浙江省海宁市40~74岁目标人群结直肠癌早诊早治筛查结果分析

[目的]评价海宁市结直肠癌早诊早治筛查效果.[方法]根据《癌症早诊早治项目技术方案》,对40～74岁目标人群采用危险因素量化评估问卷调查和两次大便隐血试验(FOBT)进行初筛,在此基础上,确定结直肠癌高危人群,然后,用电子结肠镜作进一步精筛,对查出的肠道病变进行及时干预.[结果] 2007～2012年海宁市结直肠癌筛查目标人群为322 034人,完成病史问卷调查286 470例,顺应率为88.96％;其中病史阳性16 807例,阳性率为5.87％;两次大便隐血试验461 348份,其中阳性25 928份,阳性率为5.62％.经初筛确定高危人群40 103人需进一步作结肠镜精筛.完成结肠镜检查29 069例,顺应率为72.90％;共检出肠道病变(息肉、腺瘤、癌)7408例,检出率25.48％,其中进展期以上病变1570例.病史阳性占检出病例数的41.10％,FOBT阳性占58.90％,而在205例结直肠癌中FOBT阳性占了91.71％.[结论]结直肠癌筛查成效显著,使无症状的结直肠癌及癌前期病变患者能够实现“三早”,减轻家庭和社会疾病负担.     

2014—2019年山东省青岛市城市居民结直肠癌早诊早治项目筛查结果分析

摘 要：［目的］ 分析总结2014—2019年青岛市城市居民结直肠癌高危人群的风险评估及临床筛查结果。［方法］ 通过问卷初筛确定高危人群,通过结肠镜筛查进行精筛,对青岛市2个辖区的结直肠癌高危人群进行结直肠癌及癌前病变筛査,分析评估结直肠癌的高风险率、依从性和检出率。［结果］ 2014—2019年共对103 229名居民进行危险因素调查,评估出结直肠癌高危人群10 582名,高风险率为10.25%。2735人完成结肠镜筛查,筛查依从性为25.85%(2735/10582)。高风险率和筛查依从性随年龄增加而增大。共有1557名完成病理活检,活检率为56.93%(1557/2735),共检出非瘤性息肉364例,检出率为13.31%(364/2735);非进展期腺瘤1071例,检出率为39.16%(1071/2735);进展期腺瘤114例,检出率为4.17%(114/2735),有随年龄增加而检出率升高的趋势;癌8例(包括早癌6例),检出率为0.29%(8/2735),另有癌前病变819例,早诊率为99.75%（825/827）。结直肠筛查依从性逐年提升。［结论］ 城市癌症早诊早治项目是实现肿瘤“早发现、早诊断、早治疗”的有效途径,提高了项目高危人群结直肠癌早诊早治的比例。肿瘤健康宣教有利于提高肿瘤高危人群的“三早意识”（早发现、早诊断、早治疗）,然而,结肠镜筛查的依从性受多方因素影响,除加强宣教外,可探索将肿瘤筛查纳入医保范围。     

广东省佛山市顺德区某街道大肠癌筛查结果分析

目的 对广东省佛山市顺德区容桂街道特定年龄组高危人群进行大肠癌筛查.方法 自2013年7月1日至2016年6月30日,本院对广东省佛山市顺德区容桂街道40～75岁常住居民,采用问卷调查和免疫法粪便潜血试验进行初步筛查,初筛阳性者行结肠镜检查,并对筛查结果进行分析.结果 初筛4016人,初筛应答率为50.1％,问卷调查者为3014人(75.05％),FOBT为1002人(24.95％),筛查结果阳性人数为702人,初筛阳性率17.48％.肠镜筛查顺应率为50.7％(356/702),肠镜病变总检出率为31.46％(112/356),结直肠癌检出率为1.69％ (6/356),其中乙状结肠癌2例(0.56％),乙状结肠早期癌2例(0.56％),直肠早期癌2例(0.56％),结直肠息肉88例(24.72％),其中76例(21.35％)为1级～3级腺瘤性息肉,12例(3.37％)为炎性息肉.结直肠炎15例(4.21％),结直肠黑变病3例(0.84％).结论 大肠癌筛查可以有效发现结直肠癌及癌前病变.     

