Participation In Colorectal Cancer Screening Research Articles

Knowledge, Attitudes, and Beliefs About Colorectal Cancer Screening in Puerto Rico

The purpose of this study was to describe the psychosocial factors influencing participation in colorectal cancer screening (CRCS) among Puerto Rican men and women. We conducted seven focus groups in metropolitan and rural areas of Puerto Rico (PR) with men and women (using gender specific groups) aged 50 to 80 years (n = 51) who were non-adherent to CRC guidelines. The focus group guide included questions related to colorectal cancer (CRC) and CRC screening knowledge, attitudes, and beliefs. We analyzed data using a modified grounded theory approach to identify emergent themes. Focus groups revealed seven major themes that represented barriers to CRCS: (1) lack of CRC knowledge, (2) lack of knowledge about colorectal cancer screening tests as well as the required preparation, (3) embarrassment, (4) low perceived benefit of CRCS and sense of fatalism, (5) transportation (mostly among participants in rural areas), (6) lack of time, and (7) financial burden. All participants understood the benefits of CRCS once the procedure was explained. Additionally, participants reported a lack of provider recommendation for CRCS. In this group of Puerto Rican participants who were non-adherent to CRCS, there were misconceptions about CRC, screening tests available, and preparation and testing procedures. Participants’ low levels of knowledge and negative attitudes concerning CRCS and low reported provider recommendation were important deterrents to screening. These findings suggest the need for educational efforts to increase knowledge and attitudes about CRCS and improved patient-provider communication to reduce missed opportunities to recommend.

Masculinity Barriers to Ever Completing Colorectal Cancer Screening among American Indian/Alaska Native, Black, and White Men (Ages 45-75).

Disparities in colorectal cancer (CRC) mortality among White, Black, and American Indian/Alaska Native (AIAN) men are attributable to differences in early detection screening. Determining how masculinity barriers influence CRC screening completion is critical for cancer prevention and control. To determine whether masculinity barriers to medical care are associated with lower rates of ever completing CRC screening, a survey-based study was employed from December 2020–January 2021 among 435 White, Black, and AIAN men (aged 45–75) who resided in the US. Logistic regression models were fit to four Masculinity Barriers to Medical Care subscales predicting ever completing CRC screening. For all men, being strong was associated with 54% decreased odds of CRC screening completion (OR 0.46, 95% CI 0.23 to 0.94); each unit increase in negative attitudes toward medical professionals and exams decreased the odds of ever completing CRC screening by 57% (OR 0.43, 95% CI 0.21 to 0.86). Black men who scored higher on negativity toward medical professionals and exams had decreased odds of ever screening. Consideration of masculinity in future population-based and intervention research is critical for increasing men’s participation in CRC screening, with more salience for Black men.

Reasons for participation and non-participation in colorectal cancer screening

ObjectivesThe aim of the present analysis is to identify the reasons for accepting or rejecting the invitation to be screened by the Faecal Immunochemical Test as part of the free Danish screening programme for colorectal cancer (CRC). Study designA cross-sectional representative survey of 15,072 Danish citizens aged 50–80 years was collected in 2019 via a Web-based questionnaire administered by Statistics Denmark. Among the net sample of 6807 respondents (45%), 177 were excluded because of current treatment for colorectal disease. MethodsTo determine the reasons for accepting or refusing the invitation to be screened for CRC, a latent class analysis was conducted, which allowed participants to provide several reasons for acceptance or rejection of screening. ResultsThe most important reason for participating in CRC screening was the active public programme. A further reason for participation was the perceived risk for CRC, mainly in combination with the public programme. The reasons for participation did not differ between individuals who had participated and those who intended to participate when offered. Among participants who declined screening, the most frequent reasons were that they forgot to participate or that they were concerned about the unpleasant test procedure. Among individuals who intended to decline screening, a perceived low risk for CRC was the most frequently cited reason. ConclusionsRecommendation from a general practitioner (GP) was not given as a frequent reason for CRC screening participation which is discussed as a challenge to participation rates in population based screening program The main reasons reported for non-participation in CRC screening (i.e. forgot to participate or the unpleasant test procedure) might be addressed by a stronger endorsement from GPs.

