Significance of Colorectal Cancer Screening for Early Diagnosis of Colorectal Neoplasms / 胃肠病学

ABSTRACT

Background: The incidence rate and mortality of colorectal cancer (CRC) in China are increasing, and the age of onset is tending to be younger. Aims: To analyze the results of colonoscopy in patients positive for CRC screening, and to explore the significance of a CRC screening protocol that combines risk assessment questionnaire with fecal occult blood test (FOBT) in early diagnosis of colorectal neoplasms. Methods: Individuals who were positive for the first stage of screening (questionnaire + FOBT) in a community CRC screening program in Shanghai Huangpu District from May 2013 to October 2019 and then received the second stage of screening (colonoscopy) in Ruijin Hospital Luwan Branch were enrolled consecutively. Biopsy or polypectomy specimens were taken for pathological examination if any lesions were found endoscopically. Patients who underwent colonoscopy due to changes in bowel habits in the same period were served as controls. The detection rates of colorectal neoplasms in these two groups and the disease characteristics in the screening positive group were analyzed. Results: The screening positive group included 1 329 residents positive for the first stage of screening. The overall detection rate of colorectal lesions was 63.3%, and the detection rates of CRC, colorectal polyps and adenomatous polyps were 2.6% (34 cases), 60.7% (807 cases) and 35.2% (468 cases), respectively. While in control group (n=22 438), the rates were 43.6%, 1.8%, 41.5%, and 21.6%, respectively, all were significantly lower than those in screening positive group (all P<0.05). In screening positive group, the overall detection rate of colorectal lesions was higher in male than in female (73.7% vs. 54.2%, P<0.05) and increased with aging (P<0.05). Most of the CRC cases were in 60-79 years old age group with no gender difference. All CRC and most of the adenomas with dysplasia were greater than or equal to 1 cm in diameter, while most of the adenomas without dysplasia, hyperplastic polyps and inflammatory polyps were less than 1 cm in diameter. Conclusions: The community CRC screening program practiced in China can increase the detection rates of CRC and precancerous lesions effectively.