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Colorectal Cancer Screening Based on Fecal Immunochemical Test and Risk Assessment: A Population-based Study

Dong Hang1, Chen Zhu2, Xiaolin Yang1

  • 1Department of Epidemiology, Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, School of Public Health, Nanjing Medical University.

Journal of Epidemiology
|December 8, 2024
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Summary

Combining fecal immunochemical testing (FIT) and questionnaire-based risk assessment (QRA) effectively identifies high-risk individuals for colorectal cancer (CRC) precursors. Those positive for both FIT and QRA require immediate colonoscopy for advanced neoplasia detection.

Keywords:
colonoscopycolorectal cancerfecal immunochemical testrisk assessmentscreening

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Area of Science:

  • Gastroenterology
  • Oncology
  • Public Health

Background:

  • Fecal immunochemical test (FIT) is a common colorectal cancer (CRC) screening tool.
  • The combined performance of FIT with questionnaire-based risk assessment (QRA) for CRC screening is not well-established.
  • Risk factors for different CRC precursors detected during screening require further comparative analysis.

Purpose of the Study:

  • To evaluate the practical performance of FIT combined with QRA in a large-scale population-based CRC screening.
  • To compare the compliance, detection rates, and colonoscopy workload associated with FIT and QRA results.
  • To identify risk factors for conventional adenomas and serrated polyps.

Main Methods:

  • A population-based CRC screening study in China involving 2,120,340 participants.
  • Participants completed both FIT and QRA; colonoscopy was recommended for positive FIT or high QRA scores.
  • Analysis of compliance, detection rates, colonoscopy workload, and risk factors for adenomas and serrated polyps.

Main Results:

  • Colonoscopy compliance was highest in the FIT (+) and QRA (+) group (41.4%), followed by FIT (+) and QRA (-) (38.7%), and FIT (-) and QRA (+) (16.4%).
  • Advanced neoplasia detection rates were 18.2% (FIT+/QRA+), 13.2% (FIT+/QRA-), and 9.3% (FIT-/QRA+).
  • Increased BMI, smoking, alcohol, red meat, and type 2 diabetes were linked to higher risks of advanced adenomas and serrated polyps; vegetable intake showed an inverse association.

Conclusions:

  • FIT and QRA can synergistically identify individuals at high risk for colorectal advanced neoplasia.
  • Individuals testing positive for both FIT and QRA warrant immediate colonoscopic evaluation.
  • Modifiable lifestyle factors can complement screening strategies for preventing CRC precursors.