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According to Finnish researchers, colorectal cancer screening (CRC) using fecal occult blood test (FOBT) tests improves outcomes in men and more so than in women, especially men with tumor on the left side. Their conclusion comes from a new analysis of data from a large screening study.
The Finnish FOBT screening program (2004-2011) was conducted in more than 320,000 men and women aged 60 to 69 years. Participants were randomly assigned to control and control groups. The results of this trial, published in 2015, showed no difference in mortality between the two groups, unlike the results of several previous randomized screening trials.
At present, a team of researchers led by Laura Koskenvuo, MD, PhD, gastrointestinal surgeon at the University Hospital of Helsinki, Finland, has re-examined the data in order to "evaluate" the results at the beyond mortality ".
They found that biannual FOBT screening "appears to be effective in improving several different outcomes in men, but not in women."
It was particularly beneficial in men with tumors on the left. In this subgroup, FOBT screening was associated with better overall survival, lower non-radical resection rates, and reduced need for postoperative chemotherapy.
However, these benefits have not been observed in women, men, or women with right-sided tumors.
The research was published online on November 21 in the British Journal of Surgery.
The team suggests that, since FOBT screening does not appear to be associated with improved survival in women, "screening by different methods or at different intervals or at different ages should be considered in women. ".
Details of findings
The Finnish FOBT survey covered about 41% of Finnish men and women in the target age group (60 to 69 years) at the end of 2011.
Although there was no significant difference in CRC mortality between the screening group and the control group, the results suggested that there was a reduction in CRC mortality. with screening in men and an increase in women. This discovery has also been found in other studies of the biennial FOBT, the researchers comment.
"Virtually no cancer screening has had an impact on overall mortality," Koskenvuo said in a press release.
"However, they can still be helpful in other ways, and we wanted to study whether patients could avoid the more intense treatments they were involved in screening for colorectal cancer," she said.
The team collected data on CRC diagnoses from the Finnish Cancer Registry and reviewed patients' medical records to identify the clinical and pathological TNM stage; symptoms and extent of surgery; the need for patients for emergency surgery, stoma or chemotherapy; and histopathological diagnoses.
Of the 321,311 individuals participating in the study, 743 cases of colorectal cancer were detected in the screening arm and 617 in the control arm.
Patients in the screening group were more likely to undergo complete removal of the tumor, less likely to require chemotherapy and less likely to undergo emergency surgery.
"The control group had 50% more emergency surgeries, 40% incomplete tumor removals and 20% more chemotherapy treatments than patients in the screening group," said Ville Sallinen, co-author, Assistant Professor at the University of Helsinki.
Colorectal cancer was less common in women than men, at a rate of 0.34% versus 0.50% (risk ratio [RR]0.82).
Women were less likely to be asymptomatic than men, at 16.7% versus 22.0 (RR, 0.76). Abdominal pain was the only symptom significantly more prevalent in women than in men (RR, 1.36).
Women were significantly more likely than men to have a tumor on the right side, at 32.0% vs. 21.3% (RR, 1.51).
The cancers in screening group patients were lower T (RR, 1.25), N (RR, 1.14) and M (RR, 1.33) than the control group .
Among men with left-sided tumors, in the screening group, the cancers were lower N (RR, 1.23) and M (RR, 1.57) than those in the control group .
Among men with left-sided tumors, those in the control group were more likely to undergo non-radical resection than those in the screening group, at 26.2% versus 15.7% (RR, 1.67), and were more likely to undergo postoperative chemotherapy, at 61.6%. % vs 48.2% or (RR, 1.28).
Survival was worse in the control group than in the screening group in men with CRC (risk ratio [HR], 1.31), but it was not different in women [HR, 1.07].
In men, the 5-year overall survival rate was 68.8% in the test group compared to 61.5% in the control group. For women, the rates were 70.7% and 71.5%, respectively.
With respect to the lateral aspect of the tumor, in men with left-sided tumors, survival was better in the detected arm than in the control arm (HR, 1.37).
However, this survival advantage was not observed in men with tumors on the right side (HR, 1.19)
.
. Survival rates were not affected by the tumor side in women.
Co-author Nea Malila, MD, PhD, director of the Finnish Cancer Registry in Helsinki, said the large size of the sample was one of the highlights of the study.
"This randomized a huge number of people into the public health system, which allowed us to objectively assess the benefits of screening," she noted.
"Similar studies are not available anywhere else," she said.
"In the future, we need to examine whether different screening techniques could improve the patient's situation and facilitate the diagnosis of right colorectal cancer," the researchers conclude.
The study received financial support from Vatsatautien Tutkimussäätiö, research funds from the Helsinki University Hospital, the Mary and Georg Ehrnrooth Foundation and the Cancer Foundation Finland. The authors did not reveal any relevant financial relationship.
Br J Surg. Posted online 21 November 2018. Full text
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