Journal of the National Cancer Institute Advance Access originally published online on December 9, 2008
JNCI Journal of the National Cancer Institute 2008 100(24):1818-1821; doi:10.1093/jnci/djn404
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© The Author 2008. Published by Oxford University Press.
Colorectal Cancer Mortality in Two Areas of Tuscany With Different Screening Exposures
Affiliation of authors: ISPO Cancer Prevention and Research Institute, Florence, Italy
Correspondence to: Adele Seniori Costantini, MD, Environmental and Occupational Epidemiology Unit, ISPO Cancer Prevention and Research Institute, Via di S. Salvi 12, 50135 Florence, Italy (e-mail: a.seniori{at}ispo.toscana.it).
Several randomized trials have demonstrated the efficacy of colorectal cancer screening by the fecal occult blood test in reducing colorectal cancer mortality, but an evaluation of population-based screening programs is still lacking. We compared the colorectal cancer mortality rates (both adjusted rates and 3-year moving average rates) during 1985–2006 for two geographic areas in the provinces of Florence and Prato in the Tuscany region of Italy that began active population-based screening for colorectal cancer at different times: the Empolese–Mugello district, in the early 1980s, and the rest of the Florence and Prato provinces, in early 2000. A log-linear Poisson model was used to estimate the annual percent change in mortality and to examine whether geographic area modified the effect of calendar year on it. The Empolese–Mugello district had a greater decrease in colorectal cancer mortality than the rest of the Florence and Prato provinces (estimated annual percent change in age-adjusted colorectal cancer mortality rate, 2.7% decrease per year [95% confidence interval {CI} = 1.7% to 3.7%] vs 1.3% decrease per year [95% CI = 0.8% to 1.7%], respectively). The interaction between calendar period and area was statistically significant (P < .001). Our results support the hypothesis that the implementation of colorectal cancer screening in the early 1980s in the Empolese–Mugello district, where approximately 17 500 people were tested each year with the fecal occult blood test, was associated with a larger reduction in colorectal cancer mortality than that observed in the rest of Florence and Prato provinces, where screening started 15–20 years later and where approximately 38 000 people were screened each year beginning in 2000.
| CONTEXT AND CAVEATS Prior knowledge The efficacy of colorectal cancer screening by the fecal occult blood test in reducing colorectal cancer mortality has been evaluated in several randomized trials but not in the context of a population-based screening program. Study design A comparison of colorectal cancer mortality rates during 1985–2006 for two geographic areas in the provinces of Florence and Prato of Tuscany, Italy, that began active population-based screening for colorectal cancer by fecal occult blood test at different times: the Empolese–Mugello district, in the early 1980s, and the rest of the Florence and Prato provinces, in early 2000. Contribution Colorectal cancer mortality decreased during the study period (1985–2006) in the Tuscan provinces of Florence and Prato, and the reduction was larger (13%) in the Empolese–Mugello district than in the rest of the Florence and Prato provinces, where fecal occult blood test–based screening was started 15–20 years later. Implications The earlier implementation of colorectal cancer screening in the Empolese–Mugello district was associated with a larger reduction in colorectal cancer mortality. Limitations Downstaging of the incident colorectal cancers was not assessed because data on colorectal cancer stage at diagnosis were not available for the whole study population for the entire period. From the Editors
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Manuscript received May 12, 2008; revised September 17, 2008; accepted October 6, 2008.
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