Colorectal Cancer Screening In China Research Articles

Screening and prevention strategies for colorectal cancer

Colorectal cancer is one of the most common malignant cancers in the world. In China, the incidence of colo-rectal cancer is increasing year by year, with the characteristics of the insidious onset, long-time canceration and high cure rate of early-stage tumors. These will lead to the crucial significance of prevention and screening work for reducing the incidence of colorectal cancer, improving the cure rate and reducing the relevant medical costs. Screening and prevention of colorectal cancer has been carried out for nearly half a century in the world. However, systematic screening began at the beginning of this century in China. This article reviewed the results, methods, strategies and main problems of colorectal cancer screening in China and abroad. Key words: Colonic neoplasms; Rectal neoplasms; Prevention; Screening; Strategies

Adherence to screening colonoscopy and its influencing factors in China: a multicentre population-based cross-sectional study

BackgroundScreening for colorectal cancer is effective in reducing the burden of this disease. The measure of adherence is crucial in determining the magnitude of the health impact of screening for colorectal cancer at a population level. We aimed to assess adherence of screening colonoscopy and its influencing factors in a population-based programme of colorectal cancer screening in China. MethodsThis study was done under the framework of Screening Program in Urban China supported by the central government of China. Urban permanent residents of aged 40–69 years were defined as the eligible population for the cancer screening programme. Eligible participants were invited to fill an epidemiological questionnaire survey for assessment of cancer risk based on Harvard Cancer Risk Index, and those who were assessed to be at high risk of colorectal cancer were recommended to take a screening colonoscopy. We collected detailed questionnaires and colonoscopy reports. For this analysis, we used research data for 2012–14. We applied logistic regression to identify potential factors associated with the adherence to screening colonoscopy. This study was approved by the Institutional Review Board of the Cancer Hospital of Chinese Academy of Medical Sciences. Written informed consent was obtained from each participant in the study. FindingsOverall, 97 445 participants were assessed to be potentially at high risk of colorectal cancer in 2012–14. 14 949 (15·3%) of the high-risk population followed the recommendation of undertaking screening colonoscopy. Adherence rates varied greatly across the 12 participating provinces, ranging from 7·9% to 26·2%. We noted a significantly higher adherence rate in 2013–14 (17·0%, 9766 of 57 280 participants) than in 2012–13 (12·9%, 5183 of 40 165 participants). After adjusting potential confounding factors, past positive result of fecal occult blood test (odd ratio 1·40, 95% CI 1·31–1·49), previous polyp detection (1·44, 1·38–1·50), inflammatory bowel disease (1·63, 1·56–1·69), and family history of colorectal cancer (1·59, 1·53–1·66) were found to be associated with the adherence to screening colonoscopy. InterpretationThe adherence rate of screening colonoscopy is low in a population-based screening programme in China. Adoption of effective primary screening modalities to precisely identify high-risk population and carrying out health promotion campaigns would be necessary to improve the adherence to screening colonoscopy in China. FundingThe National Health and Family Plan Committee of China.

Abstract 1795: The feasibility study of a randomized cancer screening trial in China

Abstract Lung cancer has been the leading cause of cancer death in China since the 1990s and the disease burden likely will increase. The US National Lung Screening Trial (NLST) showed a 16-20% mortality reduction in a high-risk population that had undergone Low-Dose Computed Tomography (LDCT). China would like to confirm the main result from the US NLST in the Chinese population. The aim of this study is to obtain necessary information on performance of the organizations involved in designing, conducting, monitoring and managing the study. Another goal is to test colorectal cancer screening strategies in China. This is a first randomized trial on lung and colorectal cancer screening in China. The feasibility study will aid in the development of a practical design for the Randomized Cancer Screening Trial in China. This study has been carried out in three cites (Changsha city, Hunan province; Lanzhou city, Gansu province; and Haining city, Zhejiang province) since August, 2014. Individuals at elevated risk of lung cancer were randomized into three arms: annual low-dose helical CT exams for three years (T0, T1, T2) and baseline colonoscopy (T0); two low-dose helical CT exams (T0, T2) plus annual faecal immunochemical test (OC-faecal immunochemical tests at T0, T1, T2); and annual InSure-faecal immunochemical tests combined with Septin 9 test (T0, T1, T2). All participants will be followed for at least three years from randomization to yield data relevant to answering the study objectives. As of March 31, 2015, a total of 2696 eligible participants were enrolled at 3 cancer hospitals and randomly assigned to three study arms (894 in arm 1, 902 in arm 2, and 900 in arm 3). The gender distribution is 53% male and 47% female. Baseline characteristics of the study population by age, gender and total pack-year exposure were balanced. The rate of adherence to LDCT screening at the first round (T0) was 89.0%. 1598 participants received LDCT in the first round. The rate of abnormality was 77.4% with LDCT and 6.5% and 6.1% with suspicious for lung cancer for arm 1 and arm 2 respectively at T0. 2150 participants received colorectal cancer screening. The positivity was 34.1% with colonoscopy screening, 8.0% with OC-FIT test, 4.5% with InsureFIT test, and 5.8% with Septin9 test. Citation Format: Ping Hu, Min Dai, Jufang Shi, Jiansong Ren, Jiang Li, Xianzhen Liao, Lingbin Du, Yuqing Liu, Zhaoli Chen, Ning Wu, Qian Liu, Paul Pinsky, Philip Prorok, Richard Fagerstrom, Martina Taylor, Barnett Kramer, Jie He. The feasibility study of a randomized cancer screening trial in China. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 1795.

