Comparative assessment of questionnaire and fecal immunochemical test efficacy in colorectal cancer screening

Abstract

The aim of the study: to estimate the efficacy of the colorectal cancer (CRC) risk assessment according to the questionnaire and the fecal immunochemical test (FIT). The pilot study included 2,324 respondents over 40 years of age, without severe comorbidities, who filled out the original questionnaire and had the FIT. Risk stratification (high, moderate, low) was done using the original software for automatic data processing. Occult blood detection in feces was done using the fecal immunochemical test. Colonoscopy was proposed for all persons included in the screening program. The questionnaire revealed the high CRC risk in 272 (11.7 %) respondents, moderate risk — in 1,349 (58.0 %), and low risk — in 703 (30.0 %) respondents. The respondents with the high CRC risk had positive FIT results significantly more often — 199 (73.2 %) respondents, with 148 (11.0 %) respondents in the moderate-risk group, and 21 (3.0 %) respondents in the low-risk group (р<0.0001). Colonoscopy was performed in 28 (10.3 %) persons in the high-risk group, 76 (5.6 %) — in the moderate-risk group and in 50 (7.1 %) respondents in the low-risk group. The clinically important colon diseases (CRC, colorectal polyps, and IBD) were revealed significantly more often in the high-risk group than in moderate- and low-risk groups (82.1 % vs 68.0 %; p=0.02) and in those with positive FIT (87.5 % vs 60.5 %; p=0.01). Conclusion: the preliminary results showed that risk stratification by questionnaire is not inferior in the detection of clinically significant diseases of the colon than the fecal immunochemical test. It is necessary to continue the screening project with increasing the proportion of colonoscopies in all risk groups to obtain valid results.