How a faecal immunochemical test screening programme changes annual colorectal cancer incidence rates: an Italian intention-to-screen study

Abstract

Background: This study aimed to evaluate the effectiveness of a biennial faecal immunochemical test (FIT) screening programme in reducing annual colorectal cancer (CRC) incidence in its dynamic target population.

Methods: The target population included over 1,000,000 persons aged 50-69 living in a region of northern Italy. The average annual response rate to invitation was 51.4%. Each observed annual age-standardised (Europe) rate per 100,000 persons between 2005, the year of introduction of the programme, and 2016 was compared with each expected annual rate as estimated with age-period-cohort (men) and age-period (women) models.

Results: For both sexes, the rates observed in 1997-2004 and those expected in 2005-2016 were stable. Observed rates increased in 2005, peaked in 2006 (the first full year of screening), dropped significantly below the expected level in 2009, and continued to decrease until 2013 (the eighth full year), after which no further significant changes occurred. In the pooled years 2013-2016, the observed incidence rate per 100,000 persons was 102.2 [95% CI: 97.4, 107.1] for men, 75.6 [95% CI: 71.6, 79.7] for women and 88.4 [95% CI: 85.3, 91.5] for both sexes combined, with an observed:expected incidence rate ratio of 0.68 [95% CI: 0.65, 0.71], 0.79 [95% CI: 0.76, 0.82] and 0.72 [95% CI: 0.66, 0.81], respectively.

Discussion: The study provided multiple consistent proofs of a causal relationship between the introduction of screening and a stable 28% decrease in annual CRC incidence after eight years.

Fig. 1. Curves of observed and expected annual colorectal cancer incidence rates.

The graphs show the curve of observed annual colorectal cancer incidence rates per 100,000 persons aged 50–69 years in 1997–2016 (bold line) and the curve of rates that would be expected in 2005–2016 in the absence of the organised faecal immunochemical test screening programme (dashed line) by sex (a men; b women). The dotted lines represent the 95% confidence bands around the expected annual rates. The expected annual rates were estimated by analysing the observed annual rates in 1997–2016 with an age-period-cohort model (men) and an age-period model (women). 2005 was the year of introduction of the screening programme. 2006 was the first full year of screening. All rates were age-standardised using the European standard population. Emilia-Romagna Region, Italy, 1997–2016.