title: Impact on colorectal cancer mortality of screening programmes based on the faecal immunochemical test.
abstract: OBJECTIVE
  Colorectal cancer (CRC) screening programmes based on the guaiac faecal occult blood test (gFOBT) reduce CRC-specific mortality. Several studies have shown higher sensitivity with the faecal immunochemical test (FIT) compared with gFOBT. We carried out an ecological study to evaluate the impact of FIT-based screening programmes on CRC mortality.
  
  
  METHODS
  In the Veneto Region (Italy), biennial FIT-based screening programmes that invited 50-69-year-old residents were introduced in different areas between 2002 and 2009. We compared CRC mortality rates from 1995 to 2011 between the areas where screening started in 2002-2004 (early screening areas (ESA)) and areas that introduced the screening in 2008-2009 (late screening areas (LSA)) using Poisson regression models. We also compared available data on CRC incidence rates (1995-2007) and surgical resection rates (2001-2012).
  
  
  RESULTS
  Before the introduction of screening, CRC mortality and incidence rates in the two areas were similar. Compared with 1995-2000, 2006-2011 mortality rates were 22% lower in the ESA than in the LSA (rate ratio (RR)=0.78; 95% CI 0.68 to 0.89). The reduction was larger in women (RR=0.64; CI 0.51 to 0.80) than in men (RR=0.87; CI 0.73 to 1.04). In the ESA, incidence and surgery rates peaked during the introduction of the screening programme and then returned to the baseline (2006-2007 incidence) or dropped below initial values (surgery after 2007).
  
  
  CONCLUSIONS
  FIT-based screening programmes were associated with a significant reduction in CRC mortality. This effect took place much earlier than reported by gFOBT-based trials and observational studies.
authors.affiliation: Veneto Tumour Registry, Veneto Region, Padua, Italy.
authors.forename: Manuel
authors.initials: M
authors.lastname: Zorzi
authors.affiliation: SER-Epidemiological Department, Veneto Region, Padua, Italy.
authors.forename: Ugo
authors.initials: U
authors.lastname: Fedeli
authors.affiliation: SER-Epidemiological Department, Veneto Region, Padua, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Schievano
authors.affiliation: Veneto Tumour Registry, Veneto Region, Padua, Italy.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Bovo
authors.affiliation: Veneto Tumour Registry, Veneto Region, Padua, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Guzzinati
authors.affiliation: Veneto Tumour Registry, Veneto Region, Padua, Italy.
authors.forename: Susanna
authors.initials: S
authors.lastname: Baracco
authors.affiliation: Veneto Tumour Registry, Veneto Region, Padua, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Fedato
authors.affiliation: SER-Epidemiological Department, Veneto Region, Padua, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Saugo
authors.affiliation: Veneto Tumour Registry, Veneto Region, Padua, Italy Department of Pathology, Santa Maria di Ca' Foncello Hospital, Treviso, Italy.
authors.forename: Angelo Paolo
authors.initials: AP
authors.lastname: Dei Tos
mesh_terms: D000368:Aged; D003082:Colectomy / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009780:Occult Blood
keywords: CANCER EPIDEMIOLOGY; CANCER PREVENTION; COLORECTAL CANCER SCREENING