To assess the long-term association between organised colorectal cancer (CRC) screening strategies and CRC-relate mortality. We systematically reviewed studies on organised CRC screening through PubMed, Ovid Medline, Embase and Cochrane from the inception. We retrieved characteristics of organised CRC screening from included literature and matched mortality (over 50 years) of those areas from the International Agency for Research on Cancer in May 2023. The variations of mortality were reported via the age-standardised mortality ratio. A random-effects model was used to synthesis results. We summarised 58 organised CRC screening programmes and recorded > 2.7 million CRC-related deaths from 22 countries where rollout screening programmes were performed. The CRC screening strategy with faecal tests (guaiac faecal occult blood test (gFOBT) or faecal immunochemical tests (FIT)) or colonoscopy as the primary screening offer was associated with a 41.8% reduction in mortality, which was higher than those offered gFOBT (4.4%), FIT (16.7%), gFOBT or FIT (16.2%), and faecal tests (gFOBT or FIT) or flexible sigmoidoscopy (16.7%) as primary screening test. The longer duration of screening was associated with a higher reduction in the pooled age-standardised mortality ratio. In particular, the pooled age-standardised mortality ratio became non-significant when the screening of FIT was implemented for less than 5 years. A CRC screening programme running for > 5 years was associated with a reduction of CRC-related mortality. Countries with a heavy burden of CRC should implement sustainable, organised screening providing a choice between faecal tests and colonoscopy as a preferred primary test.

中文翻译：

---

有组织的结直肠癌筛查策略与降低相关死亡率之间的关联：系统评价和荟萃分析

评估有组织的结直肠癌 (CRC) 筛查策略与 CRC 相关死亡率之间的长期关联。我们从一开始就通过 PubMed、Ovid Medline、Embase 和 Cochrane 系统地回顾了有组织的 CRC 筛查研究。我们从国际癌症研究机构 2023 年 5 月纳入的文献中检索了有组织的 CRC 筛查的特征以及这些地区的匹配死亡率（超过 50 岁）。死亡率的变化通过年龄标准化死亡率来报告。使用随机效应模型来综合结果。我们总结了 58 个有组织的 CRC 筛查项目，并记录了 22 个开展筛查项目的国家超过 270 万 CRC 相关死亡病例。以粪便测试（愈创木脂粪便潜血测试 (gFOBT) 或粪便免疫化学测试 (FIT)）或结肠镜检查作为主要筛查方案的 CRC 筛查策略可将死亡率降低 41.8%，高于提供 gFOBT 的策略（4.4 %)、FIT (16.7%)、gFOBT 或 FIT (16.2%) 以及粪便测试（gFOBT 或 FIT）或柔性乙状结肠镜检查 (16.7%) 作为主要筛查测试。筛查持续时间越长，合并年龄标准化死亡率的降低程度越高。特别是，当 FIT 筛查实施时间少于 5 年时，合并年龄标准化死亡率变得不显着。运行超过 5 年的 CRC 筛查计划与 CRC 相关死亡率的降低有关。结直肠癌负担较重的国家应实施可持续的、有组织的筛查，提供粪便检测和结肠镜检查作为首选主要检测的选择。