Participation and yield of a population-based colorectal cancer screening programme in China

Effect of laxative use and laxative type on colorectal cancer risk: A pooling up analysis and evidence synthesis

Colorectal cancer (CRC) is the third most common cancer worldwide and there is a controversy regarding the influence of laxative use on the incidence of CRC. Therefore, the present study aimed to investigate the effects of laxative use and different subtypes of laxatives on the incidence of CRC. To this aim, a comprehensive search of three databases (PubMed, Embase and the Cochrane Library) was conducted on April 12, 2022, using key words that included 'laxative' and 'CRC', which initially retrieved 305 records. Ultimately, 12 studies involving 415,313 patients met all eligibility criteria and were included in a meta-analysis. Subsequently, patients were categorized into the laxative use and non-laxative use groups. Stata 16.0 software was used for all data analyses. The results indicated that laxative use was not significantly associated with CRC risk [odds ratio (OR), 0.95; 95% confidence interval (CI), 0.75-1.20; P=0.65; I2=94.63%]. In the subgroup analyses, the effects of different laxative types were further examined. Notably, all types of laxatives except for fiber laxatives showed no significant influence on CRC risk (P>0.1). By contrast, fiber laxatives were associated with a reduced risk of CRC (OR, 0.74; 95% CI, 0.59-0.93; P=0.01; I2=32.15%), suggesting a potential protective effect of this medication. In conclusion, the findings of the present study suggest that the use of laxatives does not increase the risk of CRC. Moreover, the use of fiber laxatives may have a protective effect by reducing CRC incidence.

Microbiome and fragmentation pattern of blood cell-free DNA and fecal metagenome enhance colorectal cancer micro-dysbiosis and diagnosis analysis: a proof-of-concept study

Colorectal cancer (CRC) is the third most common cancer, and it can be prevented by performing early screening. As a hallmark of cancer, the human microbiome plays important roles in the occurrence and development of CRC. Recently, the blood microbiome has been proposed as an effective diagnostic tool for various diseases, yet its performance on CRC deserves further exploration. In this study, 133 human feces and 120 blood samples are collected, including healthy individuals, adenoma patients, and CRC patients. The blood cfDNA and fecal genome are subjected to shotgun metagenome sequencing. After removing human sequences, the microbial sequences in blood are analyzed. Based on the differential microbes and functions, random forest (RF) models are constructed for adenoma and CRC diagnosis. The results show that alterations of blood microbial signatures can be captured under low coverage (even at 3×). RF diagnostic models based on blood microbial markers achieve high area under the curve (AUC) values for adenoma patients (0.8849) and CRC patients (0.9824). When the fragmentation pattern is combined with microbial and KEGG markers, higher AUC values are obtained. Furthermore, compared to the blood microbiome, the fecal microbiome shows a different community composition, whereas their changes in KEGG pathways are similar. Pathogenic bacteria Fusobacterium nucleatum (F. nucleatum) in feces increased gradually from the healthy group to the adenoma and CRC groups. Additionally, F. nucleatum in feces and blood shows a positive correlation in CRC patients. Cumulatively, the integration of blood microbiome and fragmentation pattern is promising for CRC diagnosis.IMPORTANCEThe cell-free DNA of the human microbiome can enter the blood and can be used for cancer diagnosis, whereas its diagnostic potential in colorectal cancer and association with gut microbiome has not been explored. The microbial sequences in blood account for less than 1% of the total sequences. The blood microbial composition, KEGG functions, and fragmentation pattern are different among healthy individuals, adenoma patients, and CRC patients. Machine learning models based on these differential characteristics achieve high diagnostic accuracy, especially when they are integrated with fragmentation patterns. The great difference between fecal and blood microbiomes indicates that microbial sequences in blood may originate from various organs. Therefore, this study provides new insights into the community composition and functions of the blood microbiome of CRC and proposes an effective non-invasive diagnostic tool.

Disability-adjusted life years for colorectal cancer in China, 2017-2030: A prevalence-based analysis focusing on the impact of screening coverage and the application of local weights

BACKGROUND

Most studies have evaluated disability-adjusted life years (DALYs) of colorectal cancer (CRC) patients based on a set of generic disability weights (DWs). This study aimed to apply local CRC-stage-specific DWs to estimate the burden of DALYs for CRC (CRC-DALYs) in populations in China and consider the influence of local screening coverage of CRC.

METHODS

A prevalence-based model was constructed using data from various sources. Years lived with disability (YLDs) were estimated mainly via cumulative prevalence data (based on CRC incidence rates, population numbers, and survival rates), stage-specific proportions of CRC, and DWs of the local population. Years of life lost (YLLs) were calculated based on the CRC mortality rates and standard life expectancies. CRC incidence and mortality rates for the years 2020, 2025, and 2030 were estimated by joinpoint regression, and the corresponding DALYs were predicted. The main assumption was made for CRC screening coverage. Sensitivity analyses were used to assess the impact of population, DWs, and coverage.

RESULTS

In 2017, among the Chinese population, the estimated number of CRC-DALYs was 4,303,314 (11.9% for YLDs). If CRC screening coverage rate in China (2.3%) remains unchanged, the overall DALYs in 2030 are predicted to increase by 37.2% (45.1% of those aged ≥65 years). More optimistically, the DALYs would then decrease by 0.7% in 2030 (from 5,902,454 to 5,860,200) if the coverage could be increased to 25.0%. A sensitivity analysis revealed that using local DWs would change the base-case values by 5.7%.

CONCLUSIONS

The estimated CRC-DALYs in China using population-specific DWs were considerably lower (with a higher percentage of YLDs) than the global burden of disease (GBD) estimates (5,865,004, of 4.6% for YLDs), suggesting the impact extent of applying local parameters. Sustainable scale-up CRC screening needs to be in place to moderate the growth trend of CRC-DALYs in China.

Effectiveness of single-target fecal DNA methylation test in regional mass screening for colorectal cancer and precancerous lesions in China

Background

Colorectal cancer (CRC) is the third-most-common malignancy and the second-leading cause of cancer-related deaths worldwide and current screening methods such as guaiac-based fecal occult blood test (gFOBT), fecal immunochemical test (FIT), and colonoscopy have their own pros and cons. This study aimed to assess the effectiveness of a fecal DNA methylation test by using methylated SDC2 (mSDC2) as the epigenetic biomarker for detecting CRC in a screening-naïve population.

Methods

Fecal mSDC2 test and FIT were simultaneously performed on eligible 40- to 74-year-old adults of a regional township in China. Subjects with positive results were recommended for colonoscopy. Data of positivity rates, positive predicted values (PPVs), and detection rates associated with clinical characteristics were analysed.

Results

The positivity rate of mSDC2 was 7.6% for 10,578 participants with valid results from both fecal mSDC2 test and FIT. With an adherence rate of 63.8% to colonoscopy referral, 25 CRCs, 189 advanced adenomas (AAs), and 165 non-advanced adenomas (NAAs) and polyps were detected. The PPVs of mSDC2 were 4.93%, 37.28%, and 32.54% for CRC, AA, and non-advanced lesions, respectively. When the CRCs and AAs were counted as positive findings, the fecal mSDC2 test showed a higher detective rate than FIT (relative risk [RR], 1.313 [1.129-1.528], P < 0.001). When NAAs and polyps were also specified as treatable lesions, the mSDC2 test was more effective in detecting these benign growths (RR, 1.872 [1.419-2.410]; P < 0.001). A combination of mSDC2 and FIT detected 29 CRCs, 298 AAs, and 234 NAAs and polyps. Overall, the fecal mSDC2 test had a higher detection rate for both advanced and non-advanced colonic lesions. The false-positive rate of the fecal mSDC2 test was comparable to that of FIT (RR, 1.169 [0.974-1.403]; P = 0.113).

Conclusions

The single-target stool-based mSDC2 test can effectively and accurately detect CRC and precancerous lesions in a large-scale CRC-screening program.

Trial registration number

NCT05374369.

Development and validation of an information-motivation-behavioral skills questionnaire for colorectal cancer prevention in a high-risk population

BACKGROUND

Colorectal cancer (CRC) is one of the most prevalent cancers, and the risk of CRC is substantially greater in a high-risk population than in the general population. However, no existing assessment instruments have been specifically designed to evaluate CRC prevention behaviors in a high-risk population. The aim of this study was to develop and psychometrically validate an information-motivation-behavioral skills (IMB) questionnaire tailored for the population at high risk for CRC (IMB-CRC) to assess the factors influencing prevention behaviors.

METHODS

This cross-sectional study was conducted in northeastern China. The initial questionnaire items were derived from a comprehensive literature review, semistructured interviews analyzed via content analysis, and expert focus group discussions. Content validity was assessed through expert consultation using the Delphi method, and face validity was evaluated in the high-risk population for CRC. Explanatory factor analysis (EFA) was performed on Sample 1 (N = 287) to identify underlying factors, and confirmatory factor analysis (CFA) was performed on Sample 2 (N = 224) to validate the model. Internal consistency and test-retest reliability were also examined to ensure the stability and consistency of the questionnaire.

RESULTS

The final IMB-CRC comprises 21 items distributed across four dimensions: prevention information (7 items), objective skills (5 items), self-efficacy (5 items), and motivation (4 items), collectively accounting for 61.99% of the variance. CFA indicated that the proposed model fit the data well (χ2/df = 1.779, RMSEA = 0.059, AGFI = 0.852, GFI = 0.883, CFI = 0.950, IFI = 0.951, TLI = 0.943, and NFI = 0.894). The item content validity index (I-CVI) for individual items ranged from 0.905 to 1, and the scale content validity index (S-CVI) was 0.952, suggesting good content validity. The IMB-CRC demonstrated high reliability, with a Cronbach's alpha of 0.937, McDonald's omega of 0.939, and test-retest reliability of 0.919. Significant positive correlations were observed between the IMB-CRC and each of its four dimensions, indicating that higher IMB-CRC scores were associated with greater engagement in cancer prevention behaviors among the high-risk population.

CONCLUSION

The IMB-CRC exhibited appropriate validity and reliability, indicating that this questionnaire is a robust tool for assessing behavioral components essential for CRC prevention in the high-risk population. Health care professionals and policymakers can use the IMB-CRC to develop targeted CRC risk communication and behavioral education strategies, thereby improving the preventive abilities of a high-risk population.