Examining the Association of Food Insecurity and Being Up-to-Date for Breast and Colorectal Cancer Screenings.

Food insecurity (FI) has been associated with poor access to health care. It is unclear whether this association is beyond that predicted by income, education, and health insurance. FI may serve as a target for intervention given the many programs designed to ameliorate FI. We examined the association of FI with being up-to-date to colorectal cancer and breast cancer screening guidelines. Nine NCI-designated cancer centers surveyed adults in their catchment areas using demographic items and a two-item FI questionnaire. For the colorectal cancer screening sample (n = 4,816), adults ages 50-75 years who reported having a stool test in the past year or a colonoscopy in the past 10 years were considered up-to-date. For the breast cancer screening sample (n = 2,449), female participants ages 50-74 years who reported having a mammogram in the past 2 years were up-to-date. We used logistic regression to examine the association between colorectal cancer or breast cancer screening status and FI, adjusting for race/ethnicity, income, education, health insurance, and other sociodemographic covariates. The prevalence of FI was 18.2% and 21.6% among colorectal cancer and breast cancer screening participants, respectively. For screenings, 25.6% of colorectal cancer and 34.1% of breast cancer participants were not up-to-date. In two separate adjusted models, FI was significantly associated with lower odds of being up-to-date with colorectal cancer screening [OR, 0.7; 95% confidence interval (CI), 0.5-0.99)] and breast cancer screening (OR, 0.6; 95% CI, 0.4-0.96). FI was inversely associated with being up-to-date for colorectal cancer and breast cancer screening. Future studies should combine FI and cancer screening interventions to improve screening rates.

A139 EQUITY IN ACCESS TO COLORECTAL CANCER SCREENING IN NOVA SCOTIA

Abstract Background Population-based colorectal cancer (CRC) screening programs aim to minimize inequities in participation through universal access, however, there remain disparities associated with low education, socio-economic status, and population centre. In the United States racialized groups have lower screening participation, and Black and Indigenous adults have higher CRC mortality. There is no Canadian data on racialized group participation in CRC screening because racial and ethnic data is not routinely collected. The Nova Scotia Colon Cancer Prevention Program (NSCCPP) mails fecal immunochemical tests (FIT) biennially to all residents aged 50–74 and allows for optional self-identified race and ethnicity. Aims To determine whether participation rates in the NSCCPP differ on the basis of race/ethnicity, age, sex, or population centre. In this preliminary analysis we report screening participation on the basis of race/ethnicity. Methods A retrospective cohort study was performed using the NSCCPP database to identify screen-eligible adults who returned a FIT to the program (i.e. participated) from 2011 to 2021. Racialized groups were identified based on self-identification form results allowing for multiple category selections. Race/Ethnicity was categorized as White, Black/African Canadian, Indigenous, Asian, Middle Eastern. The 2016 Canadian census was used to estimate the screen-eligible population (age 50–74) and race/ethnicity group population sizes. Unique participants were identified as individuals who returned one or more FITs in the study period. Unique participants were compared to the screen-eligible population to estimate participation over the 10-year study period. Results 508,533 FITs were returned over 10 years by 208,702 unique participants. The number of annual FITs returned ranged from 14,066 in 2011 to 65,746 in 2019. Participants were 56% female, 44% male, with a mean age 62.8 (± 7.0). FIT status was 89% negative, 7% positive, and 4% indeterminate. 96% (n=490,398) of participants provided self-identification data. Table 1 provides the screen-eligible population, unique participants, and FIT participation over the 10-year study period all characterized by race/ethnicity. Over 10 years, 59% of the eligible population participated in CRC screening by returning at least one FIT. Conclusions CRC screening participation by race/ethnicity in Canada is unknown. This analysis of the NSCCPP suggests that participation by racialized individuals including Black/African Canadian, Asian, and Indigenous, are lower relative to White individuals. Further analyses will explore race/ethnicity and gender in terms of temporal and geographic trends. Table 1. Funding Agencies None

