Colorectal Cancer Screening Based on Fecal Immunochemical Test and Risk Assessment: A Population-based Study Including Two Million Participants in China
Background: The fecal immunochemical test (FIT) has been widely used in colorectal cancer (CRC) screening, yet the practical performance of FIT combined with questionnaire-based risk assessment (QRA) remains undetermined. Moreover, risk factors for distinct CRC precursors identified in screening hav...
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Japan Epidemiological Association
2025-06-01
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| Series: | Journal of Epidemiology |
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| Online Access: | https://www.jstage.jst.go.jp/article/jea/35/6/35_JE20240252/_pdf |
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| author | Dong Hang Chen Zhu Xiaolin Yang Jinjin He Huizhang Li Tingting Pan Le Wang Shi Wang Wei Wu Jieming Zhong Weiwei Gong Meng Zhu Ci Song Hongxia Ma Ni Li Yanfei Qiu Guangfu Jin Zhibin Hu Lingbin Du Xiangdong Cheng Hongbing Shen |
| author_facet | Dong Hang Chen Zhu Xiaolin Yang Jinjin He Huizhang Li Tingting Pan Le Wang Shi Wang Wei Wu Jieming Zhong Weiwei Gong Meng Zhu Ci Song Hongxia Ma Ni Li Yanfei Qiu Guangfu Jin Zhibin Hu Lingbin Du Xiangdong Cheng Hongbing Shen |
| author_sort | Dong Hang |
| collection | DOAJ |
| description | Background: The fecal immunochemical test (FIT) has been widely used in colorectal cancer (CRC) screening, yet the practical performance of FIT combined with questionnaire-based risk assessment (QRA) remains undetermined. Moreover, risk factors for distinct CRC precursors identified in screening have been rarely compared. Methods: This study was based on a population-based CRC screening in China, with 2,120,340 participants completing both FIT and QRA. Those with positive FIT or high QRA scores were recommended for colonoscopy. We reported the compliance, detection rate, and colonoscopy workload according to FIT and QRA results. We also explored risk factors for conventional adenomas and serrated polyps. Results: The compliance rate of colonoscopy in the subgroup of FIT (+) and QRA (+) was 41.4%, higher than the rates in FIT (+) and QRA (−), as well as FIT (−) and QRA (+), which were 38.7% (P < 0.001) and 16.4% (P < 0.001), respectively. The corresponding detection rates of advanced neoplasia were 18.2%, 13.2%, and 9.3% (all P < 0.001), respectively. Moreover, the required numbers of colonoscopies to detect one advanced neoplasia in the three subgroups were 5.5, 7.6, and 10.8, respectively. Increased body mass index, smoking, alcohol consumption, red meat intake, and type 2 diabetes were associated with higher risk of advanced adenomas and advanced serrated polyps, whereas vegetable intake was inversely associated with advanced adenomas. Conclusion: FIT and QRA can synergistically identify individuals at high risk of colorectal advanced neoplasia, with those testing positive for both deserving immediate attention. Modifiable factors were identified to complement screening for preventing CRC precursors. |
| format | Article |
| id | doaj-art-f39aa3587d824e36bfa5c2b54cbc74fb |
| institution | Kabale University |
| issn | 0917-5040 1349-9092 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Japan Epidemiological Association |
| record_format | Article |
| series | Journal of Epidemiology |
| spelling | doaj-art-f39aa3587d824e36bfa5c2b54cbc74fb2025-08-20T03:24:51ZengJapan Epidemiological AssociationJournal of Epidemiology0917-50401349-90922025-06-0135629730210.2188/jea.JE20240252Colorectal Cancer Screening Based on Fecal Immunochemical Test and Risk Assessment: A Population-based Study Including Two Million Participants in ChinaDong Hang0Chen Zhu1Xiaolin Yang2Jinjin He3Huizhang Li4Tingting Pan5Le Wang6Shi Wang7Wei Wu8Jieming Zhong9Weiwei Gong10Meng Zhu11Ci Song12Hongxia Ma13Ni Li14Yanfei Qiu15Guangfu Jin16Zhibin Hu17Lingbin Du18Xiangdong Cheng19Hongbing Shen20Department 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, Nanjing, ChinaDepartment of Cancer Prevention, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, ChinaDepartment 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, Nanjing, ChinaDepartment 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, Nanjing, ChinaDepartment of Cancer Prevention, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, ChinaDepartment of Cancer Prevention, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, ChinaDepartment of Cancer Prevention, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, ChinaDepartment of Endoscopy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, ChinaDepartment of