Screening History and 7-Year Survival in 32,099 Colorectal Cancer Patients: A Population-Based Cohort Study

Abstract

Background

It is unclear whether colorectal cancer screening history, regardless of stage, is an independent predictor of survival, and if the screening advantage persists after diagnosis. 32 099 patients with colorectal cancer were enrolled in this population-based cohort study.

Methods

We used data from the Taiwan Cancer Registry on patients with a first-time diagnosis of colorectal cancer between 2013 and 2015. In addition, we utilized data from a nationwide database of colorectal cancer screening programs to evaluate patients’ screening histories, and sourced outcome data from the National Death Registry, tracking patients up to the last day of 2019.

Results

Compared with fecal immunochemical testing (FIT)-positive patients with a follow-up examination, the adjusted hazard ratios (95% confidence intervals) for death from colorectal cancer were 1.40 (1.26–1.56) for FIT-positive patients without a follow-up examination, 1.63 (1.48–1.78) for FIT-negative patients, and 1.76 (1.65–1.89) for never screened patients. The adjusted hazard ratios for the FIT-positive patients with a follow-up examination increased when diagnosis was delayed by more than 12 months and were 1.2 after a 2-year delay. The adjusted hazard ratios for FIT-negative patients were approximately 2.0, decreased rapidly to 1.6, and stabilized after the 9th time-to-diagnosis month.

Conclusion

In colorectal cancer patients, screening history prior to diagnosis is an independent prognostic factor, regardless of cancer stage or other variables. This study recommends that physicians take screening history into account during diagnosis to optimize follow-up and management for patients at higher risk.

Keywords:

• cancer registry
• cancer screening
• cohort study
• colorectal cancer
• prognosis

Acknowledgment

The content of this research may not represent the opinion of the Taiwan Health Promotion Administration, Ministry of Health and Welfare. This study originated from the doctoral dissertation of Bo-Yu Hsiao, the first author of this paper, which was conducted at the National Taiwan University under the supervision of Professor Wen-Chung Lee, the corresponding author. This article was subsidized for English editing by National Taiwan University under the Excellence Improvement Program for Doctoral Students (grant number 108-2926-I-002-002-MY4), sponsored by the National Science and Technology Council, Taiwan.

Disclosure

All authors declare no conflicts of interest in this work.

Additional information

Funding

This work is supported by grants from the Health Promotion Administration, the Ministry of Health and Welfare in Taiwan (A1111010; Tobacco Health and Welfare Taxation), and the National Science and Technology Council in Taiwan (MOST 111-2314-B-002-089-MY3). The funders had no role in study design, data collection, and analysis, the decision to publish, or preparation of the manuscript.