厦门市海沧区结直肠癌筛查结果分析

目的通过分析厦门市海沧区结直肠癌的筛查结果,探索筛查的结直肠癌最佳方案,以期达到对结直肠肿瘤的早发现、早诊断和早治疗。方法 自2008年12月—2010年10月,采用中国癌症基金会推荐的结直肠癌筛查方案,对海沧区4个行政村40~74岁常住居民结合问卷调查和连续粪便隐血试验(Fecal occult blood test,FOBT)进行初筛,共8179人,实际接受筛查6380人。高危人群接受全结肠镜检查。结果 经问卷调查和FOBT检测,获得结直肠癌高危人群1035例。81.06%的高危者接受全结肠镜检查,结直肠癌和腺瘤息肉及其他病变检出率分别为1.67%和23.96%。问卷调查及FOBT均阳性者结直肠癌检出率显著高于单纯问卷调查阳性者或单纯FOBT阳性者(P＜0.05);FOBT两次阳性者结直肠癌检出率显著高于FOBT阴性和FOBT单次阳性检出率(P＜0.05)。FOBT检测阳性次数与结直肠癌检出率和腺瘤息肉及其他病变检出率呈线性关系(P＜0.05)。结论 调查问卷和连续粪便隐血试验筛查可明显缩小高危人群,大大降低筛查的工作量。     

结直肠癌和癌前病变检出率与其危险因素关系

摘 要：［目的］ 探索结直肠癌各类危险因素与结直肠癌及其癌前病变检出率关系,为合理制定结直肠癌筛查策略与防控措施提供科学依据。［方法］ 基于海宁市2010～2012年40～74岁目标人群结直肠癌筛查信息,分析各类危险因素与结直肠癌及癌前病变检出率关系。［结果］危险因素量化评估问卷调查240 177人,筛查顺应率为88.25%,病史阳性率6.09%;两次大便隐血试验（FOBT）388 780份,阳性21 079份,阳性率5.42%,初筛确定高危人群33 624人,占筛查人数的13.85%;高危人群结肠镜检查24 046例,顺应率为76.01 %;共检出肠道病变（息肉、腺瘤、癌、溃疡）6552例（其中结直肠癌119例,进展期腺瘤1042例）,总检出率为27.25%。男性检出率明显高于女性(P<0.01);检出率随年龄增长而上升（趋势检验,P<0.01）,70岁年龄组的检出率比40岁组高出1倍左右。多因素非条件Logistic回归分析表明：年龄大(OR=1.103,95%CI：1.075～1.133,P=0.000),大便隐血试验（FOBT）阳性（OR=4.470 95%CI：2.129～9.385,P=0.000）,有慢性阑尾炎或手术史(OR=0.445,95%CI：0.199～0.996,P=0.049),结直肠息肉史（OR=0.225,95%CI：0.051～0.995,P=0.049）与结直肠癌检出率存在统计关联。［结论］ 应加强对有黏液血便、有慢性阑尾炎或手术史、结直肠息肉史、大便隐血试验阳性的老年男性的结直肠癌筛查。     

浙江省临海市2020—2021年重点人群结直肠癌筛查结果分析

目的：通过分析浙江省临海市首次适龄人群结直肠癌筛查的结果,为制定全县域大规模结直肠癌筛查策略提供参考依据。方法：2020—2021年,采用问卷评估及定性粪便隐血试验（fecal occult blood test,FOBT）的筛查方法,对临海市50～74岁目标人群进行结直肠癌筛查,并对初筛阳性人群进行全结肠镜检查,随后分析筛查结果。结果：2020—2021年,临海市共计完成初筛71 942人,有15 170人初筛阳性,男性初筛阳性率显著高于女性（χ2=724.005,P<0.001）,且60～69岁人群中初筛阳性率最高。结肠镜检查总体依从率为24.19%,男性和女性结肠镜检查依从率差异无统计学意义（χ2=0.256,P=0.613）,且结肠镜检查依从率随年龄增长逐渐下降。2020年—2021年,结肠镜下总病变检出率为52.92%,其中结直肠癌有47例,进展期结直肠腺瘤有333例,非进展期结直肠腺瘤有561例,非腺瘤性良性病变有1 001例;男性总病变检出率明显高于女性（χ2=82.451,P<0.001）;随年龄的增长,总病变检出率、进展期结直肠腺瘤、非进展期结直肠腺瘤检出...     