Assessment of the participation rate and effectiveness of upper gastrointestinal cancer screening in China: a multicenter population-based screening study

This study estimated the participation rate and effectiveness of endoscopic screening of upper gastrointestinal cancer (UGIC) in China.From 2014 to 2015, we recruited 192805 adults from seven cities in China to build a prospective cohort for UGIC screening, including esophageal cancer and gastric cancer. Overall, 39991 participants were at high risk for UGIC according to an established risk score system and were recommended for endoscopic examination. Participation rates were reported, and their associated factors were explored. After inverse probability of treatment weighting (IPTW) based on propensity scores, Poisson regression was used to estimate the incidence rate ratio (IRR) and 95%CI for UGIC incidence and mortality between screened and non-screened groups from cohort entry until 31 December 2021.10442 participants underwent endoscopy, giving a participation rate of 26.1%. Higher participation was observed among individuals with higher education levels, history of upper gastrointestinal diseases, and family history of cancer. After a median follow-up of 6.8 years (interquartile range 6.7-6.9), UGIC incidences after IPTW were 94.6 per 100000 person-years in the screened group and 84.7 per 100000 person-years in the non-screened group. The weighted UGIC mortality rates were 13.1 and 33.4 per 100 000 person-years, respectively. The screened group had significantly lower UGIC mortality than the non-screened group, with a weighted IRR of 0.39 (95%CI 0.19-0.82).Participation in endoscopic screening among a high-risk UGIC population in China was low. We found that one-time endoscopic screening significantly reduced mortality caused by UGIC.

Understanding Cancer Screening Behavior in South Korea: A Biopsychosocial Approach to Regional Differences

Background/Objectives: This study aimed to examine regional cancer screening participation rates among South Korean adults aged 40 and over and to identify biological, psychological, and sociocultural factors associated with cancer screening behavior using the biopsychosocial model. Methods: This research was a secondary analysis study. Data were obtained from the 2023 Korean Community Health Survey, focusing on adults residing in cities that exhibited the highest and lowest rates of cancer screening. Differences in cancer screening rates by city were visualized using a location-based open service platform. Variables were categorized into biological, psychological, and sociocultural factors, and logistic regression analysis was conducted to ascertain the factors associated with screening participation. Results: The cancer screening rate for adults aged 40 or older in 17 metropolitan cities in Korea ranged from 64.9% to 76.0%, and the national average was 70.9%. In the city with the highest screening rate, participation was positively associated with oral health, physical activity, breakfast-eating habits, and past smoking. In the city with the lowest screening rate, higher screening participation correlated with family cohabitation and satisfaction with the social environment. Conclusions: Our results suggest that cancer screening participation rates vary across regions and that the factors associated with cancer screening participation differ between regions with the highest and lowest participation rates. These results provide evidence for targeted interventions that take into account regional factors to improve cancer screening rates in South Korea.

Colorectal cancer early screening: Dilemmas and solutions

Colorectal cancer (CRC) is a prevalent malignancy worldwide, posing a significant public health concern. Mounting evidence has confirmed that timely early screening facilitates the detection of incipient CRC, thereby enhancing patient prognosis. Obviously, non-participation of asymptomatic individuals in screening programs hampers early diagnosis and may adversely affect long-term outcomes for CRC patients. In this letter, we provide a comprehensive overview of the current status of early screening practices, while also thoroughly examine the dilemmas and potential solutions associated with early screening for CRC. In response to these issues, we proffer a set of recommendations directed at governmental authorities and the general public, which focus on augmenting financial investment, establishing standardized screening protocols, advancing technological capabilities, and bolstering public awareness campaigns. The importance of collaborative efforts from various stakeholders cannot be overstated in the quest to enhance early detection rates and alleviate the societal burden of CRC.

Impact of lifestyle and mental health on colorectal adenomas in China: a prospective cross-sectional survey

Background

Colorectal adenomas, which are precancerous lesions that can develop into colorectal cancer, present a significant challenge due to the lack of comprehensive early screening and clear identification of risk factors.

Objectives

We conduct a double-blind, prospective cross-sectional analysis to examine the relationship between lifestyle, mental health, and colorectal adenomas.

Methods

Between June 2023 and July 2024, we surveyed 246 participants at Hubei Provincial Hospital of Traditional Chinese Medicine in Wuhan using a self-administered online questionnaire.

Results

The majority of participants were over the age of 50 (49.6%), married or living with a partner (87.08%), and employed as office workers or technicians (44.3%). Among the total population, 435 individuals (53.5%) were diagnosed with colorectal adenomas. A significant positive association was observed between being a manager (OR = 2.340; 95% CI = 1.043-5.248) and the presence of colorectal adenomas, as well as having a BMI over 28 (OR = 6.000; 95% CI = 1.501-23.991). After adjusting for professional role and BMI, no significant associations were found between scores on the HADS-D (AOR = 1.031; 95% CI = 0.967-1.099) or PSS-10 (AOR = 0.971; 95% CI = 0.923-1.022) scales and colorectal adenomas. However, higher scores on the AUDIT (AOR = 1.001-1.144), CDS-12 (AOR = 1.028; 95% CI = 1.003-1.054), PSQI (AOR = 1.079; 95% CI = 1.003-1.161), and HADS-A (AOR = 1.156; 95% CI = 1.059-1.262) scales were significantly associated with an increased likelihood of colorectal adenomas.

Conclusion

The study highlights the significance of addressing alcohol consumption, smoking, sleep quality, and anxiety to reduce the risk of colorectal adenomas. Targeted mental health interventions may play a crucial role in alleviating this health burden and enhancing overall population health.

Participation and Yield in Multiple Rounds of Colorectal Cancer Screening Based on Fecal Immunochemical Test: A Systematic Review and Meta-Analysis

INTRODUCTION

The evidence on the cumulative participation and yield in multiple rounds of colorectal cancer (CRC) screening based on fecal immunochemical test is sparse. We aimed to assess the trends in participation and detection for advanced colorectal neoplasm under different screening intervals in multiround fecal immunochemical testing-based CRC screening by synthesizing the current available evidence.

METHODS

PubMed, Embase, and Cochrane were retrieved from January 1, 2002, to April 16, 2024, for potential eligible studies, and then, we synthesized participation and advanced colorectal neoplasm detection rates for each screening round, along with their respective 95% confidence intervals (CIs).

RESULTS

Nineteen studies involving a total of 2,296,071 individuals were included. As screening rounds increased, participation exhibited a gradual consistent increase, reaching 78.45% and 74.97% for annual and biennial screening strategies. For annual screening, the cumulative detection rates for 3 rounds were 1.38% (95% CI: 1.18%-1.63%), 1.95% (95% CI: 1.72%-2.21%), and 2.50% (95% CI: 2.29%-2.72%), respectively. For biennial screening, the cumulative detection rates for 4 rounds were 2.22% (95% CI: 1.22%-3.22%), 3.44% (95% CI: 2.06%-4.82%), 4.26% (95% CI: 2.70%-5.83%), and 5.10% (95% CI: 3.28%-7.29%), respectively. Notably, the per-round detection rate of advanced colorectal neoplasms declined yet as the screening progressed.

DISCUSSION

In population-based CRC screening programs, the participation exhibited a slow upward trend for both screening strategies, but the incremental benefits in CRC detection gradually diminished. Tailored strategies, such as extending intervals for individuals with multiple negative fecal immunochemical testing results, might optimize effectiveness and cost-efficiency in population-based CRC screening.

Family History of Colorectal Cancer and the Risk of Colorectal Neoplasia: A Systematic Review and Meta-Analysis

INTRODUCTION

Although there is enough pooled evidence supporting the positive association between family history of colorectal cancer (CRC) in first-degree relatives (FDRs) and the risk of CRC, synthesized data on its association with the risk of other colorectal neoplasia are lacking. Therefore, we aimed to systematically assess this issue.

METHODS

We searched PubMed, Web of Science, and Embase from database inception through May 9, 2024, to identify observational studies investigating the association between family history of CRC in FDRs and the risk of colorectal neoplasia (excepting CRC). Adenoma, nonadvanced adenoma (NAA), advanced adenoma (AA), and advanced neoplasia (AN) were further chosen as main outcomes because of data availability. Random-effects model was used for data synthesis. Subgroup meta-analyses were performed to evaluate the robustness of results.

RESULTS

Of 5,172 initial records screened, 75 studies (with 931,515 participants) were identified for analysis. Family history of CRC in FDRs was associated with increased risk of adenoma (pooled odds ratio [OR] 1.67, 95% confidence interval [CI] 1.46-1.91), NAA (pooled OR 1.35, 95% CI 1.21-1.51), AA (pooled OR 1.66, 95% CI 1.46-1.88), and AN (pooled OR 1.58, 95% CI 1.44-1.73). The positive associations persisted in all examined subgroups. The risk of adenoma (pooled OR 4.18, 95% CI 1.76-9.91), AA (pooled OR 2.42, 95% CI 1.72-3.40), and AN (pooled OR 2.00, 95% CI 1.68-2.38) was more evident among individuals with 2 or more affected FDRs.

DISCUSSION

Family history of CRC is associated with increased risk of adenoma, NAA, AA, and AN totally, and in all available subgroups. The findings further strengthen the necessity and importance of an intensified screening strategy for individuals with a positive family history of CRC, which is very useful for related health resource allocation and policymaking.

Lifetime probabilities of developing and dying from cancer in China: comparison with Japan and the United States in 2022

The numbers of new cancer cases and deaths in China were the largest in the world, causing a huge social and economic burden. We attempt to use more intuitive indicators to measure the probabilities of being diagnosed of or dying from cancer in China and compare these probabilities with those in Japan and the United States (US). We obtained the cancer data from GLOBOCAN 2022 for China, Japan, and the US and the all-cause mortality and population data from the United Nations. The lifetime risks of developing and dying from cancer were estimated with adjusted actual life expectancy, multiple primaries, and death-competing risks from causes other than cancers. Approximately 27.61% of Chinese people developed cancer and 1 in 5 persons were likely to die from cancer. The highest-risk cancer among men and women was lung cancer in China, but in the US and Japan, prostate cancer among men and breast cancer among women posed the highest risk. Lung cancer presented the highest likelihood of death, but women in Japan had the highest likelihood of dying from colorectal cancer. China had a lower lifetime risk of developing cancer compared with Japan and the US, but a higher probability of dying from cancer than the US. Although the probability of developing cancer was not as high as that in Japan and the US, China was still faced with enormous pressure due to its huge population and contradictory cancer patterns. Estimating lifetime risks can provide essential information to formulate appropriate cancer prevention and control plans.

