Salimzadeh Hamideh, Bishehsari Faraz, Sauvaget Catherine, Amani Mohammad, Hamzehloo Gholamreza, Nikfarjam Ali, Merat Shahin, Delavari Alireza, Malekzadeh Reza
Digestive Oncology Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Department of Internal Medicine, Division of Gastroenterology, Rush University Medical Center, Chicago, IL, USA.
Arch Iran Med. 2017 Dec 1;20(12):726-733.
Colorectal cancer (CRC) is the third most common cancer in Iran, where there is no mass screening for the disease yet. We aimed to measure the feasibility of a pilot CRC screening program based on fecal immunochemical test (FIT) in Iranian population and the implications for scaling-up at the national level.
A single quantitative FIT was offered by health navigators to individuals aged between 45 and 75 years in primary health centers in rural and urban areas in Tehran. Participants who had a positive FIT were referred for colonoscopy.
A total of 1044 asymptomatic average-risk individuals were enrolled. The mean age (SD) was 54.1 ± 7.0 years and nearly 63.0% (n = 657) were female. Only a small fraction of the participants had a prior screening practice (2.2%) and were aware of colon cancer (13.7%). In sum, 1002 returned the FIT kit, of whom the stool sample was unsatisfactory for testing in six participants (0.6%). The FIT uptake was 96.0%, positivity rate was 9.1% and the detection rates were 11.9% for adenomas and 7.1% for advanced adenomas. No cancer was detected. The positive predictive value (PPV) of the FIT was about 17% for any colonic neoplasms.
This is the first study that reports minimal quality metrics within a CRC screening process. FIT modality as a test of choice for colon cancer screening in average-risk people is a safe and highly acceptable method of screening in Iranian people. The results of the current study may not be limited to Iranians, and could have implications to other developing countries with similar trends of CRC epidemic.
结直肠癌（CRC）是伊朗第三大常见癌症，该国尚未开展针对该疾病的大规模筛查。我们旨在评估基于粪便免疫化学检测（FIT）的结直肠癌筛查试点项目在伊朗人群中的可行性以及对全国范围内扩大筛查规模的意义。
健康导航员在德黑兰城乡地区的初级卫生保健中心为45至75岁的个体提供单次定量FIT检测。FIT检测呈阳性的参与者被转诊进行结肠镜检查。
共纳入1044名无症状的平均风险个体。平均年龄（标准差）为54.1±7.0岁，近63.0%（n = 657）为女性。只有一小部分参与者曾进行过筛查（2.2%）且知晓结肠癌（13.7%）。总计1002人返还了FIT检测试剂盒，其中6名参与者（0.6%）的粪便样本检测不合格。FIT检测的接受率为96.0%，阳性率为9.1%，腺瘤的检出率为11.9%，高级别腺瘤的检出率为7.1%。未检测到癌症。FIT对任何结肠肿瘤的阳性预测值（PPV）约为17%。
这是第一项报告结直肠癌筛查过程中最低质量指标的研究。FIT作为平均风险人群结肠癌筛查的首选检测方法，在伊朗人群中是一种安全且高度可接受的筛查方法。本研究结果可能不仅限于伊朗人，对其他结直肠癌流行趋势相似的发展中国家也可能具有启示意义。
