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2024 ; 16
(7
): 2270-2280
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Effectiveness of colonoscopy, immune fecal occult blood testing, and risk-graded
screening strategies in colorectal cancer screening
#MMPMID39087098
Xu M
; Yang JY
; Meng T
World J Gastrointest Surg
2024[Jul]; 16
(7
): 2270-2280
PMID39087098
show ga
BACKGROUND: Colorectal cancer (CRC) is one of the most common malignant tumors,
and early screening is crucial to improving the survival rate of patients. The
combination of colonoscopy and immune fecal occult blood detection has garnered
significant attention as a novel method for CRC screening. Colonoscopy and fecal
occult blood tests, when combined, can improve screening accuracy and early
detection rates, thereby facilitating early intervention and treatment. However,
certain risks and costs accompany it, making the establishment of a risk
classification model crucial for accurate classification and management of
screened subjects. AIM: To evaluate the feasibility and effectiveness of
colonoscopy, immune fecal occult blood test (FIT), and risk-graded screening
strategies in CRC screening. METHODS: Based on the randomized controlled trial of
CRC screening in the population conducted by our hospital May 2020 to May 2023,
participants who met the requirements were randomly assigned to a colonoscopy
group, an FIT group, or a graded screening group at a ratio of 1:2:2 (after risk
assessment, the high-risk group received colonoscopy, the low-risk group received
an FIT test, and the FIT-positive group received colonoscopy). The three groups
received CRC screening with different protocols, among which the colonoscopy
group only received baseline screening, and the FIT group and the graded
screening group received annual follow-up screening based on baseline screening.
The primary outcome was the detection rate of advanced tumors, including CRC and
advanced adenoma. The population participation rate, advanced tumor detection
rate, and colonoscopy load of the three screening programs were compared.
RESULTS: A total of 19373 subjects who met the inclusion and exclusion criteria
were enrolled, including 8082 males (41.7%) and 11291 females (58.3%). The mean
age was 60.05 ± 6.5 years. Among them, 3883 patients were enrolled in the
colonoscopy group, 7793 in the FIT group, and 7697 in the graded screening group.
Two rounds of follow-up screening were completed in the FIT group and the graded
screening group. The graded screening group (89.2%) and the colonoscopy group
(42.3%) had the lowest overall screening participation rates, while the FIT group
had the highest (99.3%). The results of the intentional analysis showed that the
detection rate of advanced tumors in the colonoscopy group was greater than that
of the FIT group [2.76% vs 2.17%, odds ratio (OR) = 1.30, 95% confidence interval
(CI): 1.01-1.65, P = 0.037]. There was no significant difference in the detection
rate of advanced tumors between the colonoscopy group and the graded screening
group (2.76% vs 2.35%, OR = 1.9, 95%CI: 0.93-1.51, P = 0.156), as well as between
the graded screening group and the FIT group (2.35% vs 2.17%, OR = 1.09%, 95%CI:
0.88-1.34, P = 0.440). The number of colonoscopy examinations required for each
patient with advanced tumors was used as an index to evaluate the colonoscopy
load during population screening. The graded screening group had the highest
colonoscopy load (15.4 times), followed by the colonoscopy group (10.2 times),
and the FIT group had the lowest (7.8 times). CONCLUSION: A hierarchical
screening strategy based on CRC risk assessment is feasible for screening for CRC
in the population. It can be used as an effective supplement to traditional
colonoscopy and FIT screening programs.
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