Pathology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, ChinaDepartment of Chronic and Noncommunicable Disease Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, ChinaDepartment of Chronic and Noncommunicable Disease Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, ChinaDepartment 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, Nanjing, ChinaDepartment 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, Nanjing, ChinaDepartment 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, Nanjing, ChinaOffice of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaDepartment of Cancer Prevention, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, ChinaDepartment 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, Nanjing, ChinaDepartment 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, Nanjing, ChinaDepartment of Cancer Prevention, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, ChinaDepartment of Gastric Surgery, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, ChinaDepartment 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, Nanjing, ChinaBackground: The fecal immunochemical test (FIT) has been widely used in colorectal cancer (CRC) screening, yet the practical performance of FIT combined with questionnaire-based risk assessment (QRA) remains undetermined. Moreover, risk factors for distinct CRC precursors identified in screening have been rarely compared. Methods: This study was based on a population-based CRC screening in China, with 2,120,340 participants completing both FIT and QRA. Those with positive FIT or high QRA scores were recommended for colonoscopy. We reported the compliance, detection rate, and colonoscopy workload according to FIT and QRA results. We also explored risk factors for conventional adenomas and serrated polyps. Results: The compliance rate of colonoscopy in the subgroup of FIT (+) and QRA (+) was 41.4%, higher than the rates in FIT (+) and QRA (−), as well as FIT (−) and QRA (+), which were 38.7% (P < 0.001) and 16.4% (P < 0.001), respectively. The corresponding detection rates of advanced neoplasia were 18.2%, 13.2%, and 9.3% (all P < 0.001), respectively. Moreover, the required numbers of colonoscopies to detect one advanced neoplasia in the three subgroups were 5.5, 7.6, and 10.8, respectively. Increased body mass index, smoking, alcohol consumption, red meat intake, and type 2 diabetes were associated with higher risk of advanced adenomas and advanced serrated polyps, whereas vegetable intake was inversely associated with advanced adenomas. Conclusion: FIT and QRA can synergistically identify individuals at high risk of colorectal advanced neoplasia, with those testing positive for both deserving immediate attention. Modifiable factors were identified to complement screening for preventing CRC precursors.https://www.jstage.jst.go.jp/article/jea/35/6/35_JE20240252/_pdfcolonoscopycolorectal cancerscreeningfecal immunochemical testrisk assessment |
| spellingShingle | Dong Hang Chen Zhu Xiaolin Yang Jinjin He Huizhang Li Tingting Pan Le Wang Shi Wang Wei Wu Jieming Zhong Weiwei Gong Meng Zhu Ci Song Hongxia Ma Ni Li Yanfei Qiu Guangfu Jin Zhibin Hu Lingbin Du Xiangdong Cheng Hongbing Shen Colorectal Cancer Screening Based on Fecal Immunochemical Test and Risk Assessment: A Population-based Study Including Two Million Participants in China Journal of Epidemiology colonoscopy colorectal cancer screening fecal immunochemical test risk assessment |
| title | Colorectal Cancer Screening Based on Fecal Immunochemical Test and Risk Assessment: A Population-based Study Including Two Million Participants in China |
| title_full | Colorectal Cancer Screening Based on Fecal Immunochemical Test and Risk Assessment: A Population-based Study Including Two Million Participants in China |
| title_fullStr | Colorectal Cancer Screening Based on Fecal Immunochemical Test and Risk Assessment: A Population-based Study Including Two Million Participants in China |
| title_full_unstemmed | Colorectal Cancer Screening Based on Fecal Immunochemical Test and Risk Assessment: A Population-based Study Including Two Million Participants in China |
| title_short | Colorectal Cancer Screening Based on Fecal Immunochemical Test and Risk Assessment: A Population-based Study Including Two Million Participants in China |
| title_sort | colorectal cancer screening based on fecal immunochemical test and risk assessment a population based study including two million participants in china |
| topic | colonoscopy colorectal cancer screening fecal immunochemical test risk assessment |
| url | https://www.jstage.jst.go.jp/article/jea/35/6/35_JE20240252/_pdf |
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