Comparative Evaluation of Preliminary Screening Methods for Colorectal Cancer in a Mass Program

Area of Science:

• Oncology
• Gastroenterology
• Public Health

Background:

• The fecal immunochemical test (FIT) is a common preliminary screening tool for colorectal cancer (CRC).
• In China, the high-risk factor questionnaire (HRFQ) and quantitative risk-assessment method (QRAM) are recommended for CRC risk estimation.
• Comparing the diagnostic values of these screening methods is crucial for optimizing CRC detection strategies.

Purpose of the Study:

• To prospectively compare the diagnostic performance of different colorectal cancer (CRC) preliminary screening methods.
• To identify the most effective screening strategy for mass CRC screening programs.

Main Methods:

• A prospective study involving 96,043 individuals aged 40-74 years in a mass CRC screening program (2007-2014).
• Fecal immunochemical test (FIT) on two stool specimens and face-to-face interviews for high-risk factor questionnaire (HRFQ) and quantitative risk-assessment method (QRAM).
• Screening data linked to a CRC surveillance and registry system for case verification.

Main Results:

• FIT demonstrated a sensitivity of 75.49% and specificity of 90.36% for CRC detection.
• Quantitative risk-assessment method (QRAM) was more sensitive but less specific than HRFQ.
• FIT combined with HRFQ yielded 86.56% sensitivity and 81.37% specificity.
• FIT combined with QRAM achieved 88.93% sensitivity and 73.95% specificity.

Conclusions:

• Preliminary screening for colorectal cancer (CRC) using FIT and QRAM in parallel offers high sensitivity and acceptable specificity.
• This combined approach is identified as a valuable strategy for implementation in large-scale CRC screening programs.
• The findings support the utility of FIT and QRAM combination for improving CRC detection rates in population-based screening.