Lifestyle predictors for inconsistent participation to fecal based colorectal cancer screening

BackgroundConsistent participation in colorectal cancer (CRC) screening with repeated fecal immunochemical test (FIT) is important for the success of the screening program. We investigated whether lifestyle risk factors for CRC were related to inconsistent participation in up to four rounds of FIT-screening.MethodWe included data from 3,051 individuals who participated in up to four FIT-screening rounds and returned a lifestyle questionnaire. Using logistic regression analyses, we estimated associations between smoking habits, body mass index (BMI), physical activity, alcohol consumption, diet and a healthy lifestyle score (from least favorable 0 to most favorable 5), and inconsistent participation (i.e. not participating in all rounds of eligible FIT screening invitations).ResultsAltogether 721 (24%) individuals were categorized as inconsistent participants Current smoking and BMI ≥30 kg/m2 were associated with inconsistent participation; odds ratios (ORs) and 95% confidence intervals (CIs) were 1.54 (1.21-2.95) and 1.54 (1.20-1.97), respectively. A significant trend towards inconsistent participation by a lower healthy lifestyle score was observed (p < 0.05).ConclusionsLifestyle behaviors were associated with inconsistent participation in FIT-screening. Initiatives aimed at increasing participation rates among those with the unhealthiest lifestyle have a potential to improve the efficiency of screening.

Determining frequency and reasons associated to refusal of colorectal cancer screening at a reference center in Mexico.

67 Background: in Mexico, Colorectal Cancer (CRC) is a leading cause of cancer death, yet population-based screening programs are lacking. In our center, a cohort was created to validate a risk calculator to detect advanced colorectal neoplasia, and to understand barriers to implement a CRC screening program. We aimed to determine frequency and reasons associated to rejection of CRC screening in our population. Methods: from August 2019 to March 2020 (early close owing to COVID-19 pandemic) asymptomatic individuals between 50 and 75 years-old with standard-risk for CRC, without previous screening for CRC, from the outpatient internal medicine clinic at a tertiary care center in Mexico City, received standardized information on the importance of CRC screening and were invited to perform both Fecal Immunochemical Test and a screening colonoscopy within a clinical study at no cost. Individuals who rejected participation were given a 10-item questionnaire to select reasons for refusal, as many items as applied. Here we present two groups: 1) individuals who refused to receive information and to perform screening studies, and 2) individuals who refused to participate after receiving information. Results: 162 patients were invited to participate, 77 (47%) refused: 48 rejected immediately (group 1) and provided 51 reasons, and 29 declined after having received standardized information about CRC screening (group 2) and provided 30 reasons. Demographics for 77 patients were: 54 (70.1%) women, median age 66 (IQR 58-71) years. Main reasons for rejection in both groups were: “I do not have time” in 24 (29.6%) times, “I am not interested” in 23 (28.4%) times, and “I am scared” in 14 (17.3%) times (Table). Conclusions: in our cohort, we identified that nearly half of the population invited to participate in a CRC screening program refused. Main reasons were lack of time, lack of interest and fear. This may translate poor understanding on the importance of measures to prevent CRC, and absence of education programs to recall its importance. In order to increment participation in CRC screening, education and awareness campaigns should be implemented.[Table: see text]

Cause of Death, Mortality and Occult Blood in Colorectal Cancer Screening.

