Effects of subitems in the colorectal cancer screening protocol on the Chinese colorectal cancer screening program: an analysis based on natural community screening results
Abstract Background To date, no single colorectal cancer (CRC) screening strategy has been determined to be applicable worldwide. In China, a CRC screening protocol that combines double fecal immunochemical tests (FITs) and a high-risk factor questionnaire (HRFQ) as the first stage of screening and...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2019-01-01
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| Series: | BMC Cancer |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12885-018-5191-y |
| _version_ | 1819141415726219264 |
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| author | Shan-Rong Cai Yan-Qin Huang Su-Zhan Zhang Qi-Rong Li Xin Yuan Ma Shu Zheng |
| author_facet | Shan-Rong Cai Yan-Qin Huang Su-Zhan Zhang Qi-Rong Li Xin Yuan Ma Shu Zheng |
| author_sort | Shan-Rong Cai |
| collection | DOAJ |
| description | Abstract Background To date, no single colorectal cancer (CRC) screening strategy has been determined to be applicable worldwide. In China, a CRC screening protocol that combines double fecal immunochemical tests (FITs) and a high-risk factor questionnaire (HRFQ) as the first stage of screening and colonoscopy as the second stage of screening (scenario A) was adapted by the Chinese Ministry of Health in 2006. However, applying this CRC screening protocol nationally remains difficult because its effectiveness and convenience are controversial. This study evaluated the effects of subitems of the CRC screening protocol in China. Methods CRC screening results (scenario A) from Jiashan County, China, (2007–2009) were used to analyze the detection rates of CRC and advanced neoplasms as well as the cost-effectiveness of the protocol. Scenario A was divided into scenarios B–G (by selecting some items at the first stage of screening) for analysis. Results Compared with scenario A, removing the whole HRFQ (scenario F) reduced advanced neoplasm and adenoma detections by 29.8 and 41.2%, respectively, whereas the whole HRFQ accounted for 10.1% of the total screening cost. Removing FITs (scenario G) reduced CRC, advanced neoplasm and adenoma detections by 71.8, 56.9 and 47.7%, respectively, and the costs per case of CRC and advanced neoplasm were 82.0 and 19.1% higher, respectively, than those in scenario A. In scenarios B–E (deleting some high-risk factor questions on the HRFQ), the odds ratios (ORs) of the detection rates and costs per CRC, advanced neoplasm, adenoma, and neoplasm case were near 1.00. Scenarios C and D reduced the high-risk population and total screening costs by less than 6.0 and 4.1%, respectively. Scenarios E and B (FITs and a personal history of cancer or colorectal adenoma were reserved) reduced the high-risk population by 17.6 and 24.2% and the total screening costs by 11.2 and 15.4%, respectively, while the numbers of CRC cases were not missed, and advanced neoplasms detected decreased by only 5 and 11%, respectively. Conclusion The results of this study demonstrate that FITs and a personal history of colorectal adenoma are the most effective items in the Chinese CRC screening protocol. |
| first_indexed | 2024-12-22T11:54:06Z |
| format | Article |
| id | doaj.art-27d018e5a39446a1bb908e061ba67206 |
| institution | Directory Open Access Journal |
| issn | 1471-2407 |
| language | English |
| last_indexed | 2024-12-22T11:54:06Z |
| publishDate | 2019-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Cancer |
| spelling | doaj.art-27d018e5a39446a1bb908e061ba672062022-12-21T18:26:53ZengBMCBMC Cancer1471-24072019-01-011911810.1186/s12885-018-5191-yEffects of subitems in the colorectal cancer screening protocol on the Chinese colorectal cancer screening program: an analysis based on natural community screening resultsShan-Rong Cai0Yan-Qin Huang1Su-Zhan Zhang2Qi-Rong Li3Xin Yuan Ma4Shu Zheng5Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, Ministry of Education of China, Key Laboratory of Molecular Biology in Medical Sciences, Zhejiang Province, China), The second Affiliated Hospital, School of Medicine, Zhejiang UniversityCancer Institute (Key Laboratory of Cancer Prevention and Intervention, Ministry of Education of China, Key Laboratory of Molecular Biology in Medical Sciences, Zhejiang Province, China), The second Affiliated Hospital, School of Medicine, Zhejiang UniversityCancer Institute (Key Laboratory of Cancer Prevention and Intervention, Ministry of Education of