Evaluation of the Effectiveness of Colonoscopy, Fecal Immunochemical Test and Risk-adapted Screening Strategies in Population-based Colorectal Cancer Screening: A Multicenter Randomized Controlled Trial
Objective To evaluate the feasibility and effectiveness of colonoscopy, fecal immunochemical test(FIT) and risk-adapted screening strategies in population-based colorectal cancer screening. Methods Based on the randomized controlled trial of colorectal cancer screening(TARGET-C) which was carried...
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| Format: | Article |
| Language: | zho |
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Editorial Office of Medical Journal of Peking Union Medical College Hospital
2023-01-01
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| Series: | Xiehe Yixue Zazhi |
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| Online Access: | https://xhyxzz.pumch.cn/en/article/doi/10.12290/xhyxzz.2022-0537 |
| _version_ | 1811169339728986112 |
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| author | CHEN Hongda LIAO Xianzhen DU Lingbin DONG Dong WEI Donghua GAO Yi ZHENG Weifang CHEN Jingjun LU Ming ZHANG Yuhan LU Bin LUO Chenyu LI Na ZHOU Yueyang LUO Jiahui CAI Jie SHI Jufang DAI Min |
| author_facet | CHEN Hongda LIAO Xianzhen DU Lingbin DONG Dong WEI Donghua GAO Yi ZHENG Weifang CHEN Jingjun LU Ming ZHANG Yuhan LU Bin LUO Chenyu LI Na ZHOU Yueyang LUO Jiahui CAI Jie SHI Jufang DAI Min |
| author_sort | CHEN Hongda |
| collection | DOAJ |
| description | Objective To evaluate the feasibility and effectiveness of colonoscopy, fecal immunochemical test(FIT) and risk-adapted screening strategies in population-based colorectal cancer screening. Methods Based on the randomized controlled trial of colorectal cancer screening(TARGET-C) which was carried out in 6 centers of 5 provinces in China from May 2018 to May 2021, the participants who met the inclusion criteria of the study were randomly assigned to one of the following screening intervention groups in a ratio of 1∶2∶2, which were colonoscopy group, FIT group and risk-adapted screening group(participants evaluated to be at high risk were recommended to undertake colonoscopy, those at low risk were recommended to undertake FIT and FIT positive people received colonoscopy). The 3 groups received different schemes of colorectal cancer screening, in which the colonoscopy group only received baseline screening, whereas the FIT group and the risk-adapted screening group received annual follow-up screening on the basis of baseline screening. The main outcome was the detection rate for advanced colorectal neoplasm(including colorectal cancer and advanced adenoma). The participation rate, detection rate for any neoplasm and resource load of colonoscopy among different screening groups were further analyzed. Results A total of 19 373 participants meeting the inclusion and exclusion criteria were enrolled, including 8082 males(41.7%) and 11 291 females(58.3%), with an average age of (60.5±6.5) years. Among them, 3883 were in the colonoscopy group, 7793 in the FIT group, and 7697 in the risk-adapted screening group. After 1 or 3 rounds of screening(2 rounds of follow-up screening completed in FIT group and risk-adapted screening group), the overall participation was the highest for the FIT group(99.3%), followed by the risk-adapted screening group(89.2%) and the coloscopy group(42.3%). According to the intention-to-treat analysis, the detection rates of advanced neoplasm in the colonoscopy group was higher than that in the FIT group(2.76% vs. 2.17%, ORcolonoscopy vs FIT=1.30, 95% CI: 1.01-1.65, P=0.037); there were no statistically significant differences regarding the detection rates of advanced neoplasm between the colonoscopy group and the risk-adapted screening group(2.76% vs. 2.35%, ORcolonoscopy vs risk-adapted screening=1.19, 95% CI: 0.93-1.51, P=0.156), and between the risk-adapted screening group and the FIT group(2.35% vs. 2.17%, ORrisk-adapted screening vs FIT=1.09, 95% CI: 0.88-1.34, P=0.440). The number of colonoscopies needed to be performed to detect one advanced neoplasm was used as an indicator to evaluate the resource load of colonoscopy. The number was the highest for the coloscopy group(15.4), followed by the risk-adapted screening group(10.2) and the FIT group(7.8). Conclusions The risk-adapted screening strategy is feasible and effective in population-based colorectal cancer screening, and could serve as an effective supplement to the traditional colonoscopy and FIT-based colorectal cancer screening strategies. |