Simple SummaryColorectal cancer (CRC) screening participants with significant traces of hemoglobin in their stool have been reported to have higher mortality and different causes of death (other than CRC) compared to those without. We aimed to investigate these differences among screening participants after 33 years of follow-up. We confirmed that participants with detectable fecal hemoglobin were more likely to die in the study period and to die from different causes, such as cardiovascular and endocrine and hematological diseases, compared to those without detectable fecal hemoglobin. This confirms that fecal hemoglobin may have potential as a marker for diseases not directly related to the colon and rectum and may represent a target for future preventive measures.Fecal hemoglobin (f-Hb) detected by the guaiac fecal occult blood test (gFOBT) may be associated with mortality and cause of death in colorectal cancer (CRC) screening participants. We investigated this association in a randomly selected population of 20,694 participants followed for 33 years. We followed participants from the start of the Hemoccult-II CRC trial in 1985–1986 until December 2018. Data on mortality, cause of death and covariates were retrieved using Danish national registers. We conducted multivariable Cox regressions with time-varying exposure, reporting results as crude and adjusted hazard ratios (aHRs). We identified 1766 patients with at least one positive gFOBT, 946 of whom died in the study period. Most gFOBT-positive participants (93.23%) died of diseases unrelated to CRC and showed higher non-CRC mortality than gFOBT-negative participants (aHR: 1.20, 95% CI 1.10–1.30). Positive gFOBT participants displayed a modest increase in all-cause (aHR: 1.28, 95% CI: 1.18–1.38), CRC (aHR: 4.07, 95% CI: 3.00–5.56), cardiovascular (aHR: 1.22, 95% CI: 1.07–1.39) and endocrine and hematological mortality (aHR: 1.58, 95% CI: 1.19–2.10). In conclusion, we observed an association between positive gFOBT, cause of death and mortality. The presence of f-Hb in the gFOBT might indicate the presence of systemic diseases.

Patterns of up-to-date status for colorectal cancer screening in Alberta: a cross-sectional study using survey data

Background:Regular screening for colorectal cancer (CRC) reduces its mortality. We explored patterns of use of different CRC screening modalities and quantified the association between having a regular primary care provider and being up to date for CRC screening in a community-based population in Alberta, Canada.Methods:We conducted a cross-sectional study of adults between 50 and 74 years of age in Alberta, using Canadian Community Health Survey data (2015–2016). We defined being up to date for CRC screening as having completed a fecal occult blood test (FOBT) or fecal immunochemical test (FIT) within the previous 2 years, or having a colonoscopy or sigmoidoscopy in the previous 5 years before the survey. We analyzed data using multivariable logistic regression models.Results:Of 4600 surveyed adults, 62.6% were up to date for CRC screening, with 45.1% having completed a FIT or FOBT (45.1%), and 34.1% having undergone a colonoscopy or sigmoidoscopy. The adjusted odds ratio of being up to date for CRC screening was 0.25 (95% confidence interval 0.17–0.38) and the absolute probability of being up to date for CRC screening was 34.4% lower for adults who had no regular primary care provider, compared with those who had. This pattern was observed in both male and female subgroups.Interpretation:Our findings suggest a suboptimal uptake of CRC screening overall in Alberta, with high disparity between adults with and without a regular primary care provider. The use of customized, multicomponent intervention strategies that are shown to be effective in increasing participation in CRC screening may address this issue.

Barriers to Colorectal Cancer Screening in People with Disabilities: A mini review

People living with a disability represent one of the most marginalized populations, with substantial disparities being observed in healthcare utilization. This extends to colorectal cancer screening, as people living with disability are significantly less likely to receive or attend cancer screening programs. Although it is proposed that people with disability share many of the same barriers to cancer screening as people without disabilities, the low utilization rate among people with disabilities suggests that there are additional barriers and challenges. Hence, this literature review aims to identify and discuss the barriers to colorectal cancer screening in people with disabilities, inclusive of both physical and intellectual disabilities. We identified a range of barriers at individual and systemic levels that had a substantial impact on the participation in colorectal cancer screening by people with disabilities.