The China Cancer Screening Trial Feasibility Study

BackgroundLung cancer has been the leading cause of cancer death in China since the 1990s, and the disease burden is predicted to increase. The US National Lung Screening Trial (NLST) showed that annual low-dose CT resulted in a 15–20% mortality reduction in high-risk populations compared with chest x-ray, and the China National Cancer Center would like to confirm this finding in the Chinese population. Additionally, China has not yet developed national guidelines for lung and colorectal cancer screening, and scientific evidence from the Chinese population is needed to inform policy making. The China Cancer Screening Trial Feasibility Study seeks to obtain information necessary to design a long-term randomised lung and colorectal cancer screening trial. The primary objectives are to develop and test all data forms and data collection procedures; to assess the feasibility of recruitment and randomisation of participants into study arms, and the success of randomisation by comparing the distribution of baseline variables across arms, contamination in each arm, and compliance with screening exams and diagnostic follow-up after positive screening in each arm; to determine the positivity rates at each screening round in each arm; to identify and collect data for cancers in each arm over the study period; to develop and test procedures that collect and store biological samples; and to assess the performance of the organisations involved in designing, conducting, monitoring, and managing the study. MethodsThe study has been set up in three cites (Changsha, Hunan province; Lanzhou, Gansu province; and Haining, Zhejiang province) since August, 2014. Individuals at elevated risk of lung cancer were randomised into three arms: annual low-dose helical CT exams for 3 years (T0, T1, T2) and baseline colonoscopy (T0); two low-dose helical CT exams (T0, T2) plus annual faecal immunochemical test (OC-faecal immunochemical tests at T0, T1, T2); and annual InSure-faecal immunochemical tests combined with Septin 9 test (T0, T1, T2). A randomly selected 6 or 9 block size was used for randomisation. Staff at screening centres and all the participants were blinded to the order of randomisation, and enrolment was done by each screening centre. All participants will be followed for at least 3 years from randomisation to yield data stated in the study objectives. This study was approved by the ethics committee of Cancer Hospital, Chinese Academy of Medical Science, in June, 2014 (14-058/848). All participants signed informed consent forms before recruitment. FindingsAs of March 31, 2015, 2700 eligible participants, 900 in each study centre, were randomised into the three arms. Participants were stratified on the basis of sex and age (50–54 years, 55–59 years, 60–64 years, 65–69 years, and 70–74 years) in each centre. Low-dose spiral CT abnormality and non-calcified nodule/mass distribution were assessed. In each arm, compliance with the screening exams, positivity rates at the baseline screening, and compliance with diagnostic follow-up after positive screening exams were also studied. InterpretationThis is the first randomised trial of lung and colorectal cancer screening in China. Results from the Feasibility Study will help to develop a practical design for the Randomised Cancer Screening Trial in China. FundingCancer Institute and Hospital, Chinese Academy of Medical Sciences, and The National Health and Family Plan Committee of China.