Exploring factors influencing decision making for colonoscopy in first-degree relatives of patients with colorectal cancer: a mixed-methods study

BACKGROUND

A family history of colorectal cancer among first-degree relatives is recognized as one of the most significant and prevalent risk factors for colorectal cancer in China. Colonoscopy remains the most crucial screening method, as early colonoscopy screening can effectively reduce the risk of advanced colorectal cancer. However, the factors influencing the decision-making behavior of first-degree relatives regarding colonoscopy screening have predominantly been examined through quantitative studies, while mixed-methods research remains scarce. This study aimed to evaluate the decision-making behaviors of first-degree relatives of patients with colorectal cancer and to identify the factors influencing these behaviors.

METHODS

An explanatory sequential design was adopted within a mixed-methods framework. For the quantitative phase, convenience sampling was used to select 272 first-degree relatives of colorectal cancer patients who were treated at a tertiary hospital's gastrointestinal surgery department in Wuhan, China from March to December 2023, for a questionnaire survey. For the qualitative component, a maximum variation purposive sampling method, guided by the Protection Motivation Theory, was employed to select 16 participants from the initial survey group for semi-structured interviews.

RESULTS

Our findings revealed that participants had a high health belief score. Key factors influencing their decision to undergo colonoscopy screening included marital status, average monthly household income, medical payment method, and perceived severity. The qualitative study identified six core themes: perceived susceptibility, perceived severity, internal and external rewards, response efficacy, response costs, and self-efficacy.

CONCLUSION

Medical staff should focus on first-degree relatives of colorectal cancer who are unmarried or widowed, have lower family income, have lower reimbursement rate of medical insurance, and lack of disease severity perception. Through establishing social support system, issuing subsidies for colonoscopy screening, increasing reimbursement rate of medical insurance, emphasizing the severity of colorectal cancer, to enhance their health belief level and promote colonoscopy screening decision-making behavior.

TRIAL REGISTRATION

Not applicable.

Intestinal microbiota as biomarkers for different colorectal lesions based on colorectal cancer screening participants in community

Introduction

The dysregulation of intestinal microbiota has been implicated in the pathogenesis of colorectal cancer (CRC). However, the utilization of intestinal microbiota for identify the lesions in different procedures in CRC screening populations remains limited.

Methods

A total of 529 high-risk individuals who underwent CRC screening were included, comprising 13 advanced adenomas (Aade), 5 CRC, 59 non-advanced adenomas (Nade), 129 colon polyps (Pol), 99 cases of colorectal inflammatory disease (Inf), and 224 normal controls (Nor). 16S rRNA gene sequencing was used to profile the intestinal microbiota communities. The Gut Microbiota Health Index (GMHI) and average variation degree (AVD) were employed to assess the health status of the different groups.

Results

Our findings revealed that the Nor group exhibited significantly higher GMHIs and the lowest AVD compared to the four Lesion groups. The model incorporating 13 bacterial genera demonstrated optimal efficacy in distinguishing CRC and Aade from Nor, with an area under the curve (AUC) of 0.81 and a 95% confidence interval (CI) of 0.72 to 0.89. Specifically, the 55 bacterial genera combination model exhibited superior performance in differentiating CRC from Nor (AUC 0.98; 95% CI, 0.96-1), the 25 bacterial genera combination showed superior performance in distinguishing Aade from Nor (AUC 0.95). Additionally, the 27 bacterial genera combination demonstrated superior efficacy in differentiating Nade from Nor (AUC 0.82). The 13 bacterial genera combination exhibited optimal performance in distinguishing Inf from Nor (AUC 0.71).

Discussion

Our study has identified specific microbial biomarkers that can differentiate between colorectal lesions and healthy individuals. The intestinal microbiota markers identified may serve as valuable tools in community-based CRC screening programs.

Barriers and Facilitators of Implementing Colorectal Cancer Screening Management in China: A Mixed-Methods Study

BACKGROUND

Colorectal cancer is a major cause of cancer-related deaths in China. Timely screening is essential for reducing mortality, but implementing comprehensive programs in Chinese healthcare settings is challenging.

OBJECTIVE

This study identifies barriers and facilitators to colorectal cancer screening (CRCS) in China and recommends effective implementation strategies.

METHODS

Conducted from October 2023 to April 2024, this mixed-methods study under the Consolidated Framework for Implementation Research involved 128 practitioners and 440 residents near 5 community health centers and 4 tertiary care hospitals in Harbin, Heilongjiang Province. Quantitative data were analyzed using descriptive statistics and logistic regression, whereas qualitative data from 21 practitioners and 23 community members underwent directed content analysis.

RESULTS

The study identified 18 facilitators and 29 barriers to CRCS implementation in China, analyzed across 5 Consolidated Framework for Implementation Research domains: innovation (2 facilitators, 5 barriers), outer setting (5 facilitators, 4 barriers), inner setting (3 facilitators, 4 barriers), individual characteristics (5 facilitators, 11 barriers), and implementation process (3 facilitators, 5 barriers).

CONCLUSION

This study highlights critical facilitators and barriers from the perspectives of healthcare professionals and the screening-eligible population. It suggests strategies to enhance early CRCS initiatives in China, including regular training, public education, financial support, and improved accessibility.

IMPLICATIONS FOR PRACTICE

The findings from this study provide actionable insights for enhancing the implementation of CRCS in Chinese healthcare settings.

Explaining the Correlates of the Multi-Theory Model (MTM) of Health Behavior Change in Visual (Structural) Colorectal Cancer Screening Examinations

Colorectal cancer (CRC) ranks third in terms of global cancer prevalence and is the second most common cause of cancer-related mortality. Although CRC rates are decreasing in the United States, inequalities still exist despite the effectiveness of invasive screening methods, such as colonoscopy, flexible sigmoidoscopy, and computed tomography (CT) colonography in detecting colorectal cancer. Many current interventions promoting CRC screening do not utilize a modern theory-based approach, which has led to the low utilization of these screening methods. This cross-sectional study aims to address the lack of theory-based treatments for promoting visual CRC screening examinations by applying the multi-theory model (MTM) of health behavior change to explicate the health-related factors for individuals to seek visual colorectal cancer screening examinations for CRC screening. A 57-item validated questionnaire assessing MTM constructs and CRC screening was administered online. The survey questionnaire was administered to a sample of 640 adults from the United States. The participants were between the ages of 45 and 75 years. Hierarchical multiple regression was used to assess the relationship between MTM constructs with the initiation and sustenance of CRC screening behaviors. Out of the total participants in this nationwide sample, 71.4% (n = 457) reported that they had undergone a visual CRC screening examination. MTM subscales, specifically participatory dialogue, changes in the physical environment along with age, recommendation for CRC screening from a healthcare provider, and previous experience with colonoscopy, were found to be significant factors in predicting the initiation of visual CRC screening behavior. These factors accounted for 22% of the variation in initiation among this group (R2 = 0.222, F = 3.521, p < 0.001). The MTM can be a valuable framework for designing educational media, information media, social media platforms, and clinical interventions to promote visual colorectal cancer screening examinations.

Alpha-glucosidase inhibitor decreases the risk of colorectal adenoma in the aged with Type 2 diabetes

The rapidly aging population is fueling a surge in diabetes, especially Type 2, which heightens colorectal cancer (CRC) risk. Colorectal adenoma, a precursor, compounds this trend. Although alpha-glucosidase inhibitors are effective hypoglycemic drugs working in the GI tract, the link between them and colorectal adenoma formation remains unexplored. A retrospective cross-sectional study was conducted on type 2 diabetes patients aged 60 and above using data from Wenzhou Central Hospital from January 2021 to May 2024. We used multivariable logistic regression and propensity score matching analysis (PSM) to calculate adjusted ORs for colorectal adenoma, controlling for potential confounders. A total of 311 subjects were enrolled in the study, with a mean age of 67.55 years. 138 (44.4%) were diagnosed with colorectal adenoma. Multivariate logistic regression analysis revealed that the AGI (Alpha-glucosidase inhibitor) Group had an adjusted OR of 0.399 (95% CI = 0.22-0.723, p = 0.002) compared to those with AGI free people. A similar trend was also observed in the PSM analysis (OR = 0.362, 95% CI = 0.176-0.744, p = 0.004). Subgroup analysis reveals hypertension as a potential modulator of the inverse relationship between AGI and colorectal adenoma occurrence post-PSM (p = 0.049). And AGI reduces serum iron levels, both before (p = 0.01) and after PSM (p = 0.028). In summary, our findings indicate that AGI significantly mitigates the risk of colorectal adenoma among individuals aged 60 and above, particularly among those afflicted with hypertension. Additionally, it substantially decreases serum iron levels.

Combining methylated RNF180 and SFRP2 plasma biomarkers for noninvasive diagnosis of gastric cancer

INTRODUCTION

Gastric cancer (GC) is a common malignant tumor, and early diagnosis significantly improves patient survival rates. This study aimed to investigate the diagnostic value of ring finger protein 180 (RNF180) and secreted frizzled protein 2 (SFRP2) in GC.

MATERIALS & METHODS

A total of 165 healthy individuals, 34 patients with precancerous gastric lesions, and 104 patients with confirmed GC were divided into training and validation sets; methylated RNF180 and SFRP2 were detected in circulating DNA from blood samples. Six models, including those based on logistic regression, Naive Bayes, K-nearest neighbor algorithm, glmnet, neural network, and random forest (RF) were built and validated. Area under the curve (AUC), sensitivity, specificity, positive predictive value, and negative predictive value were determined.

RESULTS

In the training set, the RF model with RNF180 and SFRP2 (R + S) had an AUC of 0.839 (95 % CI: 0.727-0.951), sensitivity of 60.3 %, and specificity of 85.5 % for diagnosing GC. The RF model with R + S+ Tumor markers had an AUC of 0.849 (95 % CI: 0.717-0.981), sensitivity of 62.8 %, and specificity of 87.1 %. In the validation set, the RF model with R + S had an AUC of 0.844 (95 % CI: 0.774-0.923), sensitivity of 87.8 %, and specificity of 69.2 %. The RF model with R + S + Tumor markers had an AUC of 0.858 (95 % CI: 0.781-0.939), sensitivity of 85.4 %, and specificity of 76.9 %.

