Chapter Two

二十年的
台灣實證 Two Decades
of Taiwanese Evidence

When a whole nation screens — what actually happens? When a whole nation screens — what actually happens?

Why this matters

連續性的證據是起點 — 但這條路真的走得通嗎? Continuous evidence is the starting point — but does the path actually work?

知道 f-Hb 是連續性的風險指標,只是第一步。下一個問題是 —— 把它變成全國性的篩檢政策,真的能降低死亡率嗎?

2004 年,台灣啟動全民免費的 FIT 大腸癌篩檢計畫。20 年後,我們有了答案。

這是迄今全球規模最大、追蹤最完整的真實世界證據之一。

Knowing that f-Hb is a continuous risk marker is only step one. The next question — can it be turned into national policy and actually reduce mortality?

In 2004, Taiwan launched a free, nationwide FIT-based CRC screening program. Twenty years later, the answer is in.

This is one of the largest and most complete pieces of real-world evidence to date.

Featured Exhibit

740 萬人,2,130 萬次檢驗,一個答案 7.4 million people. 21.3 million tests. One answer.

VIDEO
點擊觀看影片 Watch the film
敘事影片 · 第二集 Narrative · Episode 2 Chiu et al., 2021 Gut
The Scale

規模 — 一個國家、二十年 The Scale — A Nation, Twenty Years

7.4M
完成篩檢人數 Individuals screened
21.3M
FIT 檢驗次數 FIT tests performed
134K
偵測之進階腺瘤 Advanced adenomas detected
41,571
偵測之大腸癌 Colorectal cancers detected

以上為計畫 2004–2025 累積的整體規模。下方成果分析來自 Chiu et al. 2021 Gut 的研究,該研究追蹤約 540 萬名符合資格的民眾,長達 10 年。 The figures above reflect the program's cumulative scale from 2004–2025. The outcomes below are drawn from Chiu et al., Gut 2021, which followed about 5.4 million eligible individuals over 10 years.

The Outcomes

結果 ── 全民篩檢真的有效 The Results — Universal Screening Works

EXHIBIT 1 · Incidence

第二期以上大腸癌發生率 Advanced-Stage CRC Incidence

↓ 34%
相對風險 0.66 (95% CI 0.63–0.70) Relative risk 0.66 (95% CI 0.63–0.70)

第二期(含)以上 ── 也就是已經比較難治、較具威脅的階段。遠端大腸下降 39%,近端下降 16%,差距凸顯了大腸鏡完整檢查的重要性。 "Advanced-stage" means stage II or higher — the more dangerous, harder-to-treat cases. Distal colon down 39%; proximal down 16%. The gap highlights the role of complete colonoscopy.

Chiu et al. · Gut · 2021
EXHIBIT 2 · Mortality

大腸癌死亡率 Colorectal Cancer Mortality

↓ 40%
相對風險 0.60 (95% CI 0.57–0.64) Relative risk 0.60 (95% CI 0.57–0.64)

遠端大腸死亡下降 44%,近端僅下降 28% ── 普篩確實能拯救生命,但效果並不均勻。這個落差,正是「精準篩檢」要解決的下一個問題。 Distal mortality down 44%; proximal only down 28% — universal screening saves lives, but unevenly. Closing that gap is what precision screening is for.

Chiu et al. · Gut · 2021
— The Takeaway —

一個全國的篩檢計畫,
一個十年的真實追蹤 ──

FIT 篩檢能將大腸癌死亡率
降低 40%。

普篩有效。下一個問題是 ── 它能更精準嗎? A nationwide screening program.
A decade of real-world follow-up ──

FIT screening cuts colorectal cancer mortality by 40%.

Universal works. The next question — can it work more precisely?

Continue the journey Continue the journey

接下來 ──
如果普篩有效,為什麼還需要進入「精準篩檢」的時代? Next ──
If universal screening works, why move into the era of precision screening?

前往第三展間 Enter Chapter Three