| first_indexed | 2024-04-10T16:40:50Z |
| format | Article |
| id | doaj.art-28ebbf15eb4d42f6bfcbfaf80ab58559 |
| institution | Directory Open Access Journal |
| issn | 1674-9081 |
| language | zho |
| last_indexed | 2024-04-10T16:40:50Z |
| publishDate | 2023-01-01 |
| publisher | Editorial Office of Medical Journal of Peking Union Medical College Hospital |
| record_format | Article |
| series | Xiehe Yixue Zazhi |
| spelling | doaj.art-28ebbf15eb4d42f6bfcbfaf80ab585592023-02-08T07:24:53ZzhoEditorial Office of Medical Journal of Peking Union Medical College HospitalXiehe Yixue Zazhi1674-90812023-01-0114111412310.12290/xhyxzz.2022-0537Evaluation of the Effectiveness of Colonoscopy, Fecal Immunochemical Test and Risk-adapted Screening Strategies in Population-based Colorectal Cancer Screening: A Multicenter Randomized Controlled TrialCHEN Hongda0LIAO Xianzhen1DU Lingbin2DONG Dong3WEI Donghua4GAO Yi5ZHENG Weifang6CHEN Jingjun7LU Ming8ZHANG Yuhan9LU Bin10LUO Chenyu11LI Na12ZHOU Yueyang13LUO Jiahui14CAI Jie15SHI Jufang16DAI Min17Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, ChinaDepartment of Cancer Prevention, Hunan Cancer Hospital, Changsha 410000, ChinaDepartment of Cancer Prevention, Institute of Cancer and Basic Medicine, Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou 310022, ChinaOffice of Cancer Prevention and Treatment, Xuzhou Cancer Hospital, Xuzhou, Jiangsu 221000, ChinaDepartment of Cancer Prevention, Anhui Provincial Cancer Hospital, Hefei 230031, ChinaDepartment of Colorectum Surgery, Tumor Hospital of Yunnan Province/ Third Affiliated Hospital of Kunming Medical University, Kunming 650118, ChinaDepartment of Anorectal Diseases, Lanxi Hospital of Traditional Chinese Medicine, Lanxi, Zhejiang 321100, ChinaDepartment of Cancer Screening, Taizhou Cancer Hospital, Taizhou, Zhejiang 317500, ChinaMedical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, ChinaMedical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, ChinaMedical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, ChinaMedical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, ChinaMedical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, ChinaMedical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, ChinaMedical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, ChinaDepartment of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, ChinaOffice of Cancer Screening, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, ChinaMedical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, ChinaObjective To evaluate the feasibility and effectiveness of colonoscopy, fecal immunochemical test(FIT) and risk-adapted screening strategies in population-based colorectal cancer screening. Methods Based on the randomized controlled trial of colorectal cancer screening(TARGET-C) which was carried out in 6 centers of 5 provinces in China from May 2018 to May 2021, the participants who met the inclusion criteria of the study were randomly assigned to one of the following screening intervention groups in a ratio of 1∶2∶2, which were colonoscopy group, FIT group and risk-adapted screening group(participants evaluated to be at high risk were recommended to undertake colonoscopy, those at low risk were recommended to undertake FIT and FIT positive people received colonoscopy). The 3 groups received different schemes of colorectal cancer screening, in which the colonoscopy group only received baseline screening, whereas the FIT group and the risk-adapted screening group received annual follow-up screening on the basis of baseline screening. The main outcome was the detection rate for advanced colorectal neoplasm(including colorectal cancer and advanced