2014—2018年新疆城市癌症早诊早治项目筛查结果分析

摘 要：［目的］ 分析2014—2018年新疆城市癌症早诊早治项目筛查结果。［方法］ 对新疆开展城市癌症早诊早治项目5年以来的风险评估及临床筛查数据进行汇总统计,分别计算各个癌种的高危率、筛查率和阳性病变检出率。［结果］ 2014—2018年累计完成问卷调查213 326人次。癌症高危率从高到低分别是上消化道癌（27.71%)、肺癌(25.91%)、女性乳腺癌(24.09%)、结直肠癌(21.51%)和肝癌(17.12%)。累计完成5类癌症的临床检查61 947人次,其中分癌种筛查率分别是肝癌(42.76%)、乳腺癌(42.42%)、肺癌(34.86%)、上消化道癌(14.69%)和结直肠癌(14.44%)。共检出阳性病变9 490例,分部位阳性病变检出率顺位依次为肺(21.78%)、肝(18.77%)、乳腺(16.38%)、结直肠(6.03%)和上消化道(0.42%)。［结论］新疆城市癌症早诊早治项目中结直肠癌和上消化道癌的筛查率和阳性病变检出率比较低,需进一步有针对性开展人群健康宣教和组织动员,以提升癌症筛查效果。     

2015—2021年北京市通州区结直肠癌早诊早治筛查结果分析

[目的]分析2015—2021年北京市通州区结直肠癌早诊早治筛查结果，为辖区结直肠癌预防控制策略的制定提供参考。[方法] 2015—2021年，根据北京市农村癌症早诊早治项目方案要求，在通州区抽取40～74岁的常住居民，通过问卷评估和粪便潜血试验初筛获得结直肠癌高危人群，对高危人群开展临床结直肠镜筛查，计算结直肠癌高危率、临床筛查依从率以及病变检出率。[结果]通州区共22 936名居民纳入项目，结直肠癌总体高危率为41.36%，女性高于男性（P<0.001）,50～59岁人群高危率最高。2015—2019年高危率持续处于较高水平，2020—2021年高危率有所下降（P<0.001）。共有4 639人进行肠镜检查，依从率为48.90%，男性依从率高于女性（P<0.05）。通州区结直肠癌、进展期腺瘤、非进展期腺瘤及非腺瘤性良性病变的检出率分别为0.56%、3.41%、17.22%和23.82%，男性各类型病变的检出率均高于女性，非进展期腺瘤、结直肠癌的检出率均随年龄增长呈上升趋势（P<0.05）。[结论]北京市通州区居民具有较高的结直肠癌患病风险，筛查依从率较高，肠...     

2012—2016年重庆市城市人群结直肠癌筛查结果分析

摘 要：［目的］ 分析2012—2016年重庆城市高风险人群结直肠癌筛查情况,为开展癌症早诊早治项目工作提供依据。［方法］ 2012—2016年对重庆市4个辖区(沙坪坝、南岸区、渝中区和九龙坡区)中40~69岁户籍人口进行高风险评估,对评估出的结直肠癌高危人群采用全结肠镜、指示性活检技术开展相应的检查,探讨结直肠癌筛查效果。［结果］ 4年共计评估出结直肠癌高危人群21 441名,高风险评估率为12.19%;实际参与全结肠镜检查者4110名,总体依从性为19.17%。息肉检出率为19.51%(802/4110),男性息肉检出率(26.73%)明显高于女性(14.33%);随着年龄的增长,息肉检出率逐渐上升,且差异有统计学意义(P<0.01)。有936例患者在结肠镜下取标本进行病理检查,检出结直肠癌9例(0.22%),癌前病变106例(2.58%),非进展期腺瘤341例(8.30%),非瘤性息肉235例(5.72%);每种病变的检出率男性均高于女性,并且随着年龄增长呈上升趋势。［结论］ 高危人群中肠道病变检出率男性均明显高于女性,年龄越大检出率越高。男性或年长者是结直肠癌筛查关注的重点,应进一步提高他们在结直肠癌筛查中的依从性。     

