The Impact of Screening on the Survival of Colorectal Cancer in Shanghai, China: a Population Based Study

Overview

Journal BMC Public Health

Publisher Biomed Central

Specialty Public Health

Date 2019 Jul 31

PMID 31357981

Citations 22

Authors

Xiaopan Li

Yi Zhou

Zheng Luo

Yian Gu

Yichen Chen

Chen Yang

Jing Wang

Shaotan Xiao

Qiao Sun

Mengcen Qian

Genming Zhao

Affiliations

Soon will be listed here.

Abstract

Background: Shanghai is one of the earliest cities in developing countries to introduce an organized colorectal screening program for its residents to fight against the rising disease burden of colorectal cancer (CRC). This study aims to investigate the impact of the Shanghai screening program implemented in 2013 on the survival rates of CRC patients.

Methods: We calculated up to 5-year survival rates for 18,592 CRC patients from a representative district of Shanghai during 2002-2016, using data from the Shanghai Cancer Registry. We performed joinpoint regressions to examine temporal changes in the trends of the CRC survival rates. We then conducted Kaplan-Meier and Cox proportional hazards modelling to study the association of the survival rates with screening behaviors of the patients. In all the model specifications, we took into account the gender, age and TNM stage at diagnosis, and level of treatment hospital of the patients.

Results: We find that the annual percentage changes of the survival rates increased faster after somewhere around 2013, however, the differential trends were not significant. Results from the Cox multivariate regression analysis suggest that patients who did not participate in the screening program showed significantly lower cancer-specific survival (hazard ratio (HR) = 1.46; 95% confidence interval (CI): 1.12-1.91) and all-causes survival (HR = 1.37; 95% CI: 1.05-1.77), compared to those who did. Among program participants, delayed colonoscopy was associated with poor cancer-specific survival (hazard ratio (HR) = 2.93; 95% confidence interval (CI): 1.64-5.23) and all-causes survival (HR = 3.29; 95% CI: 1.85-5.84).

Conclusion: Screening participation and high level of colonoscopy compliance can improve the survival of CRC participants.

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