CONCLUSION

Our results suggest that RNF180 and SFRP2 could serve as diagnostic biomarkers for GC when using the RF model.

Fecal methylated syndecan-2 (SDC2) testing for early screening of colorectal cancerous and precancerous lesions: A real-world retrospective study in China

Background

Colorectal cancer (CRC) is a major public health concern and the second leading cause of cancer-related deaths worldwide. However, challenges remain in deploying effective screening strategies for early-stage CRC. This study aimed to evaluate the effectiveness of a fecal-based syndecan-2 (SDC2) methylation test for the detection of colorectal lesions and CRC.

Methods

We retrospectively collected data on participants who underwent fecal SDC2 methylation testing from January 1, 2019, to May 30, 2023. Patients with positive results were recommended to undergo colonoscopy. Performance indicators associated with certain clinical characteristics, including positive rate (PR), positive predictive value (PPV), and colonoscopy compliance rate (CCR), were subjected to statistical analysis.

Results

We analyzed data from 113,209 participants, of whom 11,841 (10.4% PR) had positive fecal SDC2 methylation test results. A total of 4315 participants with positive results adhered to the colonoscopy recommendations, and the CCR was 36.4%. Finally, 3169 colorectal lesions were detected, including 1134 polyps, 875 non-advanced adenomas (NAAs), 770 advanced adenomas (AAs), and 390 CRCs, with PPV values of 26.3% (1134/4315), 20.3% (875/4315), 17.8% (770/4315), and 9.0% (390/4315), respectively. Notably, the PPV for CRC increased significantly with age (χ 2 = 164.40, P < 0.0001). In addition, as the cycle threshold (CT) values increased, the PPVs of AAs and CRCs generally decreased, whereas those of NAAs and polyps significantly increased. Moreover, the clinical patient group had the highest incidence of late-stage CRC (stage II and higher), whereas asymptomatic populations from the staff physical examination group and rural town-based screening programs had the highest number of stage 0 and I CRCs detected (P = 0.0107).

Conclusions

This study indicates that fecal SDC2 methylation testing combined with colonoscopy may be an effective screening method for colorectal lesions and CRC.

Age, frequency, and strategy optimization for organized colorectal cancer screening: a decision analysis conducted in China for the years 2023-2038

BACKGROUND

The colorectal cancer mortality rate in China has exceeded that in many developing countries and is expected to further increase owing to multiple factors, including the aging population. However, the optimal policy for colorectal cancer screening is unknown.

METHODS

We synthesized the most up-to-date data using a 12-state Markov model populated with a cohort of Chinese men and women born during 1949-1988, and evaluated 16 conventional and 40 risk-tailored schemes for colorectal cancer screening, considering possible combinations of age (starting at 40 + years and ending at 75 years), frequency, and strategy (standard colonoscopy, fecal immunochemical testing with colonoscopy if positive, or risk-tailored). We projected the incidence and mortality of CRC, cost, and quality-adjusted life years for 2023-2038; and performed incremental cost-effectiveness, probability acceptability, and sensitivity analyses to identify the optimal scheme and the factors affecting this choice.

RESULTS

By 2038, all standard colonoscopy, colonoscopy following fecal immunochemical testing, and risk-tailored schemes were effective in reshaping China's colorectal cancer trajectory, with relative reductions in colorectal cancer incidence and mortality rates of up to 34% and 33.7%, respectively, versus no screening. Two standard colonoscopy, one colonoscopy following fecal immunochemical testing, and four risk-tailored schemes were efficient using a starting age of 40 years. Among these options, a risk-tailored scheme (standard colonoscopy every 5 years for high-risk and annual fecal immunochemical testing screening for moderate-to-low-risk) had a high probability (31.1%) of being optimal (with ≥ 40% uptake for a high-risk population, in particular), given China's present per capita gross domestic product, and would yield the highest gain in quality-adjusted life years in 17 of 31 provinces.

CONCLUSIONS

Our findings suggest the commencement of colorectal cancer screening at 40 years of age in China, and that risk-tailored and some conventional schemes would be effective and cost-efficient. These findings should be valuable for policy-making regarding cancer control and resource allocation.

Temporal trends in disability adjusted life year and mortality for colorectal cancer attributable to a high red meat diet in China from 1990 to 2021: an analysis of the global burden of disease study 2021

BACKGROUND

High red meat consumption is a main modifiable risk factor for colorectal cancer mortality (CRC), but its attributable disease burden remains unclear in China. We aimed to analyze the temporal trends in CRC deaths and disability-adjusted life years (DALYs) attributable to high red meat consumption in China from 1990 to 2021 and to predict the disease burden in the next 15 years.

METHODS

Data was obtained from the Global Burden of Disease (GBD) 2021 study. The Joinpoint regression model was used to calculate the annual percentage change (APC) and the average annual percentage change (AAPC). In addition, the age-period-cohort (APC) model was employed to explore the effects of age, period, and cohort on CRC mortality. The autoregressive integrated moving average (ARIMA) model was utilized to predict the disease burden in 2022-2036. We also compared the CRC burden attributed to high red meat in China with 204 countries worldwide.

RESULTS

The results showed that the number of CRC deaths in China due to high red meat consumption increased nearly 2.5 times, from 17,608 (95% UI: -3 to 36,613) in 1990 to 43,580 (95% UI: -16 to 92,083) in 2021. Male CRC deaths exhibited a more pronounced increase, rising from 9,800 in 1990 to 27,600 in 2021. Additionally, the number of DALYs increased from 518,213 (95% UI: -105,107 to 1,074,174) in 1990 to 1,091,788 (95% UI: -509 to 2,295,779) in 2021. Joinpoint regression analysis confirmed that the AAPC in ASDR and ASMR was - 0.20 (95% CI: -0.40 ∼ 0.00) and - 0.30 (95% CI: -0.40 ~ -0.10). When age, period, and cohort effects were examined as the reference group, the risk of CRC was found to increase with age. However, women experienced a marked decline in both period and cohort effects compared to men.

CONCLUSIONS

Compared to global levels, the burden in China is heavier. In terms of mortality or DALY standardized rates, Chinese women show a similar downward trend to the overall trend, while Chinese men show a striking upward trend. This study provides valuable insights into enhancing CRC prevention and improving dietary patterns in China.

Comparing Cognitive Recovery of Remimazolam versus Propofol in Elderly Patients Undergoing Colonoscopy: A Randomized Controlled Trial

Background

Remimazolam, a novel ultra-short-acting benzodiazepine, shows promise for procedural sedation. This study compared the cognitive recovery of remimazolam versus propofol in elderly patients undergoing colonoscopy.

Patients and Methods

In this prospective, randomized, double-blind, controlled trial, 228 patients aged ≥ 65 years undergoing outpatient colonoscopies were recruited. Patients received intravenous sufentanil 0.05 μg/kg, followed by either remimazolam 0.2 mg/kg or propofol 1 mg/kg for sedation induction. The assigned study drug (remimazolam 0.1 mg/kg or propofol 0.5 mg/kg) was titrated to maintain a Modified Observer's Assessment of Alertness/Sedation scale score < 3 during the procedure. The primary outcome was the incidence of cognitive recovery, assessed using the Postoperative Quality of Recovery Scale (PostopQRS) cognitive domain on postoperative day 3. Secondary outcomes included overall and other PostopQRS domains recovery, time to discharge, patient satisfaction, and adverse events.

Results

Cognitive recovery on day 3 was similar between remimazolam (84.2%) and propofol (85.1%) groups (risk ratio = 0.99; 95% CI: 0.89-1.11; p = 0.854). No significant differences were observed in overall recovery, other domains, or discharge time. Remimazolam patients reported higher satisfaction (p = 0.001) and experienced lower incidences of hypotension (21.9% vs 53.5%; p < 0.001), hypoxemia (6.1% vs 16.7%; p = 0.024), and injection site pain (15.8% vs 41.2%; p < 0.001) compared to propofol.

Conclusion

In elderly patients undergoing colonoscopy, remimazolam demonstrated comparable cognitive recovery to propofol, with higher patient satisfaction and a more favorable safety profile. Remimazolam may be the preferred alternative to propofol for procedural sedation in this vulnerable population.

Trial Registration

The Chinese Clinical Trial Registry, ChiCTR2200066689.

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 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 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.

An Inflammation-Related lncRNA Signature for Prognostic Prediction in Colorectal Cancer

BACKGROUND

Colorectal cancer (CRC) represents a commonly diagnosed malignancy affecting the digestive system. Mounting evidence shows long noncoding RNAs (lncRNAs) contribute to carcinogenesis. However, inflammation-related lncRNAs (IRLs) regulating CRC are poorly defined.

AIMS

The current study aimed to develop an IRL signature for predicting prognosis in CRC and to examine the involved molecular mechanism.

METHODS AND RESULTS

RNA-seq findings and patient data were retrieved from The Cancer Genome Atlas (TCGA), and inflammation-associated genes were obtained from the GeneCards database. IRLs with differential expression were determined with "limma" in R. Using correlation and univariable Cox analyses, prognostic IRLs were identified. The least absolute shrinkage and selection operator (LASSO) algorithm was employed to construct a prognostic model including 13 IRLs. The model's prognostic value was examined by Kaplan-Meier (K-M) survival curve and receiver operating characteristic (ROC) curve analyses. Furthermore, the association of the signature with the immune profile was assessed. Finally, RT-qPCR was carried out for verifying the expression of inflammation-related lncRNAs in nonmalignant and malignant tissue samples. A model containing 13 inflammation-related lncRNAs was built and utilized to classify cases into two risk groups based on risk score. The signature-derived risk score had a higher value in predicting survival compared with traditionally used clinicopathological properties in CRC cases. In addition, marked differences were detected in immune cells between the two groups, including CD4+ T cells and M2 macrophages. Furthermore, RT-qPCR confirmed the expression patterns of these 13 lncRNAs were comparable to those of the TCGA-CRC cohort.

CONCLUSION

The proposed 13-IRL signature is a promising biomarker and may help the clinical decision-making process and improve prognostic evaluation in CRC.