Reasearch progress in health economic evaluation of colorectal cancer screening in China

Burden of colorectal cancer is rising in China. More attention and financial input have been paid to it by central government that colorectal cancer screening program has been carried out recently in many areas in China. Diversity of screening strategies and limited health resources render selecting the best strategy in a population-wide program a challenging task that economy was also required to be considered except safety and efficacy. To provide a reference for the subsequent further economic evaluation, here we reviewed the evidence available on the economic evaluation of colorectal cancer screening in China. Meanwhile, information related to screening strategies, participation and mid-term efficacy of screening, information and results on economic evaluation were extracted and summarized. Three of the four studies finally included evaluated strategies combining immunochemical fecel occult blood test (iFOBT) with high-risk factor questionnaire as initial screening, colonoscopy as diagnostic screening. There was a consensus regarding the efficacy and effectiveness of screening compared to no screening. Whereas the lack and poor comparability between studies, multi-perspective and multi-phase economic evaluation of colorectal cancer screening is needed, relying on current population-based screening program to conduct a comprehensive cost accounting.

Barrier-focused intervention to increase colonoscopy attendance among nonadherent high-risk populations

To increase attendance for colonoscopy among nonadherent high-risk individuals for colorectal cancer (CRC) screening in China. During the first 12 mo without intervention, only 428 of the 2398 high-risk subjects attended a scheduled colonoscopy examination. The 1970 subjects who did not attend for CRC screening were enrolled in the present study. Prior barrier investigation was performed to ascertain the reasons for nonadherence. A barrier-focused intervention program was then established and implemented among eligible nonadherent subjects by telephone interviews and on-site consultations. The completion rates of colonoscopy during the first 12 mo without intervention and the second 12 mo with intervention were compared. Variations in the effect of the intervention on some high-risk factors and barrier characteristics were analyzed using logistic regression. 540 subjects who were not eligible were excluded from the study. The colonoscopy attendance rate was 23.04% (428/1858) during the first 12 mo without intervention, and 37.69% (539/1430) during the second 12 mo with intervention (P < 0.001). Logistic regression analysis showed that the intervention was more effective among subjects with only objective barriers (OR: 34.590, 95% CI: 23.204-51.563) or subjects with some specific high-risk characteristics: first-degree relatives diagnosed with CRC (OR: 1.778, 95% CI: 1.010-3.131), personal history of intestinal polyps (OR: 3.815, 95% CI: 1.994-7.300) and positive result for immunochemical fecal occult blood testing (OR: 2.718, 95% CI: 1.479-4.996). The barrier-focused telephone or on-site consultation intervention appears to be a feasible means to improve colonoscopy attendance among nonadherent high-risk subjects for CRC screening in China.

Performance value of high risk factors in colorectal cancerscreening in China

To analyze the performance value of high risk factors in population-based colorectal cancer (CRC) screening in China. We compared the performance value of the immunochemical fecal occult blood test (iFOBT) and other high risk factors questionnaire in a population sample of 13 214 community residents who completed both the iFOBT and questionnaire investigation. Patients with either a positive iFOBT and/or questionnaire were regarded as a high risk population and those eligible were asked to undergo colonoscopy. The iFOBT had the highest positive predictive value and negative predictive value in screening for advanced neoplasia. The iFOBT had the highest sensitivity, lowest number of extra false positive results associated with the detection of one extra abnormality for screening advanced neoplasias and adenomas. A history of chronic cholecystitis or cholecystectomy, chronic appendicitis or appendectomy, and chronic diarrhea also had a higher sensitivity than a history of adenomatous polyps in screening for advanced neoplasias and adenomas. The sensitivity of a history of chronic cholecystitis or cholecystectomy was highest among the 10 high risk factors in screening for non-adenomatous polyps. A history of chronic appendicitis or appendectomy, chronic constipation, chronic diarrhea, mucous and bloody stool, CRC in first degree relatives, malignant tumor and a positive iFOBT also had higher sensitivities than a history of adenomas polyps in screening for non-adenomatous polyps. Except for a history of malignant tumor in screening for non-adenomatous polyps, the gain in sensitivity was associated with an increase in extra false positive results associated with the detection of one extra abnormality. The iFOBT may be the best marker for screening for advanced neoplasias and adenomas. Some unique high risk factors may play an important role in CRC screening in China.

Does Fecal Occult Blood Test Have a Place for Colorectal Cancer Screening in China in 2006?

Does Fecal Occult Blood Test Have a Place for Colorectal Cancer Screening in China in 2006?