A Risk-Scoring System Combined With a Fecal Immunochemical Test Is Effective in Screening High-Risk Subjects for...

Area of Science:

• Gastroenterology
• Oncology
• Preventive Medicine

Background:

• Colorectal cancer risk factors in Asia include age, sex, smoking, and family history.
• The Asia-Pacific Colorectal Screening (APCS) scoring system was developed to identify high-risk individuals for advanced neoplasm (AN).

Purpose of the Study:

• To evaluate an algorithm combining APCS scores with fecal immunochemical test (FIT) for colorectal cancer screening.
• To assess the effectiveness of the APCS-FIT algorithm in identifying subjects with AN and reducing colonoscopy workload.

Main Methods:

• A multicenter prospective study enrolled 5657 asymptomatic individuals over 40 years old across 12 Asia-Pacific regions.
• Subjects were stratified into low (LR), medium (MR), and high risk (HR) for AN based on APCS scores.
• LR and MR subjects received FIT, while HR subjects underwent colonoscopy; algorithm sensitivity for AN detection was calculated.

Main Results:

• AN prevalence was 1.5% in LR, 5.1% in MR, and 10.9% in HR groups, with significantly increased AN risk in MR (3.4-fold) and HR (7.8-fold) compared to LR.
• The APCS-FIT algorithm correctly identified 70.6% of subjects with AN and 95.1% with invasive cancers for early colonoscopy.

Conclusions:

• The APCS scoring system is a valuable tool for assessing colorectal cancer and advanced adenoma risk in asymptomatic individuals.
• An APCS score-based triage algorithm for FIT or colonoscopy can significantly decrease the burden on colonoscopy services.