Improved Effectiveness of Combined Screening for Multiple Cancers: A Government-Organized Population-Based Study in China

OBJECTIVE

The purpose of this study was to analyze the effectiveness of the Cancer Screening Program in Urban China (CanSPUC) in Hebei Province, 2016-2023.

METHODS

A questionnaire for risk factors of lung, breast, upper gastrointestinal, liver, and colorectal cancers was administered to urban residents aged 40-74 years in five cities to assess their cancer risk. High-risk participants were invited for screening and classified into five groups on the basis of the number of cancer types that were assessed to be high risk. The participation and positive outcome rates were analyzed. The incidence and the mortality of five types of cancer and all-cause mortality of the screened and nonscreened participants were calculated via inverse probability weighting.

RESULTS

A total of 237,975 eligible participants were enrolled in our study and 118,339 participants (49.94%) were assessed to be at high risk for one or more of the five cancer types. The number of screenings performed was 103,824, with a screening participation rate of 40.49%. Among the 57,315 screening participants, 9077 (15.84%) had positive cancer diagnoses and 871 (1.52%) were diagnosed with suspected cancer. Compared with the participants at high risk for a single cancer type, the participation and positive outcome rate increased by 45% and 71.5% in the participants at high risk for multiple cancer types. Compared with the non-screened participants, the screened participants had a 27.0% decrease in mortality due to the five types of cancer and a 45.8% decrease in all-cause mortality.

CONCLUSION

A combined screening program for multiple cancers could increase participation and positive outcome rates. It could also decrease the five types of cancer mortality and all-cause mortality. Our findings highlight the effectiveness of combined screening for multiple cancers with limited health care resources, and may provide foundational evidence for the feasibility of conducting combined screening programs.

Colorectal cancer screening using a multi-locus blood-based assay targeting circulating tumor DNA methylation: a cross-sectional study in an average-risk population

BACKGROUND

Effective screening for colorectal cancer (CRC) enables earlier diagnosis and intervention to improve patient survival.

METHODS

In this study, we prospectively conducted a blood-based CRC screening program for community residents in Hanjiang District, Yangzhou City, and evaluated the screening efficacy of a blood-based multi-locus DNA methylation assay (ColonAiQ). The ColonAiQ-positive rate and colonoscopy participation rate of the population, detection rate of intestinal lesions, and positive predictive value (PPV) of CRC and advanced adenoma (AA) were calculated, and the associated factors were explored.

RESULTS

A total of 105,285 participants were enrolled from January 2021 to December 2022, all of whom completed the ColonAiQ assay, yielding a positive rate of 6.42% (6759/105,285). The colonoscopy compliance rate was 48.56% (3282/6759). Intestinal lesions were detected in 1773 individuals (54.02%), including 63 cases of CRCs (predominately early-stage), 1195 adenomas (441 cases of AAs), 327 polyps, and 188 other benign lesions. CRC patients exhibited higher ColonAiQ scores and more positive loci compared to healthy individuals. The PPVs were 1.92% for CRC and 13.44% for AA. Among participants, 66,121 (62.8%) completed questionnaires graded by the Asia-Pacific Colorectal Screening score, with 12,139 (18.36%) classified in the high-risk tier. High-risk participants had a higher ColonAiQ-positive rate (11.07%) and PPVs for CRC (3.46%) and AA (22.18%). Factors associated with increased detection rates for CRC and AA included male gender, older age, a history of alcohol consumption, and prior polyps.

CONCLUSIONS

Our study demonstrated that ColonAiQ assay effectively identifies high-risk population. These findings strongly suggest that the ColonAiQ assay represents a promising strategy for the early detection of CRC and AA in individuals at average risk.

TRIAL REGISTRATION

Registered at ClinicalTrials.gov (NCT05336539).

Yield and Effectiveness of 2-Sample Fecal Immunochemical Test-Based Screening Program for Colorectal Cancer

BACKGROUND AND AIMS

Colorectal cancer (CRC) incidence and mortality of China account for nearly 30% of the global attributable fraction. We aimed to estimate the yield and effectiveness of a 2-sample fecal immunochemical test (FIT)-based screening program in China.

METHODS

Eligible individuals were invited for 2-sample FIT between 2007 and 2021, with positive ones (cutoff 40 μg/g before 2013 and 20 μg/g thereafter) referred for colonoscopy. Participation rates, detection rates, and positive predictive values were calculated. Participants were classified into: FIT+/colonoscopy compliers, FIT+/colonoscopy noncompliers, and FIT- as control subjects. We compared CRC incidence and mortality and calculated the age reaching comparable risk.

RESULTS

Among 246,349 invitees, 150,524 (61.10%) participated in 2-sample FIT, with 16,994 (11.29%) identified as FIT+; 12,816 (75.41%) underwent colonoscopy, yielding a detection rate and positive predictive value of 0.57% and 6.70% for advanced neoplasia, respectively. Median follow-up was 10.58 years. Compared with FIT- participants, CRC incidence and mortality were relatively similar among FIT+/colonoscopy compliers with hazard ratios of 0.94 (95% confidence interval [CI], 0.75-1.19) and 1.62 (95% CI, 1.09 to 2.41) but higher among noncompliers, with hazard ratios of 3.52 (95% CI, 2.85-4.34) and 4.41 (95% CI, 2.96-6.55). Taking CRC incidence and mortality risk of FIT- participants at 50.0 years of age as the benchmark, FIT+/colonoscopy compliers reached same risk at 50.6 and 46.1 years of age, while noncompliers reached the same risk at 38.0 and 37.9 years of age, respectively.

CONCLUSIONS

Two-sample FIT could effectively identify high-risk populations, and colonoscopy compliance is associated with a lower risk of CRC incidence and mortality. This strategy might facilitate CRC screening practice in countries with large populations.

Chinese national clinical practice guidelines on prevention, diagnosis and treatment of early colorectal cancer

BACKGROUND

The incidence and mortality of colorectal cancer (CRC) in China are increasing in recent years. The clarified pathogenesis and detectable precancerous lesions of CRC make it possible to prevent, screen, and diagnose CRC at an early stage. With the development of endoscopic and surgical techniques, the choice of treatment for early CRC is also worth further discussion, and accordingly, a standard follow-up program after treatment needs to be established.

METHODS

This clinical practice guideline (CPG) was developed following the recommended process of the World Health Organization, adopting Grading of Recommendations Assessment, Development and Evaluation (GRADE) in assessing evidence quality, and using the Evidence to Decision framework to formulate clinical recommendations, thereby minimizing bias and increasing transparency of the CPG development process. We used the Reporting Items for practice Guidelines in HealThcare (RIGHT) statement and Appraisal of Guidelines for Research and Evaluation II (AGREE II) as reporting and conduct guides to ensure the guideline's completeness and transparency.

RESULTS

This CPG comprises 46 recommendations concerning prevention, screening, diagnosis, treatment, and surveillance of CRC. In these recommendations, we have indicated protective and risk factors for CRC and made recommendations for chemoprevention. We proposed a suitable screening program for CRC based on the Chinese context. We also provided normative statements for the diagnosis, treatment, and surveillance of CRC based on existing clinical evidence and guidelines.

CONCLUSIONS

The 46 recommendations in this CPG are formed with consideration for stakeholders' values and preferences, feasibility, and acceptability. Recommendations are generalizable to resource-limited settings with similar CRC epidemiology pattern as China.

Combining FITs and HRFQ with colonoscopy improve the cost-effectiveness of a 9-year mass colorectal cancer screening program

BACKGROUND

Colorectal cancer (CRC) incidence has been increasing. Colonoscopy is still a gold standard method for its early diagnosis but using colonoscopy alone as a mass screening method is unrealistic. This study is to investigate whether combining fecal immunochemical test (FIT) and high-risk-factors questionnaire (HRFQ) with colonoscopy improve the cost-effectiveness of a mass CRC screening.

PATIENTS AND METHODS

CRC screening protocol combining FITs and HRFQ in the first stage and colonoscopy in the second stage was used in 50 villages/towns in 2007-2015. Residents aged 40-74 years were eligible for this free screening. A total of 160 210 (76.12%) participants completed first-stage screening, and 28 679 (17.90%) participants were defined as positive, among which 21 715 (75.72%) participants completed colonoscopy and were included in the final analysis. Outcomes were followed up until 2020.

RESULTS

The compliance was 76.12% and 75.72% in the first and second screening stage, respectively. A total of 252 CRC, 4033 adenoma, 1234 advanced neoplasm, and 5534 total neoplasm cases were detected in the screening. The positive predictive values of CRC, adenoma, advanced neoplasm, and total neoplasm were higher in FITs+ than those in the HRFQ+ population, respectively. A total of 64.60% and 43.42% total neoplasm cases were found in FITs+ and HRFQ+ (8.02% for both), respectively. The total colorectal neoplasm and CRC cases detected by combining HRFQ and FITs increased by 55.08% and 40.00%, respectively, and their increases were higher compared to HRFQ. The detection cost per any neoplasm by combining HRFQ and FITs was <$5331, while that by FITs and HRFQ alone was <$4570 and $5380, respectively.

CONCLUSIONS

Combining FITs and HRFQ with colonoscopy improve the cost-effectiveness of a mass CRC screening program. This protocol can be recommended for most populations, especially those in the countries and areas with high population density and low physician/population ratio.

Early Diagnosis of Colorectal Cancer Based on Bisulfite-free Site-specific Methylation Identification PCR Strategy: High-Sensitivity, Accuracy, and Primary Medical Accessibility

Due to its decade-long progression, colorectal cancer (CRC) is most suitable for population screening to achieve a significant reduction in its incidence and mortality. DNA methylation has emerged as a potential marker for the early detection of CRC. However, the current mainstream methylation detection method represented by bisulfite conversion has issues such as tedious operation, DNA damage, and unsatisfactory sensitivity. Herein, a new high-performance CRC screening tool based on the promising specific terminal-mediated polymerase chain reaction (STEM-PCR) strategy is developed. CRC-related methylation-specific candidate CpG sites are first prescreened through The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) databases using self-developed bioinformatics. Next, 9 homebrew colorectal cancer DNA methylated STEM‒PCR assays (ColoC-mSTEM) with high sensitivity (0.1%) and high specificity are established to identify candidate sites. The clinical diagnostic performance of these selected methylation sites is confirmed and validated by a case-control study. The optimized diagnostic model has an overall sensitivity of 94.8% and a specificity of 95.0% for detecting early-stage CRC. Taken together, ColoC-mSTEM, based on a single methylation-specific site, is a promising diagnostic approach for the early detection of CRC which is perfectly suitable for the screening needs of CRC in primary healthcare institutions.

