Abstract
BackgroundThe positive predictive value (PPV) of high risk factor questionnaire (HRFQ) plus fecal immunochemical test (FIT) as preliminary screening strategy for colorectal-related neoplasia is relatively low. We aim to explore independent factors associated with PPVs of HRFQ combined FIT for selecting high risk individuals for colonoscopy.MethodsA total of 6971 residents were enrolled in a community-based screening program. Participants who had positive results of HRFQ and/or FIT and subsequently received colonoscopy were involved. The associations of socio-demographic factors, lifestyle behaviors, and high risk factors of colorectal cancer with PPVs of HRFQ, FIT, and their combination were evaluated by multivariable logistic regression models.ResultsAmong 572 involved cases, 249 (43.5%) colorectal neoplasms were detected by colonoscopy, including 71 advanced adenoma (12.4%) and 9 colorectal cancer (CRC) (1.6%). The PPVs of preliminary screening were 43.5% for total colorectal neoplasms, 14.0% for advanced neoplasm, and 1.6% for CRC. Adding positive HRFQ to FIT could improve the PPV from 3.5 to 8.0% for detecting CRC. Preliminarily screened positive individuals who were males [adjusted odds ratio (AOR): 1.95, 95% CI 1.31, 2.90; p < 0.001], elders (> 60 years) (AOR: 1.70, 95% CI 1.17, 2.46; p = 0.005), or ex-/current smokers (AOR: 3.04, 95% CI 1.31, 7.09; p = 0.10) had higher odds of PPVs of detecting colorectal neoplasms.ConclusionsCombining HRFQ and FIT could largely improve PPVs for screening advanced neoplasm and CRC. Gender and age-specific FIT cut-off values as well as initiating ages for CRC screening might be recommended to improve the accuracy and effectiveness of current screening algorithm.
Highlights
Colorectal cancer (CRC) is one of the leading causes of cancer death worldwide, with estimating 1.8 million new incident cases and 881,000 death cases in 2018 [1]
In China, due to the limited economic resources and health structure and infrastructure, a two-step sequential screening strategy is recommended by China National Commission of Cancer Early Detection and Treatment [5]: eligible individuals are preliminarily screened by a validated high risk factor questionnaire (HRFQ) or fecal immunochemical test (FIT), and positive cases identified in preliminary screening step are further referred for colonoscopy confirmation
A total of 249 (43.5%) colorectal neoplasms were detected in colonoscopy examination, including 79 non-adenomatous benign lesions (13.8%), 90 non-advanced adenoma (15.7%), 71 advanced adenoma (12.4%), and 9 colorectal cancer (CRC) (1.6%) (Fig. 1; Table 2)
Summary
Colorectal cancer (CRC) is one of the leading causes of cancer death worldwide, with estimating 1.8 million new incident cases and 881,000 death cases in 2018 [1]. Accumulated data shows that preliminary screening of HRFQ plus FIT has a relatively low positive predictive values (PPVs) for selecting high-risk cases of colorectal-related neoplasia [7,8,9,10]. These results indicate that individuals with positive result in preliminary screening would have less than 20% probability of colorectal neoplasm and 2% of CRC, respectively. The positive predictive value (PPV) of high risk factor questionnaire (HRFQ) plus fecal immunochemical test (FIT) as preliminary screening strategy for colorectal-related neoplasia is relatively low. Gender and age-specific FIT cut-off values as well as initiating ages for CRC screening might be recommended to improve the accuracy and effectiveness of current screening algorithm
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