POSB341 Participants' Motivation for Colorectal Cancer Screening in Japan: A Secondary Qualitative Study

Although colorectal cancer screening has been provided as a national program in Japan, the participation rate has remained lower than in other OECD countries. While several strategies for improving participation in cancer screening have been promoted in Japan, participants’ motivation for undertaking cancer screening has rarely been examined. To investigate participants’ reasons for attending colorectal cancer screening in Japan, a secondary qualitative study was conducted by using the Database of Individual Patient Experience Japan（https://www.dipex-j.org/about/). Colorectal cancer patients or participants in colorectal cancer screening were purposefully sampled from the archive. The subjects were either involved in primary screening or work-up exams, which were included for analysis. Individuals with a disability, hereditary disease, or symptomatic outpatients were excluded because they were not targeted for colorectal cancer screening. A thematic analysis was performed on transcripts of the selected subjects. Emerging codes and themes were inductively categorized, and individual motivations were examined by mapping the linkage of these emerging topics. In total, 22 cases were selected for analysis from the database involving 35 subjects. Of eighteen patients who talked about their experience of primary screening, fifteen patients attended the screening. Many of them decided to take part in the screening because of their screening history, and several patients felt their participation was an obligation. Another twelve patients mentioned that they were recommended to receive a work-up exam by doctors due to their FOBT-positive Results: Six out of the twelve patients rejected the suggestion because they did not feel obligated but prioritized their time at work. Participants’ knowledge and their screening history were related to motivation for colorectal cancer screening. The seriousness with which patients received physician’s suggestions regarding cancer screening greatly varied. It is imperative to understand how patients perceive the risk and benefit of cancer screening or work-up examination.

The Impact of Driving Time on Participation in Colorectal Cancer Screening with Sigmoidoscopy and Faecal Immunochemical Blood Test

The Impact of Driving Time on Participation in Colorectal Cancer Screening with Sigmoidoscopy and Faecal Immunochemical Blood Test

What can We Learn From High-Performing Screening Programs to Increase Bowel Cancer Screening Participation in Australia?

BackgroundColorectal cancer (CRC) is the second most diagnosed cancer in men and women and second most common cause of cancer death in Australia; Australia’s CRC incidence and mortality are among the world’s highest. The Australian National Bowel Cancer Screening Program began in 2006; however, only 33% of those approached for the first time by the Program between 2018 and 2019 returned the kit. Of the 5.7 million kits sent during this period, only 44% were returned. Our aim was to identify practices and features of national bowel cancer screening programs in countries with similar programs but higher screening participation, to identify potential interventions for optimising Australian CRC screening participation.MethodsWe searched published and grey literature for CRC screening programs reporting at least 50% screening participation using postal invitation and free return of iFOBT home kits. Interviews were conducted with cancer registry staff and academic researchers, focused on participant and practitioner engagement in screening.ResultsNational programs in Netherlands, Scotland, Denmark, and Finland reported over 50% screening participation rates for all invitation rounds. Shared characteristics include small populations within small geographic areas relative to Australia; relatively high literacy; a one-sample iFOBT kit; national registration systems for population cancer screening research; and screening program research including randomised trials of program features.ConclusionsApart from the one-sample kit, we identified no single solution to persistent Australian low uptake of screening. Research including randomised trials within the program promises to increase participation.ImpactThis screening program comparison suggests that within-program intervention trials will lead to increased Australian screening participation.

Racism Is a Modifiable Risk Factor: Relationships Among Race, Ethnicity, and Colorectal Cancer Outcomes

Racism Is a Modifiable Risk Factor: Relationships Among Race, Ethnicity, and Colorectal Cancer Outcomes

The long term participation trend for the colorectal cancer screening after the 2011 triple disaster in Minamisoma City, Fukushima, Japan

Colorectal cancer (CRC) screening is a well-established cancer screening method, and its effectiveness depends on maintaining a high participation rate in the target population. In this study, we analyzed the trends in CRC screening participation rates over 10 years in Minamisoma City, where residents were forced to evacuate after the 2011 triple disaster in Fukushima, Japan. The immunochemical fecal occult blood test is provided as municipal CRC screening. We calculated the annual CRC screening participation rate and analyzed the factors associated with participation in screening. Overall, 4069 (12.3%) and 3839 (11.7%) persons participated in CRC screening in 2009 and 2010, respectively; however, the number decreased significantly to 1090 (3.4%) in 2011 when the earthquake occurred. Over the following 3 years, the rate gradually recovered. Multivariable logistic analysis showed that age < 65 years, living alone, and evacuation were significant associated factors for non-participation after 2011 (p < 0.05). In conclusion, the CRC screening participation rate decreased significantly during the Great East Japan Earthquake but recovered over the next 3 years. Further analysis of factors preventing CRC screening participation and research on the long-term effects of its post-disaster decline are important to consider in assessing the need for intervention in post-disaster cancer screening.