adenoma). The participation rate, detection rate for any neoplasm and resource load of colonoscopy among different screening groups were further analyzed. Results A total of 19 373 participants meeting the inclusion and exclusion criteria were enrolled, including 8082 males(41.7%) and 11 291 females(58.3%), with an average age of (60.5±6.5) years. Among them, 3883 were in the colonoscopy group, 7793 in the FIT group, and 7697 in the risk-adapted screening group. After 1 or 3 rounds of screening(2 rounds of follow-up screening completed in FIT group and risk-adapted screening group), the overall participation was the highest for the FIT group(99.3%), followed by the risk-adapted screening group(89.2%) and the coloscopy group(42.3%). According to the intention-to-treat analysis, the detection rates of advanced neoplasm in the colonoscopy group was higher than that in the FIT group(2.76% vs. 2.17%, ORcolonoscopy vs FIT=1.30, 95% CI: 1.01-1.65, P=0.037); there were no statistically significant differences regarding the detection rates of advanced neoplasm between the colonoscopy group and the risk-adapted screening group(2.76% vs. 2.35%, ORcolonoscopy vs risk-adapted screening=1.19, 95% CI: 0.93-1.51, P=0.156), and between the risk-adapted screening group and the FIT group(2.35% vs. 2.17%, ORrisk-adapted screening vs FIT=1.09, 95% CI: 0.88-1.34, P=0.440). The number of colonoscopies needed to be performed to detect one advanced neoplasm was used as an indicator to evaluate the resource load of colonoscopy. The number was the highest for the coloscopy group(15.4), followed by the risk-adapted screening group(10.2) and the FIT group(7.8). Conclusions The risk-adapted screening strategy is feasible and effective in population-based colorectal cancer screening, and could serve as an effective supplement to the traditional colonoscopy and FIT-based colorectal cancer screening strategies.https://xhyxzz.pumch.cn/en/article/doi/10.12290/xhyxzz.2022-0537colorectal neoplasmfecal immunochemical testcolonoscopyrisk-adapted screeningrisk assessment |
| spellingShingle | CHEN Hongda LIAO Xianzhen DU Lingbin DONG Dong WEI Donghua GAO Yi ZHENG Weifang CHEN Jingjun LU Ming ZHANG Yuhan LU Bin LUO Chenyu LI Na ZHOU Yueyang LUO Jiahui CAI Jie SHI Jufang DAI Min Evaluation of the Effectiveness of Colonoscopy, Fecal Immunochemical Test and Risk-adapted Screening Strategies in Population-based Colorectal Cancer Screening: A Multicenter Randomized Controlled Trial Xiehe Yixue Zazhi colorectal neoplasm fecal immunochemical test colonoscopy risk-adapted screening risk assessment |
| title | Evaluation of the Effectiveness of Colonoscopy, Fecal Immunochemical Test and Risk-adapted Screening Strategies in Population-based Colorectal Cancer Screening: A Multicenter Randomized Controlled Trial |
| title_full | Evaluation of the Effectiveness of Colonoscopy, Fecal Immunochemical Test and Risk-adapted Screening Strategies in Population-based Colorectal Cancer Screening: A Multicenter Randomized Controlled Trial |
| title_fullStr | Evaluation of the Effectiveness of Colonoscopy, Fecal Immunochemical Test and Risk-adapted Screening Strategies in Population-based Colorectal Cancer Screening: A Multicenter Randomized Controlled Trial |
| title_full_unstemmed | Evaluation of the Effectiveness of Colonoscopy, Fecal Immunochemical Test and Risk-adapted Screening Strategies in Population-based Colorectal Cancer Screening: A Multicenter Randomized Controlled Trial |
| title_short | Evaluation of the Effectiveness of Colonoscopy, Fecal Immunochemical Test and Risk-adapted Screening Strategies in Population-based Colorectal Cancer Screening: A Multicenter Randomized Controlled Trial |
| title_sort | evaluation of the effectiveness of colonoscopy fecal immunochemical test and risk adapted screening strategies in population based colorectal cancer screening a multicenter randomized controlled trial |
| topic | colorectal neoplasm fecal immunochemical test colonoscopy risk-adapted screening risk assessment |
| url | https://xhyxzz.pumch.cn/en/article/doi/10.12290/xhyxzz.2022-0537 |
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