the results of previous guaiac faecal occult blood testing-based RCTs and FIT-based observational studies, such as our study. Despite the design of our study, we demonstrated a stronger association between the introduction of the screening programme and a decrease in advanced-stage CRC incidence than other cohort studies due to the analyses by birth cohort.To conclude, we observed a short increase in advanced-stage CRC for all invitation cohorts first invited for screening in 2014–2019, followed by a decrease below expected incidence levels, coinciding with the pattern of the phased implementation. The cumulative advanced-stage CRC incidence in the 2014–2016 invitation cohorts was lower than the expected cumulative advanced-stage CRC incidence in the period 2010–2019. These findings support a causal relationship between the introduction of the Dutch CRC screening programme and a decrease in advanced-stage CRC incidence.This analysis has been carried out as part of the national monitoring and evaluation of the CRC screening programme, funded by the National Institute for Public Health and the Environment (RIVM). The funder had no role in the study design, data analysis and preparation of the manuscript.The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Manon C.W. Spaander received research support from Sentinel, Sysmex, Boston Scientific, Norgine and Medtronic. Evelien Dekker received endoscopic equipment on loan of Olympus and FujiFilm and research grant from FujiFilm; received honorarium for consultancy from FujiFilm, Tillots, Olympus, GI Supply, Cancer Prevention Pharmaceuticals, PAION and Ambu; and a speakers' fee from Olympus, Roche, GI Supply, PAION and IPSEN. All other authors have nothing to disclose. Funding Information: This analysis has been carried out as part of the national monitoring and evaluation of the CRC screening programme, funded by the National Institute for Public Health and the Environment ( RIVM ). The funder had no role in the study design, data analysis and preparation of the manuscript. Publisher Copyright: © 2022 The Author(s)
PY - 2023/1/1
Y1 - 2023/1/1
N2 - Background and aims: From 2014, the Dutch colorectal cancer (CRC) faecal immunochemical testing-based screening programme was gradually rolled out by birth cohort. We evaluated changes in advanced-stage CRC incidence by timing of invitation to further strengthen the evidence for the effectiveness of CRC screening. Methods: Data on advanced-stage CRC incidence in the period 2010–2019 by invitation cohort were collected through the Netherlands Cancer Registry. Crude rates of advanced-stage CRC incidence and cumulative advanced-stage CRC incidence were calculated. Observed advanced-stage CRC incidence and cumulative advanced-stage CRC incidence were compared with expected advanced-stage CRC incidence and cumulative advanced-stage CRC incidence by invitation cohort using trend lines extrapolating data prior to the introduction of screening. Results: For the invitation cohort that was first invited for screening in 2014, advanced-stage CRC incidence increased before the introduction of screening from 94.1 to 124.7 per 100,000 individuals in the period 2010–2013. In 2014, the observed increase was higher than in preceding years, to 184.9 per 100,000 individuals. Hereafter, a decrease in incidence was observed to levels below expected incidence based on trends before the introduction of screening. A similar pattern was observed for invitation cohorts in subsequent years, coinciding with the first invitation to the screening programme. In 2019, the observed incidence for all invitation cohorts remained below expected incidence. The cumulative advanced-stage CRC incidence in the 2014–2016 invitation cohorts was significantly lower than the expected cumulative CRC incidence in the period 2010–2019. Conclusions: In the period 2014–2019, an increase in advanced-stage CRC incidence was observed for all invitation cohorts first invited for screening, followed by a decrease below expected incidence, following the pattern of the phased implementation. The cumulative advanced-stage CRC incidence in invitation cohorts invited for screening multiple times was lower than expected based on trends from the pre-screening era. These findings support a causal relationship between the introduction of the Dutch screening programme and a decrease in advanced-stage CRC incidence.
AB - Background and aims: From 2014, the Dutch colorectal cancer (CRC) faecal immunochemical testing-based screening programme was gradually rolled out by birth cohort. We evaluated changes in advanced-stage CRC incidence by timing of invitation to further strengthen the evidence for the effectiveness of CRC screening. Methods: Data on advanced-stage CRC incidence in the period 2010–2019 by invitation cohort were collected through the Netherlands Cancer Registry. Crude rates of advanced-stage CRC incidence and cumulative advanced-stage CRC incidence were calculated. Observed advanced-stage CRC incidence and cumulative advanced-stage CRC incidence were compared with expected advanced-stage CRC incidence and cumulative advanced-stage CRC incidence by invitation cohort using trend lines extrapolating data prior to the introduction of screening. Results: For the invitation cohort that was first invited for screening in 2014, advanced-stage CRC incidence increased before the introduction of screening from 94.1 to 124.7 per 100,000 individuals in the period 2010–2013. In 2014, the observed increase was higher than in preceding years, to 184.9 per 100,000 individuals. Hereafter, a decrease in incidence was observed to levels below expected incidence based on trends before the introduction of screening. A similar pattern was observed for invitation cohorts in subsequent years, coinciding with the first invitation to the screening programme. In 2019, the observed incidence for all invitation cohorts remained below expected incidence. The cumulative advanced-stage CRC incidence in the 2014–2016 invitation cohorts was significantly lower than the expected cumulative CRC incidence in the period 2010–2019. Conclusions: In the period 2014–2019, an increase in advanced-stage CRC incidence was observed for all invitation cohorts first invited for screening, followed by a decrease below expected incidence, following the pattern of the phased implementation. The cumulative advanced-stage CRC incidence in invitation cohorts invited for screening multiple times was lower than expected based on trends from the pre-screening era. These findings support a causal relationship between the introduction of the Dutch screening programme and a decrease in advanced-stage CRC incidence.
KW - Colorectal cancer
KW - Colorectal cancer screening
KW - Faecal immunochemical testing
UR - http://www.scopus.com/inward/record.url?scp=85141945606&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.ejca.2022.10.016
DO - https://doi.org/10.1016/j.ejca.2022.10.016
M3 - Article
C2 - 36403368
SN - 0959-8049
VL - 178
SP - 60
EP - 67
JO - European Journal of Cancer
JF - European Journal of Cancer
ER -