Discovery and Validation of Methylation Signatures in Circulating Cell-Free DNA for the Detection of Colorectal Cancer

This study was conducted with the primary objective of assessing the performance of cfDNA methylation in the detection of colorectal cancer (CRC). Five tumor tissue, 20 peripheral blood leucocyte, and 169 cfDNA samples were collected for whole-genome bisulfite sequencing (WGBS) analysis. Bioinformatic analysis was conducted to identify differentially methylated regions (DMRs) and their functional characteristics. Quantitative methylation-specific PCR (qMSP) was used to validate the methylation levels of DMRs in the tissues and leucocytes. cfDNA samples from CRC patients and healthy controls were used to evaluate the performance of the DMR analysis. WGBS analysis revealed a decrease in DNA methylation levels in the CpG context in CRC tumor tissues compared with adjacent normal tissues. A total of 132 DMRs in cfDNA were identified as potential markers for diagnosing CRC. In a cohort of 95 CRC patients and 74 healthy controls, a combination of the three DMRs (DAB1, PPP2R5C, and FAM19A5) yielded an AUC of 0.763, achieving 64.21% sensitivity and 78.38% specificity in discriminating CRC patients from healthy controls. This study provides insights into DNA methylation patterns in CRC and identifies a set of DMRs in cfDNA with potential diagnostic value for CRC. These DMRs hold promise as biomarkers for CRC detection, offering promise for non-invasive CRC diagnosis. Further research is warranted to validate these findings in larger cohorts.

Development and evaluation of a risk prediction tool for risk-adapted screening of colorectal cancer in China

Risk prediction tools for colorectal cancer (CRC) have potential to improve the efficiency of population-based screening by facilitating risk-adapted strategies. However, such an applicable tool has yet to be established in the Chinese population. In this study, a risk score was created using data from the China Kadoorie Biobank (CKB), a nationwide cohort study of 409,854 eligible participants. Diagnostic performance of the risk score was evaluated in an independent CRC screening programme, which included 91,575 participants who accepted colonoscopy at designed hospitals in Zhejiang Province, China. Over a median follow-up of 11.1 years, 3136 CRC cases were documented in the CKB. A risk score was created based on nine questionnaire-derived variables, showing moderate discrimination for 10-year CRC risk (C-statistic = 0.68, 95 % CI: 0.67-0.69). In the CRC screening programme, the detection rates of CRC were 0.25 %, 0.82 %, and 1.93 % in low-risk (score <6), intermediate-risk (score: 6-19), and high-risk (score >19) groups, respectively. The newly developed score exhibited a C-statistic of 0.65 (95 % CI: 0.63-0.66), surpassing the widely adopted tools such as the Asia-Pacific Colorectal Screening (APCS), modified APCS, and Korean Colorectal Screening scores (all C-statistics = 0.60). In conclusion, we developed a novel risk prediction tool that is useful to identify individuals at high risk of CRC. A user-friendly online calculator was also constructed to encourage broader adoption of the tool.

A 5-Hydroxymethylcytosine-Based Noninvasive Model for Early Detection of Colorectal Carcinomas and Advanced Adenomas: The METHOD-2 Study

PURPOSE

Detection of colorectal carcinomas at a time when there are more treatment options is associated with better outcomes. This prospective case-control study assessed the 5-hydroxymethylcytosine (5hmC) biomarkers in circulating cell-free DNA (cfDNA) for early detection of colorectal carcinoma and advanced adenomas (AA).

EXPERIMENTAL DESIGN

Plasma cfDNA samples from 2,576 study participants from the multicenter METHOD-2 study (NCT03676075) were collected, comprising patients with newly diagnosed colorectal carcinoma (n = 1,074), AA (n = 356), other solid tumors (n = 80), and non-colorectal carcinoma/AA controls (n = 1,066), followed by genome-wide 5hmC profiling using the 5hmC-Seal technique and the next-generation sequencing. A weighted diagnostic model for colorectal carcinoma (stage I-III) and AA was developed using the elastic net regularization in a discovery set and validated in independent samples.

RESULTS

Distribution of 5hmC in cfDNA reflected gene regulatory relevance and tissue of origin. Besides being confirmed in internal validation, a 96-gene model achieved an area under the curve (AUC) of 90.7% for distinguishing stage I-III colorectal carcinoma from controls in 321 samples from multiple centers for external validation, regardless of primary location or mutation status. This model also showed cancer-type specificity as well as high capacity for distinguishing AA from controls with an AUC of 78.6%. Functionally, differential 5hmC features associated with colorectal carcinoma and AA demonstrated relevance to colorectal carcinoma biology, including pathways such as calcium and MAPK signaling.

CONCLUSIONS

Genome-wide mapping of 5hmC in cfDNA shows promise as a highly sensitive and specific noninvasive blood test to be integrated into screening programs for improving early detection of colorectal carcinoma and high-risk AA.

Access to colorectal cancer screening in populations in China, 2020: A coverage-focused synthesis analysis

In populations in China, colorectal cancer (CRC) screening can be mainly accessed through organized screening, opportunistic screening, and physical examination. This screening intervention is found to be effective but the exact coverage rate is difficult to measure. Based on data from published articles, official websites, and available program reports, the screening coverage rate and related indicators were quantified. A rapid review was then conducted to estimate the overall and the breakdown coverage rates of the sub-type screening services, by leveraging the numbers of articles and the by-type median sample sizes. Up to 2020, two central government-funded and four provincial/municipal-level organized CRC screening programs have been initiated and included in this analysis. For populations aged 40-74, the estimated coverage rate of organized programs in China was 2.7% in 2020, and the 2-year cumulative coverage rate in 2019-2020 was 5.3% and the 3-year cumulative coverage rate in 2018-2020 was 7.7%. The corresponding coverage rates of 50-74-year-olds were estimated to be 3.4%, 7.1%, and 10.3%, respectively. Based on the rapid review approach, the overall screening coverage rate for 40-74 years, considering organized screening programs, opportunistic screening, and physical examinations, was then estimated to be 3.0% in China in 2020. However, comparing the findings of this study with the number of health check-ups reported in the local national health statistics yearbooks suggests that the number of CRC physical examinations may be underestimated in this study. The findings suggest that further efforts are needed to improve population access to CRC screening in China. Furthermore, evidence for access to opportunistic CRC screening and physical examination is limited, and more quantitative investigation is needed.

Diagnostic and prognostic value of double-negative T cells in colorectal cancer

Objective

To evaluate the T-lymphocyte subset distribution and the diagnostic and prognosis value of double-negative T (DNT) cells in colorectal cancer (CRC).

Methods

This retrospective study compared the T-lymphocyte subsets and DNT of 114 patients with CRC with those of 107 healthy controls (HC). The diagnostic potential of DNT and T-lymphocyte subsets was assessed using the receiver operating characteristic (ROC) curve, and prognostic values were evaluated using the Kaplan-Meier curve and the Cox regression model.

Results

The percentages of CD8+ T cells and DNT cells, and value of carcinoembryonic antigen (CEA), were remarkably higher in patients with CRC than in those with HC, but the ratio of CD4+/CD8+ was decreased. Using ROC curve analysis, DNT cell percentage, CEA, and CD4+/CD8+ ratio all had good diagnostic efficacy, with areas under the curve (AUCs) of 0.865, 0.786 and 0.624, respectively. The combination of DNT cell percentage and CEA had an AUC of 0.905, which was significantly higher than that of any single biomarker (p < 0.05). In univariate analysis, the Tumor Node Metastasis (TNM) clinical stage, CD4+/CD8+ ratio, and DNT cell percentage were significantly associated with overall survival (OS) (p < 0.05). In multivariate analysis, TNM clinical staging (HR = 2.37, 95 % CI: 1.15-4.90), a decreased CD4+/CD8+ ratio (HR = 0.33, 95 % CI: 0.15-0.74), and an increased DNT cell percentage (HR = 2.29, 95 % CI: 1.11-4.73) were independent prognostic factors for CRC.

Conclusion

The percentage of DNT cells may be useful as an evaluation index for CRC diagnosis and prognosis, which was even better when combined with serum CEA.

An internally and externally validated nomogram for predicting cancer-specific survival in octogenarians after radical resection for colorectal cancer

AIMS

We aimed to develop an elaborative nomogram that predicts cancer-specific survival (CSS) in American and Chinese octogenarians treated with radical resection for CRC.

METHODS

The patient data of newly diagnosed patients aged 80 years or older who underwent radical resection for CRC from 2010 to 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database and then randomly divided into a training cohort and a validation cohort. The patients collected from our hospital were defined as the external validation cohort. Univariate and multivariate Cox regression was used to select independent predictive factors for the construction of a nomogram to predict 1-, 2- and 3-year CSS.

RESULTS

The multivariate Cox regression model identified age, T stage, N stage, perineural invasion, chemotherapy, tumour deposits, carcinoembryonic antigen level, number of lymph node metastases, and number of solid organ metastases as independent predictors of survival. The C-index of the nomogram for 1-, 2- and 3-year CSS was 0.758, 0.762, and 0.727, respectively, demonstrating significant clinical value and substantial reliability compared to the TNM stage. The calibration curve and area under the curve also indicated considerable predictive accuracy. In addition, decision curve analysis demonstrated desirable net benefits in clinical application.

CONCLUSION

We constructed a nomogram for predicting the CSS of individual octogenarian patients with CRC who underwent radical resection. The nomogram performed better than the TNM staging system in this particular population and could guide clinicians in clinical follow-up and individual therapeutic plan formulation.

Screening of colorectal cancer: Methods and strategies

Colorectal cancer (CRC) has high incidence and mortality rates, and the emergence and application of CRC screening have helped us effectively control the occurrence and development of CRC. Currently, common international screening methods include tests based on feces and blood, and examination methods that allow for visualization, such as sigmoidoscopy and colonoscopy. Some methods have been widely used, whereas others such as multi-target stool RNA test are still being explored and developed, and are expected to become front-line screening methods for CRC in the future. The choice of screening method is affected by external conditions and the patients' situation, and the clinician must choose an appropriate strategy according to the actual situation and the patient's wishes. This article introduces various CRC screening methods and analyzes the factors relevant to the screening strategy.