两种风险评估模型在结直肠癌筛查中应用效果的比较研究

目的 比较两种风险评估模型在结直肠癌早期筛查中的应用效果,探讨更适用于我国居民结直肠癌早期筛查的评估模型。方法 以2017—2019年参加深圳市南山区城市癌症早诊早治项目的40~74岁常住居民为研究对象,采用两种风险评估模型对同一人群进行结直肠癌风险评估,比较不同模型的筛查效果和预测价值。结果 共纳入4 141例研究对象,平均年龄(56.4±9.0)岁。模型一、模型二的初筛阳性率分别为15.2%和21.3%,总体一致率为93.50%(Kappa值=0.784,P＜0.001)。702例肠镜检查者中,肠炎、息肉、腺瘤、肠癌、其他肠道病变的检出率分别为12.5%、12.0%、15.8%、0.7%、30.7%,两种模型初筛阳性者的肠镜检查结果分布无统计学差异(χ²=8.679,P=0.123)。模型一的灵敏度为 45.7%,低于模型二(61.2%);而模型一的特异度(64.8%)、阳性预测值(76.7%)、Kappa值(0.081)、约登指数(0.103)均高于模型二(41.7%、72.6%、0.026、0.029)。两种模型的ROC曲线下面积分别为0.660(95% CI:0.618~0.702)和0.675(95% CI:0.634~0.715),两者之间无统计学差异(P=0.584)。结论 两种风险评估模型对结直肠癌早期诊断均具有一定的预测能力和优势,但在筛查准确度和筛查效益方面,模型一稍优于模型二,在大规模人群筛查中,建议两种模型取长补短,综合应用。     

2006～2015年中国大肠癌筛查人群依从性的Meta分析

[目的]系统评价中国大肠癌筛查人群的依从性,为开展相关预防与控制工作提供基础数据.[方法]计算机检索中国生物医学文献数据库(光盘版)、中文期刊全文数据库(光盘版)、万方电子期刊、PubMed、EBSCO等数据库,并辅以参考文献追溯和手工检索方法,查找大肠癌初筛人群数量在5000～300 000人的研究文献,且采用的筛查方法为问卷调查与大便潜血检测(FOBT)进行初筛,发现高危人群再接受肠镜检查.检索时限为建库时间至2016年6月.由2位评价员按照纳入与排除标准独立筛选文献、提取资料和评价纳入研究的方法学质量后,采用R3.3.1软件进行Meta分析.[结果]最终纳入25篇文献,共827 904人接受初筛.Meta分析结果显示,问卷调查、FOBT、肠镜的依从率分别为56％ (95％CI:40％～72％,P＜0.0001)、50％ (95％CI:33％～67％,P＜0.0001)、44％ (95％CI:33％～56％,P＜0.0001).对肠镜依从率分层分析发现,农村地区肠镜依从率为64％(95％CI:52％～75％,P＜0.0001),高于城市地区33％ (95％CI:22％～45％,P＜0.0001);北方为44％(95％CI:27％～70％,P＜0.0001),略高于南方42％(95％CI:29％～55％,P＜0.0001);初筛人数≥10 000人的大样本研究依从率为49％(95％CI:34％～64％,P＜0.0001),高于小样本研究的35％(95％CI:16％～57％,P＜0.0001);与职工体检结合的大肠癌伺机性筛查的肠镜依从率为83％(95％CI:32％～98％,P＜0.0001),高于一般社区人群筛查的40％ (95％CI:29％～52％,P＜0.0001).[结论]中国大肠癌筛查人群依从性较低,因此需从筛查方式的选择、筛查流程设计、筛查过程的质量控制、健康宣传等多方面入手提高依从性.     