Colorectal cancer screening participation according to poverty rates in the department of Bouches-du-Rhône (France)

The rate of participation in organized colorectal cancer screening (DOCCR) remains insufficient in France, with strong disparities between departments. The aim of this work was to assess the relationship between the DOCCR response rates for the communes of the Bouches-du-Rhône (BdR) department and the boroughs ofMarseille and their poverty levels. The DOCCR response rate was assessed for the 2017-2018 campaign. The Pearson coefficient wascalculated to assess correlations with the average poverty rate per commune/borough, the density of general practitioners (GPs) and Potential Localized Accessibility (PLA) to GPs. Among the DOCCR guests, 29.7% (±4.7) responded. The rate of respondents differed significantly between the communes/boroughs of the department (P&lt;0.001). The rate of respondents was inversely correlated with the rate of people living below the poverty line, both for the communes/boroughs of the department, with a high correlation (r=-0.795, P&lt;0.001) and for the Marseille boroughs, with an even higher correlation (r=-0.910, P&lt;0.001). It was inversely correlated with the density of GPs (r=-0.430, P&lt;0.001). On the other hand, there was a weak positive correlation with Potential Localized Accessibility to GPs (r= 0.193, P&lt;0.001), as well as with the age of guests (r=0.476, P&lt;0.001). The poverty rate in the BdR, which is higher than the national average, may partly explain the low rate of DOCCR respondents; other factors such as the density of GPs and their accessibility may play a role.

A practical approach to selecting a colorectal cancer screening test.

Colorectal cancer is the second leading cause of cancer-related deaths in the United States, but timely, effective, and adherent screening can reduce the number of cases. Screening tests continue to evolve, creating opportunities and challenges. Medical societies offer varying guidelines about optimal screening tests and when to begin screening. This article reviews available and emerging colorectal cancer screening tests and discusses how to educate patients, advise them in selecting an appropriate test, and promote increased participation in colorectal cancer screening.

Mobile health interventions for improving colorectal cancer screening rates: A systematic review and meta-analysis.

Objective:The aim of this systematic review and meta-analysis was to determine the efficacy of different mHealth interventions in increasing colorectal cancer (CRC) screening rates. Methods:A literature search for eligible studies was done in ClinicalTrials.gov, PubMed, and Scopus in October 2020. Included studies were randomized controlled trials done on adults due for CRC screening, who received either an mHealth intervention to promote screening or usual care. The primary outcome from these studies was completion of CRC screening. Two reviewers independently worked on selecting studies, collecting data, and determining risk of bias. Adjusted odds ratios (AOR) for CRC screening rates were summarized into a Forest plot. Results:A total of ten trials from three continents were included in the qualitative analysis. Risk of bias is low in terms of randomization, but high in terms of participant blinding, due to the nature of the interventions. Meta-analysis of four trials showed low clinical and statistical heterogeneity (I2=0%). Overall, the use of mHealth interventions is associated with higher CRC screening uptake when compared to usual care (AOR 1.33; 95% CI, 1.20-1.46). This effect was seen across different types of mHealth interventions, which included automated and non-automated telephone education and text-message reminders. Conclusion:This study showed that mHealth is associated with increased CRC screening participation regardless of the type of intervention used.