Refining the targeted population and achieving better for colorectal cancer screening

This editorial comments on the article entitled "Stage at diagnosis of colorectal cancer through diagnostic route: Who should be screened?" by Agatsuma et al, who conducted a retrospective study aiming at clarifying the stage at colorectal cancer (CRC) diagnosis based on different diagnostic routes. We share our opinion about CRC screening programs. The current situation suggests the need for a more specific and targeted population for CRC screening.

Refining the targeted population and achieving better for colorectal cancer screening

This editorial comments on the article entitled “Stage at diagnosis of colorectal cancer through diagnostic route: Who should be screened?” by Agatsuma et al, who conducted a retrospective study aiming at clarifying the stage at colorectal cancer (CRC) diagnosis based on different diagnostic routes. We share our opinion about CRC screening programs. The current situation suggests the need for a more specific and targeted population for CRC screening.

The impact on clinical outcomes and healthcare resources from discontinuing colonoscopy surveillance subsequent to low-risk adenoma removal: A simulation study using the OncoSim-Colorectal model

OBJECTIVE

To estimate the impact on clinical outcomes and healthcare resource use from recommending that patients with 1-2 low-risk adenomas (LRAs) return to routine fecal immunochemical test (FIT) screening instead of surveillance colonoscopy, from a Canadian provincial healthcare system perspective.

METHODS

The OncoSim-Colorectal microsimulation model simulated average-risk individuals eligible for FIT-based colorectal cancer (CRC) screening in Alberta, Canada. We simulated two surveillance strategies that applied to individuals with 1-2 LRAs (<10 mm) removed as part of the average risk CRC screening program: (a) Surveillance colonoscopy (status quo) and (b) return to FIT screening (new strategy); both at 5 years after polypectomy. A 75 ng/mL FIT positivity threshold was used in the base case. The simulations projected average annual CRC outcomes and healthcare resource use from 2023 to 2042. We conducted alternative scenarios and sensitivity analyses on key variables.

RESULTS

Returning to FIT screening (versus surveillance colonoscopy) after polypectomy was projected to have minimal impact on long-term CRC incidence and deaths (not statistically significant). There was a projected decrease of one (4%) major bleeding event and seven (5%) perforation events per year. There was a projected increase of 4800 (1.5%) FIT screens, decrease of 3900 (5.1%) colonoscopies, and a decrease of $3.4 million (1.2%) in total healthcare costs per year, on average. The annual colonoscopies averted and healthcare cost savings increased over time. Results were similar in the alternative scenarios and sensitivity analyses.

CONCLUSIONS

Returning to FIT screening would have similar clinical outcomes as surveillance colonoscopy but could reduce colonoscopy demand and healthcare costs.

Derivation and validation of a nomogram incorporating modifiable lifestyle factors to predict development of colorectal adenomas after negative index colonoscopy

This retrospective cohort study aimed to identify baseline patient characteristics involving modifiable lifestyle factors that are associated with the development of colorectal adenomas, and establish and validate a nomogram for risk predictions among high-risk populations with negative index colonoscopy. A total of 83,076 participants who underwent an index colonoscopy at the Tianjin Union Medical Center between 2004 and 2019 were collected. According to meticulous inclusion and exclusion criteria, 249 subjects were enrolled and categorized into the primary and validation cohorts. Based on the primary cohort, we utilized the LASSO-Cox regression and the univariate/multivariate Cox proportional hazards (Cox-PH) regression parallelly to select variables, and incorporated selected variables into two nomogram models established using the multivariate Cox-PH regression. Comparison of the Akaike information criterion and the area under the receiver operating characteristic curve of the two models demonstrated that the nomogram model constituted by four covariates retained by the LASSO-Cox regression, including baseline age, body mass index, physical activity and family history of colorectal cancer (CRC) in first-degree relatives, performed better at predicting adenoma-free survival probabilities. Further validation including the concordance index, calibration plots, decision curve analysis and Kaplan-Meier survival curves also revealed good predictive accuracy, discriminating ability, clinical utility and risk stratification capacity of the nomogram model. Our nomogram will assist high-risk individuals with negative index colonoscopy to prevent colorectal adenoma occurrence and CRC morbidity with improved cost-effectiveness.

Diagnostic performance of volatile organic compounds analysis and electronic noses for detecting colorectal cancer: a systematic review and meta-analysis

Introduction

The detection of Volatile Organic Compounds (VOCs) could provide a potential diagnostic modality for the early detection and surveillance of colorectal cancers. However, the overall diagnostic accuracy of the proposed tests remains uncertain.

Objective

This systematic review is to ascertain the diagnostic accuracy of using VOC analysis techniques and electronic noses (e-noses) as noninvasive diagnostic methods for colorectal cancer within the realm of clinical practice.

Methods

A systematic search was undertaken on PubMed, EMBASE, Web of Science, and the Cochrane Library to scrutinize pertinent studies published from their inception to September 1, 2023. Only studies conducted on human subjects were included. Meta-analysis was performed using a bivariate model to obtain summary estimates of sensitivity, specificity, and positive and negative likelihood ratios. The Quality Assessment of Diagnostic Accuracy Studies 2 tool was deployed for quality assessment. The protocol for this systematic review was registered in PROSPERO, and PRISMA guidelines were used for the identification, screening, eligibility, and selection process.

Results

This review encompassed 32 studies, 22 studies for VOC analysis and 9 studies for e-nose, one for both, with a total of 4688 subjects in the analysis. The pooled sensitivity and specificity of VOC analysis for CRC detection were 0.88 (95% CI, 0.83-0.92) and 0.85 (95% CI, 0.78-0.90), respectively. In the case of e-nose, the pooled sensitivity was 0.87 (95% CI, 0.83-0.90), and the pooled specificity was 0.78 (95% CI, 0.62-0.88). The area under the receiver operating characteristic analysis (ROC) curve for VOC analysis and e-noses were 0.93 (95% CI, 0.90-0.95) and 0.90 (95% CI, 0.87-0.92), respectively.

Conclusion

The outcomes of this review substantiate the commendable accuracy of VOC analysis and e-nose technology in detecting CRC. VOC analysis has a higher specificity than e-nose for the diagnosis of CRC and a sensitivity comparable to that of e-nose. However, numerous limitations, including a modest sample size, absence of standardized collection methods, lack of external validation, and a notable risk of bias, were identified. Consequently, there exists an imperative need for expansive, multi-center clinical studies to elucidate the applicability and reproducibility of VOC analysis or e-nose in the noninvasive diagnosis of colorectal cancer.

Systematic review registration

https://www.crd.york.ac.uk/prospero/#recordDetails, identifier CRD42023398465.

Uptake and detection rate of colorectal cancer screening with colonoscopy in China: A population-based, prospective cohort study

BACKGROUND

Colorectal cancer is the leading cause of cancer-related death worldwide. Colonoscopy is widely used as a screening test for detecting colorectal cancer in many countries. However, there is little evidence regarding the uptake and diagnostic yields of colonoscopy in population-based screening programs in countries with limited medical resources.

OBJECTIVE

We reported the uptake of colonoscopy and the detection of colorectal lesions and explored related factors based on a colorectal cancer screening program in China.

DESIGN

Individuals aged 45-74 years who were asymptomatic for colorectal cancer and had no history of colorectal cancer were recruited. An established risk score system was used to identify individuals at high risk for colorectal cancer, and they were subsequently recommended for colonoscopy.

SETTING

A population-based, prospective cohort study was implemented in 169 communities, 14 districts of Chongqing, Southwest China.

PARTICIPANTS

A total of 288,150 eligible participants were recruited from November 2013 to June 2021, and 41,315 participants were identified to be at high risk of colorectal cancer.

METHODS

Generalized linear mixed model was used to explore the individual and community structural characteristics associated with uptake of colonoscopy. Additionally, the detection rate of colorectal lesions under colonoscopy screening was also reported, and their associated factors were explored.

RESULTS

7859 subjects underwent colonoscopy, with an uptake rate of 19.02 % (95 % CI 18.64 %-19.40 %). Lower uptake rates were associated with older age, lower education, more physical activity, and structural characteristics, including residing in developing areas (OR 0.73, 95 % CI 0.69-0.78), residing more than 5 km from screening hospital (5-10 km: OR 0.85, 95 % CI 0.79-0.91; >10 km: OR 0.85, 95 % CI 0.80-0.91), and not being exposed to social media publicity (OR 0.63, 95 % CI 0.53-0.75). Overall, 8 colorectal cancers (0.10 %), 423 advanced adenomas (5.38 %), 820 nonadvanced adenomas (10.43 %), and 684 hyperplastic polyps (8.70 %) were detected, with an adenoma detection rate of 15.92 %. Several factors, including older age, male, current smoking and a family history of colorectal cancer, were positively related to colorectal neoplasms.

CONCLUSIONS

The uptake of colonoscopy for colorectal cancer screening was not optimal among a socioeconomically diverse high-risk population. The screening strategy should attempt to ensure equitable access to screening according to regional characteristics, and enhance the uptake of colonoscopy by recommended multifaceted interventions, which focus on individuals with poor compliance, select a closer screening hospital, and strengthen social media publicity at the structural level.

Screening for colorectal cancer: Study on the shedding cells of feces

Objective

The objective of this study was to explore the enrichment efficiency of an improved fecal exfoliated cell enrichment method and its application in colorectal cancer screening.

Material and Methods

Samples were collected from a cohort of 100 colorectal cancer patients being treated at the First Hospital of Hebei Medical University from January 2021 to June 2022. Patient samples were equally divided between control and experimental groups corresponding to the enrichment method being applied to the fecal exfoliated cells. Samples consisted of natural stool and bowel cleansing enema solution samples. The control group received the traditional three-layer integrated screen method, and the experimental group used nano-Fe3O4 folic acid magnetic beads to enrich the fecal exfoliated cells. The morphology of the extracted cells was observed by light microscopy through hematoxylin and eosin staining, and the positive rate of fecal occult blood test (FOBT) and the detection rate of colorectal cancer was compared between the two groups.

