University of Oulu

Sarkeala T, Färkkilä M, Anttila A, et al, Piloting gender-oriented colorectal cancer screening with a faecal immunochemical test: population-based registry study from Finland, BMJ Open 2021;11:e046667. doi: 10.1136/bmjopen-2020-046667

Piloting gender-oriented colorectal cancer screening with a faecal immunochemical test : population-based registry study from Finland

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Author: Sarkeala, Tytti1; Färkkilä, Martti2; Anttila, Ahti3;
Organizations: 1Finnish Cancer Registry, Cancer Society of Finland, Helsinki, Finland
2Clinic of Gastroenterology, Helsinki University Central Hospital, Helsinki, Finland
3Finnish Cancer Registry, Cancer Society of Finland Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
4Department of Gastroenterology, Tampere University Hospital, Tampere, Finland
5Central Finland Health Care District, Jyväskylä, Finland
6Department of Surgery, Medical Research Center, Oulu University Hospital, Oulu, Finland
7Turku University, Turku, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.7 MB)
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Language: English
Published: BMJ, 2021
Publish Date: 2021-04-30


Objective: To assess the feasibility and evaluate the performance of a relaunched colorectal cancer (CRC) screening programme with different cut-offs for men and women.

Design: Population-based registry study.

Setting: Nine municipalities in Finland which started CRC screening with faecal immunochemical test (FIT) in April 2019 with cut-off levels 70 µg Hg/g faeces for men and 25 µg Hg/g faeces for women.

Participants: Men (n=13 059) and women (n=14 669) aged 60–66 years invited to screening during the first programme year.

Outcome measures: Participation rates, positivity rates, detection rates of CRC and advanced adenoma (AA), and positive predictive values (PPV) of FIT for CRC and AA.

Results: Altogether 21 993 invitees returned stool samples. The participation rate of women (83.4%; 95% CI 82.8 to 84.0) was significantly higher than that of men (74.7%; 95% CI 73.9 to 75.4). The positivity rates were 2.4% (2.2 to 2.7) and 2.8% (2.5 to 3.1), respectively. In total, 37 CRCs and 116 AAs were detected. The detection rates of CRC and AA per 1000 participants were 1.8 (1.1 to 2.9) and 7.2 (5.6 to 9.1) for men and 1.6 (0.9 to 2.4) and 3.8 (2.8 to 5.0) for women. The PPVs per 100 positive tests were 6.6 (4.0 to 10.3) and 25.7 (20.6 to 31.4) for men and 6.4 (3.9 to 9.8) and 15.5 (11.6 to 20.2) for women.

Conclusions: The chosen FIT strategy narrowed the gap in the diagnostic performance between men and women especially in the detection of CRC. The participation rates were excellent. The levels of positivity and detection rates were moderate and need further action. The results indicate that gender-specific protocols can be introduced to organised CRC screening. It is yet to be seen whether they are more effective than a uniform screening protocol.

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Series: BMJ open
ISSN: 2044-6055
ISSN-E: 2044-6055
ISSN-L: 2044-6055
Volume: 11
Issue: 2
Article number: e046667
DOI: 10.1136/bmjopen-2020-046667
Type of Publication: A1 Journal article – refereed
Field of Science: 3122 Cancers
Copyright information: © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.