Women require routine opioids to prevent painful colonoscopies: a randomised controlled trial

Background Women are at high risk for painful colonoscopy. Pain, but also sedation, are barriers to colorectal cancer (CRC) screening participation. In a randomised controlled trial, we compared on-demand with pre-colonoscopy opioid administration to control pain in women at CRC screening age. Methods Women, aged 55–79 years, attending colonoscopy at two Norwegian endoscopy units were randomised 1:1:1 to (1) fentanyl on-demand, (2) fentanyl prior to colonoscopy, or (3) alfentanil on-demand. The primary endpoint was procedural pain reported by the patients on a validated four-point Likert scale and further dichotomized for the study into painful (moderate or severe pain) and non-painful (slight or no pain) colonoscopy. Secondary endpoints were: willingness to repeat colonoscopy, adverse events, cecal intubation time and rate, and post-procedure recovery time. Results Between June 2017 and May 2020, 183 patients were included in intention-to-treat analyses in the fentanyl on-demand group, 177 in the fentanyl prior to colonoscopy group, and 179 in the alfentanil on-demand group. Fewer women receiving fentanyl prior to colonoscopy reported a painful colonoscopy compared to those who were given fentanyl on-demand (25.2% vs. 44.1%, p < .001). There was no difference in the proportion of painful colonoscopies between fentanyl on-demand and alfentanil on-demand (44.1% vs. 39.5%, p = .40). No differences were observed for adverse events or any of the other secondary endpoints between the three groups. Conclusions Fentanyl prior to colonoscopy provided better pain control than fentanyl or alfentanil on-demand. Fentanyl before colonoscopy should be recommended to all women at screening age. Trial registration: Clinicaltrials.gov (NCT 01538550). Norwegian Medicines Agency (16/16266-13). EU Clinical Trials Register (EUDRACTNR. 2016-005090-13)

Exploration of the Proteomic Landscape of Small Extracellular Vesicles in Serum as Biomarkers for Early Detection of Colorectal Neoplasia.

BackgroundPatient participation in colorectal cancer (CRC) screening via a stool test and colonoscopy is suboptimal, but participation can be improved by the development of a blood test. However, the suboptimal detection abilities of blood tests for advanced neoplasia, including advanced adenoma (AA) and CRC, limit their application. We aimed to investigate the proteomic landscape of small extracellular vesicles (sEVs) from the serum of patients with colorectal neoplasia and identify specific sEV proteins that could serve as biomarkers for early diagnosis.Materials and MethodsWe enrolled 100 patients including 13 healthy subjects, 12 non-AAs, 13 AAs, and 16 stage-I, 15 stage-II, 16 stage-III, and 15 stage-IV CRCs. These patients were classified as normal control, early neoplasia, and advanced neoplasia. The sEV proteome was explored by liquid chromatography-tandem mass spectrometry. Generalized association plots were used to integrate the clustering methods, visualize the data matrix, and analyze the relationship. The specific sEV biomarkers were identified by a decision tree via Orange3 software. Functional enrichment analysis was conducted by using the Ingenuity Pathway Analysis platform.ResultsThe sEV protein matrix was identified from the serum of 100 patients and contained 3353 proteins, of which 1921 proteins from 98 patients were finally analyzed. Compared with the normal control, subjects with early and advanced neoplasia exhibited a distinct proteomic distribution in the data matrix plot. Six sEV proteins were identified, namely, GCLM, KEL, APOF, CFB, PDE5A, and ATIC, which properly distinguished normal control, early neoplasia, and advanced neoplasia patients from each other. Functional enrichment analysis revealed that APOF+ and CFB+ sEV associated with clathrin-mediated endocytosis signaling and the complement system, which have critical implications for CRC carcinogenesis.ConclusionPatients with colorectal neoplasia had a distinct sEV proteome expression pattern in serum compared with those patients who were healthy and did not have neoplasms. Moreover, the six identified specific sEV proteins had the potential to discriminate colorectal neoplasia between early-stage and advanced neoplasia. Collectively, our study provided a six-sEV protein biomarker panel for CRC diagnosis at early or advanced stages. Furthermore, the implication of the sEV proteome in CRC carcinogenesis via specific signaling pathways was explored.