Strong subsite‐specific variation in detecting advanced adenomas by fecal immunochemical testing for hemoglobin

Fecal immunochemical tests (FITs) for hemoglobin are increasingly recommended and used in colorectal cancer (CRC) screening. We aimed to provide a detailed assessment of the sensitivity of FIT according to type and subsite of neoplasms in a true screening setting. A quantitative FIT (FOB Gold, Sentinel Diagnostics, Milano, Italy) was applied prior to colonoscopy by 3,466 participants of the German screening colonoscopy program. Subsite specific sensitivity for various types of colorectal neoplasms was derived by comparing FIT results with findings at screening colonoscopy. The most advanced finding at colonoscopy was CRC, advanced adenoma, and nonadvanced adenoma in 29, 354 and 686 cases, respectively. Per‐adenoma sensitivity for large advanced adenomas (>1 cm) strongly varied by location (p < 0.001): cecum: 0/14 (0%), ascending colon and right flexure: 11/43 (26%), transverse colon and left flexure: 2/14 (14%), descending colon: 7/12 (58%), sigmoid colon: 47/92 (51%), rectum: 14/39 (36%). By contrast, the FIT detected all of 5 proximal CRC and 23 out of 24 (96%) distal CRCs, whereas per‐adenoma sensitivity of both proximal (17/259, 7%) and distal nonadvanced adenomas (20/237, 8%) essentially equaled the false positivity rate among those without neoplasms (152/2,397, 6%). In conclusion, we found a very large gradient of subsite specific FIT sensitivity for detecting large advanced adenomas ranging from 0% for advanced adenomas located in the cecum to >50% for those located in the descending or sigmoid colon. By contrast, FIT sensitivity was uniformly excellent for CRC and uniformly poor for nonadvanced adenomas, regardless of their location.     

Colorectal Cancer Screening amongst First Degree Relatives of Colon Cancer Cases in Jordan

Objectives: Early detection and screening for colorectal cancer is important among first degree relatives (FDR)of colon cancer cases. Methods: Our target population comprised all such FDR, above 40 years of age, registeredduring the years 2003-2007, Jordan. Detailed information about cancer cases was collected from Jordan CancerRegistry. The screening study was conducted through two stages, where all FDR were examined at their homesfor any suggestive related symptoms of colorectal cancer, then those who were suspected to have cancer werereferred to hospital for confirmatory colonoscopy. Results: First degree relatives amounted to 3,574 subjects,153 (4.3%) were complaining of signs and/or symptoms suggestive of CRC. Of them 58 (37.9%) did not acceptcolonoscopy. The confirmation colonoscopy results for the remaining 95 (62.1%) indicated two confirmed CRCcases. Seventy three percent of the suspected cases complained mainly from change in bowel habit and about onefifth felt cramping. Conclusion: This study raised the question of cost effectiveness and cost benefits of runninga nationwide screening program for such cancer in a developing country. On the other hand it highlights theimportance of early detection activities in Jordan as it was the first study to be conducted among a communitydwelling high risk population in the country.Keywords: Colorectal cancer - screening - early     

Screening colonoscopy from a large single center of Thailand - something needs to be changed?

Background: Results of screening colonoscopy from Western countries reported adenoma detection rates(ADRs) of 30-40% while those from Asia had ADR as low as 10%. There have been limited data regardingscreening colonoscopy in Thailand. The objectives of this study were therefore to determine polyp and adenomadetection rates in Thai people, to evaluate the incidence of colorectal cancer detected during screening colonoscopyand to determine the endoscopic findings of the polyps which might have some impact on endoscopists to performpolypectomy. Materials & Methods: This study was a retrospective electronic chart review of asymptomatic Thaiadults who underwent screening colonoscopy in our endoscopic center from June 2007 to October 2010.Results:A total of 1,594 cases were reviewed. The patients had an average age of 58.3±10.5 years (range 27-82) and 55.5%were female. Most of the cases (83.8%) were handled by staff who were endoscopists. A total of 488 patients(30.6%) were reported to have colonic polyps. Left-sided colon was the most common site (45.1%), followed byright-sided colon (36.5%) and the rectum (18%). Those polyps were removed in 97.5% of cases and 88.5 % ofthe polyps were sent for histopathology (data lost 11.5%). Two hundred and sixty three cases had adenomatouspolyps, accounting for 16.5 % ADR. Advanced adenomas were detected in 43 cases (2.6%). Hyperplastic polypswere mainly located distal to the splenic flexure of the colon whereas adenomas were found throughout the largeintestine. Ten cases (0.6%) were found to have colorectal cancer. Four advanced adenomas and two malignantpolyps were reported in lesions ≤ 5 mm. Conclusion: The polyp detection rate, adenoma detection rate, advancedadenoma detection rate and colorectal cancer detection rate in the screening colonoscopy of Thai adults were30.9%, 16.5%, 2.6% and 0.6% respectively. Malignant transformation was detected regardless of the size andlocation of the polyps. Therefore, new technology would play an important role indistinguishing polyps.     