Results

The FOBT-positive rates of natural feces and intestinal cleansing liquid in the control group were 74.00% and 90.00%, respectively, and the FOBT-positive rates of natural feces and intestinal cleansing liquid in the experimental group were 76.00% and 92.00%, respectively. The positive FOBT rate was high, and the difference was statistically significant (P = 0.037 and P = 0.029). The sensitivities of natural fecal exfoliation cytology in the control and experimental groups were 82.00% and 92.00%, respectively. The sensitivity of the experimental group was higher than that of the control group, and the difference was not statistically significant (P = 0.137). The sensitivities of the exfoliated cytology examination of the intestinal cleansing liquid in the control and experimental groups were 88.00% and 98.00%, respectively. The sensitivity of the experimental group was significantly higher than that of the control group, and the difference was statistically significant (P = 0.050). Cell smear results show that the exfoliated cells collected by the three-layer integrated sieve method are unevenly distributed, with overlapping cells and a large number of impurities blurring the background, seriously affecting the observation of cell morphology. The cell structure is blurred, stained unevenly, and arranged in a disorderly manner. The exfoliated cells collected by the nanofolic acid magnetic bead enrichment method are relatively evenly distributed, with no overlapping of cells in patches. The background is clear, and the morphology of each cell can be clearly observed. The cell structure is relatively clear, stained evenly, and distributed evenly.

Conclusion

In the cytological examination of fecal exfoliation of colorectal cancer, the nano-Fe3O4 folic acid magnetic bead enrichment method can enrich more target cells compared with the traditional three-layer integrated screen method, improve the detection rate of colorectal cancer, and ensure the exfoliation The cell smears are of higher quality, providing a better sample for clinical assessment of the exfoliated cells. Nano-Fe3O4 folic acid magnetic beads enrichment method can become a simple, efficient, and relatively safe screening method for colorectal cancer, positively affecting early screening developments and diagnosis of colorectal cancer.

Willingness of healthcare providers to perform population-based cancer screening: a cross-sectional study in primary healthcare institutions in Tianjin, China

OBJECTIVE

To evaluate the willingness of healthcare providers to perform population-based screening in primary healthcare institutions in China.

METHODS

Healthcare providers of 262 primary healthcare institutions in Tianjin were invited to fill out a questionnaire consisting of demographic characteristics, workload, and knowledge of, attitude towards and willingness to perform breast, cervical and colorectal cancer screening. Willingness to screen was the primary outcome. Multilevel logistic regression models were conducted to analyse the determinants of healthcare providers' willingness to screen. ORs and 95% CIs were estimated.

RESULTS

A total of 554 healthcare providers from 244 institutions answered the questionnaire. 67.2%, 72.1% and 74.3% were willing to perform breast, cervical and colorectal cancer screening, respectively. A negative attitude towards screening was associated with a low willingness for cervical (OR=0.27; 95% CI 0.08, 0.94) and colorectal (OR=0.08; 95% CI 0.02, 0.30) cancer screening, while this was not statistically significant for breast cancer screening (OR=0.30; 95% CI 0.08, 1.12). For breast, cervical and colorectal cancer screening, 70.1%, 63.8% and 59.0% of healthcare providers reported a shortage of staff dedicated to screening. A perceived reasonable manpower allocation was a determinant of increased willingness to perform breast (OR=2.86; 95% CI 1.03, 7.88) and colorectal (OR=2.70; 95% CI 1.22, 5.99) cancer screening. However, this was not significant for cervical cancer screening (OR=1.76; 95% CI 0.74, 4.18).

CONCLUSIONS

In China, healthcare providers with a positive attitude towards screening have a stronger willingness to contribute to cancer screening, and therefore healthcare providers' attitude, recognition of the importance of screening and acceptable workload should be optimised to improve the uptake of cancer screening.

Trends in colorectal cancer screening compliance and incidence among 60- to 74-year-olds in China

BACKGROUND

Compliance with colonoscopy among elderly individuals participating in colorectal cancer (CRC) screening programs is unsatisfactory, despite a high detection rate of bowel-related diseases. In this study, our aim was to analyze the impact of risk factors on the trends of compliance and detection rates in colonoscopy among high-risk individuals aged 60-74.

METHODS

A retrospective study was conducted on the high-risk individuals aged 60-74 participating in the 2021 CRC screening program in Tianjin, China. Logistic regression analyses, including both univariate and multivariate analyses, were performed to explore the impact of different risk factors on colonoscopy compliance among the high-risk individuals. Besides, the study investigated the influence of various risk factors on the detection rates of bowel-related diseases among the high-risk individuals who underwent colonoscopy.

RESULTS

A total of 24,064 high-risk individuals were included, and 5478 individuals received a free colonoscopy, with an overall compliance of 22.76%. Among them, the adenoma detection rate was 55.46%. Males and individuals with a positive FIT had high compliance and detection rates for CRC, advanced adenomas (AA), advanced colorectal neoplasia (ACN), and colorectal neoplasm (CN). Individuals aged 70-74 were associated with low compliance but high CRC, ACN, and CN detection rates. Individuals who reported a history of chronic constipation, bloody mucous, and CRC in first-degree relative showed high compliance but no significantwere associated with the detection rates of CRC, AA, and CN.

CONCLUSION

This study reported several risk factors associated with the screening behaviors for CRC. Patterns and trends in CRC, AA, ACN, and CN compliance and detection rates correlate with risk factors.

Effects of sigmoidoscopy screening (including colonoscopy) on colorectal cancer: A meta-analysis based on randomized controlled trials

Background

This study aimed to investigate the role of endoscopy screening in colorectal cancer (CRC).

Methods

Up to January 2023, databases were searched for studies related to sigmoidoscopy and colonoscopy screening. The incidence of CRC, and/or CRC mortality were the main observation outcomes.

Results

A total of 5 randomized controlled trials (RCTs) published from 2017 to 2022 were included. Among them, four studies used sigmoidoscopy screening and one study involved colonoscopy screening. Statistical results showed that the incidence (RR: 0.78, p < 0.001) and mortality (RR: 0.75, p < 0.001) of CRC were significantly lower in the screening group than in the control group. Further, a subgroup analysis of CRC site indicated that the incidence and mortality of CRC in the screening group were significantly lower than those in the non-screened group, regardless of distal CRC (Incidence: RR: 0.66, p < 0.001; Mortality: RR: 0.62, p < 0.001) or proximal CRC (Incidence: RR: 0.94, p = 0.038; Mortality: RR: 0.89, p = 0.038). In terms of gender, compared with the non-screening group, both males (Incidence: RR: 0.73, p < 0.001; Mortality: RR: 0.68, p < 0.001) and females (Incidence: RR: 0.85, p < 0.001; Mortality: RR: 0.85, p = 0.017), the screening group had a significant decrease in the incidence and mortality of CRC.

Conclusion

This meta-analysis demonstrated that sigmoidoscopy screening (including colonoscopy) could effectively reduce the incidence and mortality of CRC.

Efficient organized colorectal cancer screening in Shenzhen: a microsimulation modelling study

BACKGROUND

Colorectal cancer (CRC) is a global health issue with noticeably high incidence and mortality. Microsimulation models offer a time-efficient method to dynamically analyze multiple screening strategies. The study aimed to identify the efficient organized CRC screening strategies for Shenzhen City.

METHODS

A microsimulation model named CMOST was employed to simulate CRC screening among 1 million people without migration in Shenzhen, with two CRC developing pathways and real-world participation rates. Initial screening included the National Colorectal Polyp Care score (NCPCS), fecal immunochemical test (FIT), and risk-stratification model (RS model), followed by diagnostic colonoscopy for positive results. Several start-ages (40, 45, 50 years), stop-ages (70, 75, 80 years), and screening intervals (annual, biennial, triennial) were assessed for each strategy. The efficiency of CRC screening was assessed by number of colonoscopies versus life-years gained (LYG).

RESULTS

The screening strategies reduced CRC lifetime incidence by 14-27 cases (30.9-59.0%) and mortality by 7-12 deaths (41.5-71.3%), yielded 83-155 LYG, while requiring 920 to 5901 colonoscopies per 1000 individuals. Out of 81 screening, 23 strategies were estimated efficient. Most of the efficient screening strategies started at age 40 (17 out of 23 strategies) and stopped at age 70 (13 out of 23 strategies). Predominant screening intervals identified were annual for NCPCS, biennial for FIT, and triennial for RS models. The incremental colonoscopies to LYG ratios of efficient screening increased with shorter intervals within the same test category. Compared with no screening, when screening at the same start-to-stop age and interval, the additional colonoscopies per LYG increased progressively for FIT, NCPCS and RS model.

CONCLUSION

This study identifies efficient CRC screening strategies for the average-risk population in Shenzhen. Most efficient screening strategies indeed start at age 40, but the optimal starting age depends on the chosen willingness-to-pay threshold. Within insufficient colonoscopy resources, efficient FIT and NCPCS screening strategies might be CRC initial screening strategies. We acknowledged the age-dependency bias of the results with NCPCS and RS.

Population-based screening for colorectal cancer in Wuhan, China

Fecal DNA test has emerged as a non-invasive alternative for colorectal cancer (CRC) screening in average-risk population. However, there is currently insufficient evidence in China to demonstrate the effectiveness of population-based CRC screening using fecal DNA based test. Here, a large-scale real-world study for CRC screening was implemented in Wuhan, Hubei province, China. A total of 98,683 subjects aged between 45 and 60 years were screened by a fecal DNA test (ColoTect®) which detected methylation status of SDC2, ADHFE1, and PPP2R5C. Participants who tested positive were advised to receive diagnostic colonoscopy. 4449 (4.5%) subjects tested positive for fecal DNA test, and 3200 (71.9%) underwent colonoscopy. Among these, 2347 (73.3%) had abnormal colonoscopy findings, of which 1330 (56.7%) subjects received pathological diagnosis. Detection rates for CRC and advanced precancerous lesions were 1.3% and 2.3%, respectively. Detection rates for nonadvanced adenomas and polyps were 14.0% and 21.6%, respectively. 28.0% of all colonoscopies showed colorectal neoplasm but lack pathological diagnosis. 6.1% showed other abnormalities such as enteritis. In conclusion, preliminary real-world evidence suggested that fecal DNA tests had promising diagnostic yield in population-based CRC screening.

Clinical trial registration

https://www.chictr.org.cn/showproj.html?proj=192838, identifier ChiCTR2300070520.