China, Key Laboratory of Molecular Biology in Medical Sciences, Zhejiang Province, China), The second Affiliated Hospital, School of Medicine, Zhejiang UniversityInstitute of Oncology Prevention and TreatmentInstitute of Oncology Prevention and TreatmentCancer Institute (Key Laboratory of Cancer Prevention and Intervention, Ministry of Education of China, Key Laboratory of Molecular Biology in Medical Sciences, Zhejiang Province, China), The second Affiliated Hospital, School of Medicine, Zhejiang UniversityAbstract Background To date, no single colorectal cancer (CRC) screening strategy has been determined to be applicable worldwide. In China, a CRC screening protocol that combines double fecal immunochemical tests (FITs) and a high-risk factor questionnaire (HRFQ) as the first stage of screening and colonoscopy as the second stage of screening (scenario A) was adapted by the Chinese Ministry of Health in 2006. However, applying this CRC screening protocol nationally remains difficult because its effectiveness and convenience are controversial. This study evaluated the effects of subitems of the CRC screening protocol in China. Methods CRC screening results (scenario A) from Jiashan County, China, (2007–2009) were used to analyze the detection rates of CRC and advanced neoplasms as well as the cost-effectiveness of the protocol. Scenario A was divided into scenarios B–G (by selecting some items at the first stage of screening) for analysis. Results Compared with scenario A, removing the whole HRFQ (scenario F) reduced advanced neoplasm and adenoma detections by 29.8 and 41.2%, respectively, whereas the whole HRFQ accounted for 10.1% of the total screening cost. Removing FITs (scenario G) reduced CRC, advanced neoplasm and adenoma detections by 71.8, 56.9 and 47.7%, respectively, and the costs per case of CRC and advanced neoplasm were 82.0 and 19.1% higher, respectively, than those in scenario A. In scenarios B–E (deleting some high-risk factor questions on the HRFQ), the odds ratios (ORs) of the detection rates and costs per CRC, advanced neoplasm, adenoma, and neoplasm case were near 1.00. Scenarios C and D reduced the high-risk population and total screening costs by less than 6.0 and 4.1%, respectively. Scenarios E and B (FITs and a personal history of cancer or colorectal adenoma were reserved) reduced the high-risk population by 17.6 and 24.2% and the total screening costs by 11.2 and 15.4%, respectively, while the numbers of CRC cases were not missed, and advanced neoplasms detected decreased by only 5 and 11%, respectively. Conclusion The results of this study demonstrate that FITs and a personal history of colorectal adenoma are the most effective items in the Chinese CRC screening protocol.http://link.springer.com/article/10.1186/s12885-018-5191-yColorectal cancerScreeningAdvanced neoplasmCost-effectiveness analysis |
| spellingShingle | Shan-Rong Cai Yan-Qin Huang Su-Zhan Zhang Qi-Rong Li Xin Yuan Ma Shu Zheng Effects of subitems in the colorectal cancer screening protocol on the Chinese colorectal cancer screening program: an analysis based on natural community screening results BMC Cancer Colorectal cancer Screening Advanced neoplasm Cost-effectiveness analysis |
| title | Effects of subitems in the colorectal cancer screening protocol on the Chinese colorectal cancer screening program: an analysis based on natural community screening results |
| title_full | Effects of subitems in the colorectal cancer screening protocol on the Chinese colorectal cancer screening program: an analysis based on natural community screening results |
| title_fullStr | Effects of subitems in the colorectal cancer screening protocol on the Chinese colorectal cancer screening program: an analysis based on natural community screening results |
| title_full_unstemmed | Effects of subitems in the colorectal cancer screening protocol on the Chinese colorectal cancer screening program: an analysis based on natural community screening results |
| title_short | Effects of subitems in the colorectal cancer screening protocol on the Chinese colorectal cancer screening program: an analysis based on natural community screening results |
| title_sort | effects of subitems in the colorectal cancer screening protocol on the chinese colorectal cancer screening program an analysis based on natural community screening results |
| topic | Colorectal cancer Screening Advanced neoplasm Cost-effectiveness analysis |
| url | http://link.springer.com/article/10.1186/s12885-018-5191-y |
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