Screening endoscopy and risk of colorectal cancer in United States men

Objectives: The purpose of this study was to describe the effect of screening endoscopy (sigmoidoscopy or colonoscopy) on colorectal cancer incidence and mortality. Methods: We used data from a prospective cohort study of 24,744 men aged 40 to 75 years in 1986, free from cancer and colon polyps, followed until 1994. The outcomes are diagnosis of colorectal cancer and death from colorectal cancer. Results: Screening endoscopy in 1986-87 was associated with a lower risk of all colorectal cancer (multivariate relative risk [RR]=0.58, 95 percent confidence interval [CI]=0.36-0.96); cancer in the distal colon or rectum (multivariate RR=0.40, CI=0.19-0.84); Dukes stage A&B (multivariate RR=0.66, CI=0.35-1.25); and Dukes stage C&D (multivariate RR=0.50, CI=0.20-1.26) colorectal cancer; and death from colorectal cancer (multivariate RR=0.56, CI=0.20-1.60), after adjusting for age and a wide range of colon cancer risk factors. Screening endoscopy in 1988-87 appeared to provide strong protection against distal stage C&D cancers (age-adjusted RR=0.16, CI=0.02-1.23) but no protection against proximal stage C&D cancers (age-adjusted RR=0.96, CI=0.32-2.91). Conclusions: This study provides strong evidence for a protective effect of screening sigmoidoscopy on colorectal cancer incidence and mortality and supports recommendations for screening sigmoidoscopy as an approach to colon cancer prevention.     

Colorectal cancer screening in elderly patients: When should be more useful?

Current guidelines endorse colon cancer screening every 5-10 years in persons over 50 years of age. However, there is no consensus regarding what age is appropriate to stop screening. Prior history of neoplasia seems to be a strong risk factor for colorectal neoplasia development in elderly people and should be considered when deciding the need for continuing screening/surveillance, however, clinical judgment of comorbidities is still required to individualize screening practice. Screening colonoscopy in very elderly persons (aged 80 years), i.e. should be performed only after careful consideration of potential benefits, risks and patient preferences. The aims of this paper are to: (1) determine the best type of colorectal cancer screening (faecal occult blood testing, flexible sigmoidoscopy, double-contrast barium enema and colonoscopy) and its association with age and health status among elderly veterans and (2) describe the outcomes of colorectal cancer screening among older veterans who have widely differing life expectancies (based on age and health status).     

Meat consumption and colorectal cancer risk in Japan: The Takayama study

Compared with the abundant data from Western countries, evidence regarding meat consumption and colorectal cancer is limited in the Japanese population. We evaluated colorectal cancer risk in relation to meat consumption in a population‐based prospective cohort study in Japan. Participants were 13 957 men and 16 374 women aged ≥35 years in September 1992. Meat intake, assessed with a validated food frequency questionnaire, was controlled for the total energy intake. The incidence of colorectal cancer was confirmed through regional population‐based cancer registries and histological identification from colonoscopy in two main hospitals in the study area. From September 1992 to March 2008, 429 men and 343 women developed colorectal cancer. After adjustments for multiple confounders, a significantly increased relative risk of colorectal cancer was observed in the highest versus lowest quartile of the intake of total and red meat among men; the estimated hazard ratios were 1.36 (95% CI: 1.03, 1.79) for total meat (P for trend = 0.022), and 1.44 (95% CI: 1.10, 1.89) for red meat (P for trend = 0.009). A positive association between processed meat intake and colon cancer risk was also observed in men. There was no significant association between colorectal cancer and meat consumption in women. These results suggest that the intake of red and processed meat increases the risk of colorectal or colon cancer among Japanese men. Abstaining from excessive consumption of meat might be protective against developing colorectal cancer.     

