[Randomized controlled trial of sequence mass screening program for colorectal cancer].

Area of Science:

• Oncology
• Public Health
• Preventive Medicine

Background:

• Colorectal cancer (CRC) poses a significant public health challenge.
• Effective mass screening programs are crucial for early detection and mortality reduction.
• Assessing novel screening strategies is vital for improving population health outcomes.

Purpose of the Study:

• To evaluate the effectiveness of a sequential mass screening program for colorectal cancer.
• The program integrated RPHA-FOBT (Rapid Passive Hemagglutination Assay-Fecal Occult Blood Test) and an individual quantitative risk assessment model (attributive degree value, AD).
• The study employed a randomized controlled trial design to assess the program's impact.

Main Methods:

• Residents of Jiashan county, aged 30 and above, were randomized into screening and control groups in 1989.
• The screening group completed a questionnaire and submitted stool samples for RPHA-FOBT.
• Positive cases underwent diagnostic evaluations, including flexible sigmoidoscopy and colonoscopy.

Main Results:

• After 8 years, the cumulative incidence of CRC was similar between groups (3.95 vs. 4.01 per 1,000).
• However, CRC mortality was reduced by 14.7% in the screening group (2.08 vs. 2.44 per 1,000).
• Notably, rectal cancer mortality decreased by 31.7%, with significantly higher survival rates in the screening group (log-rank = 9.01, P = 0.0027).

Conclusions:

• The sequential mass-screening program, combining RPHA-FOBT and AD risk assessment, demonstrated effectiveness in reducing colorectal cancer mortality.
• The findings suggest this approach is beneficial for the Chinese population.
• Further research may explore optimizing such integrated screening strategies.