Prevalence and risk factors of colorectal cancer in Asia

Globally, colorectal cancer (CRC) is a substantial public health burden, and it is increasingly affecting populations in Asian countries. The overall prevalence of CRC is reported to be low in Asia when compared with that in Western nations, yet it had the highest number of prevalent cases. This review described the prevalence of CRC in Asia according to the International Agency for Research on Cancer from World Health Organization (WHO) database and summarized its major risk factors. Non-modifiable factors include genetic factors, ethnicity, age, gender, family history and body height; smoking, alcohol drinking, weight, Westernized diet, physical inactivity, chronic diseases and microbiota were involved in environmental factors. These risk factors were separately discussed in this review according to published literature from Asian countries. CRC screening has been playing an important role in reducing its disease burden. Some recommendations on its screening practices have been formulated in guidelines for Asia Pacific countries.

Reliability and validity of EQ-5D-3L and FACT in Beijing's patients with cancer and precancerosis / 肿瘤

Objective: Based on the Cancer Screening Program in urban districts in Beijing from 2013 to 2014, target populations included pulmonary, mammary, esophageal, colorectal, hepatic and gastric cancers and precancerosis patients. The EQ-5D-3L and Functional Assessment of Cancer Therapy (FACT) questionnaires were used to measure the patients' quality of life and the reliability and validity of EQ-5D-3L and FACT were analyzed. Methods: The EQ-5D-3L and FACT questionnaires were used to measure 1 001 patients with cancer and precancerosis. The Cronbach's α coefficient was calculated to test the consistent reliability of EQ-5D-3L and FACT. The factor analysis was used to measure the construct validity of FACT and the FACT as standard to test the convergent validity of EQ-5D-3L. Results: Cronbach's α coefficients of EQ-5D-3L for pulmonary, breast, esophageal, colorectal, hepatic and gastric cancers were 0.846, 0.805, 0.877, 0.862, 0.793 and 0.844, respectively; the Cronbach's α coefficients of FACT were 0.935, 0.916, 0.950, 0.952, 0.915 and 0.953, respectively. The cumulative explained variances of FACT were 64.28%, 65.15%, 71.43%, 67.21%, 64.76% and 70.56%, respectively. Compared with FACT, the convergent validities of EQ-5D-3L were 0.592, 0.503, 0.715, 0.672, 0.561 and 0.444, respectively. The convergent validities of EQ-Visual Analogue Scale (VAS) were 0.553, 0.606, 0.576, 0.579, 0.361 and 0.364, respectively. Conclusion: EQ-5D-3L and FACT questionnaires for pulmonary, breast, esophageal, colorectal, hepatic and gastric cancers and the precancerosis patients are verified to have good reliabilities, and the FACT questionnaires of six types of cancers are being verified to have good construct validities. The EQ-5D-3L questionnaires for esophageal, colorectal, pulmonary, hepatic and breast cancers are being verified to have good convergent validities; but for the gastric cancer and precancerosis, there are limited validities.

Cost-effectiveness comparison in colorectal cancer screening with fecal immunochemical test and colonoscopy between ages and genders / 中华消化内镜杂志

Objective To investigate the rational program of colorectal cancer(CRC)screening between ages and genders by using single or repeated fecal immunochemical test(FIT)and colonoscopy. Methods Data of 6 193 patients who underwent opportunistic CRC screening at Peking Union Medical College Hospital were retrospectively analyzed.Patients were divided into four groups:(1)direct colonoscopy;(2)one FIT followed by colonoscopy;(3)two FITs followed by colonoscopy;(4)three FITs followed by colonoscopy.Cost-effectiveness of the four screening procedures was compared between different age groups and genders.Results Ninety-seven(1.6%)patients with CRC and 1 038(16.8%)with colorectal adenoma were detected. In patients younger than 40 years old,1-3 positive FIT strategies were superior to direct colonoscopy. In men aged 40 to 60,one or two positive FITs out of three was more cost-effective than direct colonoscopy,so was one positive FIT out of three in women aged 40 to 60. Direct colonoscopy was the most cost-effective strategy in men older than 60,while one positive FIT out of two was the best screening choice in women older than 60. Conclusion Age and gender are two influential factors for cost-effectiveness of CRC screening. Direct colonoscopy is the most cost-effective screening strategy for men older than 60,but one or more positive FIT followed by colonoscopy is preferred in other age and gender groups.

Fecal immunochemical test followed by colonoscopy in opportunistic screening for colorectal neoplasm / 中华全科医师杂志

Objective To assess the fecal immunochemical test (FIT) followed by colonoscopy in opportunistic screenings for colorectal neoplasm.Methods Total 6 193 patients, who underwent opportunistic colorectal cancer (CRC) screening, were classified into four groups: 3 812 patients underwent direct colonoscopy (group 1), 1 244 patients received one FIT followed by colonoscopy (group 2), 341 patients received two FITs followed by colonoscopy (group 3), and 796 patients received three FITs followed by colonoscopy (group 4).Results Total 97 (1.6%) patients with CRC and 1 038 (16.8%) with colorectal adenoma were detected.The positive predictive value of 1, 2 and 3 positive tests out of three FITs for CRC were 4.53%, 5.62% and 8.94%, respectively, which was higher than that of direct colonoscopy (1.52%).One or more positive tests out of three FIT had the largest area under receiver operating characteristic curve (0.743).For colorectal adenoma, detection rate of direct colonoscopy (17 581.25/105) was higher than all FIT strategies (3 732.30/105-13 127.41/105).Conclusions Single or repeated FIT and colonoscopy have different screening utility.One or more positive tests out of three FIT followed by colonoscopy is preferred to screen CRC, and direct colonoscopy is better for detection of colorectal adenoma.