Impact of adenoma detection on the benefit of faecal testing vs. colonoscopy for colorectal cancer

Colonoscopy quality, as measured by adenoma detection rates, varies widely across providers and is inversely related to patients' post‐colonoscopy cancer risk. This has unknown consequences for the benefits of faecal immunochemical testing (FIT) vs. primary colonoscopy screening for colorectal cancer. Using an established microsimulation model, we predicted the lifetime colorectal cancer incidence and mortality benefits of annual FIT vs. 10‐yearly colonoscopy screening at differing ADR levels (quintiles; averages 15.3–38.7%), with colonoscopy performance assumptions estimated from community‐based data on physician ADRs and patients' post‐colonoscopy risk of cancer. For patients receiving FIT screening with follow‐up colonoscopy by physicians from the highest ADR quintile, simulated lifetime cancer incidence and mortality were 28.8 and 5.4 per 1,000, respectively, vs. 20.6 and 4.4 for primary colonoscopy screening (risk ratios, RR = 1.40; 95% probability interval (PI), 1.19–1.71 for incidence, and RR = 1.22; 95%PI, 1.02–1.54 for mortality). With every 5% point ADR decrease, lifetime cancer incidence was predicted to increase on average 9.0% for FIT vs. 12.3% for colonoscopy, and mortality increased 9.9% vs. 13.3%. In ADR quintile 1, simulated mortality was lower for FIT than colonoscopy screening (10.1 vs. 11.8; RR = 0.85; 95%PI, 0.83–0.90), while incidences were more similar. This suggests that relative cancer incidence and mortality reductions for FIT vs. colonoscopy screening may differ by ADR, with fewer predicted deaths with colonoscopy screening in higher ADR settings and fewer deaths with annual FIT screening in lower ADR settings.     

Repeat colonoscopy every 10 years or single colonoscopy for colorectal neoplasm screening in average-risk Chinese: a cost-effectiveness analysis

Background: The appropriate interval between negative colonoscopy screenings is uncertain, but thenumbers of advanced neoplasms 10 years after a negative result are generally low. We aimed to evaluate thecost-effectiveness of colorectal neoplasm screening and management based on repeat screening colonoscopy every10 years or single colonoscopy, compared with no screening in the general population. Methods and materials:A state-transition Markov model simulated 100,000 individuals aged 50–80 years accepting repeat screeningcolonoscopy every 10 years or single colonoscopy, offered to every subject. Colorectal adenomas found duringcolonoscopy were removed by polypectomy, and the subjects were followed with surveillance every three years.For subjects with a normal result, colonoscopy was resumed within ten years in the repeat screening strategy. Insingle screening strategy, screening process was terminated. Direct costs such as screening tests, cancer treatmentand costs of complications were included. Indirect costs were excluded from the model. The incremental costeffectivenessratio was used to evaluate the cost-effectiveness of the different screening strategies. Results:Assuming a first-time compliance rate of 90%, repeat screening colonoscopy and single colonoscopy can reducethe incidence of colorectal cancer by 65.8% and 67.2% respectively. The incremental cost-effectiveness ratio forsingle colonoscopy (49 Renminbi Yuan [RMB]) was much lower than that for repeat screening colonoscopy (474RMB). Single colonoscopy was a more cost-effective strategy, which was not sensitive to the compliance rate ofcolonoscopy and the cost of advanced colorectal cancer. Conclusion: Single colonoscopy is suggested to be themore cost-effective strategy for screening and management of colorectal neoplasms and may be recommendedin China clinical practice.