Abstract
Colorectal cancer (CRC) screening has been widely implemented in Europe and the USA. However, there is little evidence of participation and diagnostic yields in population-based CRC screening in China. The participation rate and detection of colorectal lesions in this program were reported and related factors were explored. The analysis was conducted in the context of the Cancer Screening Program in Urban China, which recruited 282,377 eligible participants aged 40–74 years from eight cities in Henan province from 2013 to 2019. A total of 39,834 participants were evaluated to be high risk for CRC by an established risk score system and were subsequently recommended for colonoscopy. Of 39,834 with high risk for CRC, 7,454 subjects undertook colonoscopy (participation rate of 18.71%). We found that 50–64 years, high level of education, marriage, former smoking, current alcohol drinking, low levels dietary intake of vegetables, high levels dietary intake of processed meat, lack of physical activity, fecal occult blood test positive result, history of colonic polyp, history of colorectitis, and family history of CRC were associated with increased participation of colonoscopy screening. Overall, 17 CRC (0.23%), 95 advanced adenoma (1.27%), 478 non-advanced adenomas dysplasia (6.41%), 248 hyperplastic polyp (3.33%), and 910 other benign lesions (12.21%) were detected. The findings from the study will provide important references for designing effective population-based CRC screening strategies in the future. Given the relatively low participation rate, there was room for improvement in the yield of CRC screening.
Highlights
Colorectal cancer (CRC) is one of the most commonly diagnosed cancers worldwide, with an age-standardized incidence rate of 19.4 per 100,000 and an age-standardized mortality rate of 8.9 per 100,000, in 2018 (1)
Of the 39,834 high-risk CRC participants, 7,454 of them underwent colonoscopy according to our research recommendations
The identification of high-risk populations for colonoscopy screening through the evaluation of a high-risk cancer risk questionnaire is one of the screening strategies recommended in the existing consensus on screening for colorectal cancer in China, which can well find out colorectal cancer and precancerous lesions (12)
Summary
Colorectal cancer (CRC) is one of the most commonly diagnosed cancers worldwide, with an age-standardized incidence rate of 19.4 per 100,000 and an age-standardized mortality rate of 8.9 per 100,000, in 2018 (1). The incidence of CRC is increasing in China owing to the improvement of living standards, Determinants of Participation of Colorectal Cancer lifestyle changes, and the growing number of elderly population (2). Studies have shown that it takes about [7,8,9,10,11,12] years to progress from adenomatous polyps to early CRC. Colonoscopy with biopsies for histologic confirmation has been shown to significantly reduce CRC mortality through early detection of cancer or removal of adenomatous polyps (5). It is recommended that participants who are assessed as high risk for specific types of cancer undergo appropriate screening interventions in accordance with the research protocol. For CRC screening, it is recommended that people at high risk of CRC follow a procedure and go to a designated tertiary hospital for colonoscopy
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