Chen H D, Lu M, Liu C C, Zhang Y H, Zou S M, Shi J F, Ren J S, Li N, Dai M
Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
Zhonghua Liu Xing Bing Xue Za Zhi. 2020 Oct 10;41(10):1655-1661. doi: 10.3760/cma.j.cn112338-20200227-00196.
To compare the rates of acceptance of colonoscopy, fecal immunochemical test (FIT), or a novel risk-adapted screening approach in the colorectal cancer (CRC) screening program. Related risk factors were also studied. The study has been based on an ongoing randomized controlled trial on colorectal cancer screening programs in six centers of research since May 2018. The involved participants were those who presented at the baseline screening phase. All the participants were randomly allocated into one of the following three intervention arms in a 1∶2∶2 ratio: colonoscopy group, FIT group, and a novel risk-adapted screening group. All the participants underwent risk assessment on CRC by an established risk score system. The subjects with high-risk were recommended to undertake the colonoscopy while the low-risk ones were receiving the FIT. Detailed epidemiological data was collected through questionnaires and clinical examinations. Rates of participation and compliance in all three groups were calculated. Multivariate logistic regression models were used to explore the potential associated factors related to the acceptance of screening. There were 19 546 eligible participants involved in the study, including 3 916 in the colonoscopy group, 7 854 in the FIT group, and 7 776 in the novel risk-adapted screening group, respectively. Among the 19 546 participants, the mean age was 60.5 years (=6.5), and 8 154 (41.7) were males. The rates of participation in the colonoscopy, FIT and the novel risk-adapted screening groups were 42.5, 94.0 and 85.2, respectively. In the novel risk-adapted screening group, the participation rate was 49.2 for the high-risk participants who need to undertake colonoscopy and was 94.0 for the low-risk ones who need to undertake FIT. Results from the multivariate logistic regression models demonstrated that there were several factors associated with the rates of participation in CRC screening, including age, background of education, history of smoking cigarettes, previous history of bowel examination, chronic inflammatory bowel disease and family history of CRC among the 1(st)-degree relatives. FIT and the novel risk-adapted screening approach showed superior participation rates to the colonoscopy. Further efforts including health promotion campaign for specific target population are needed to improve the engagement which ensures the effectiveness of CRC screening programs.
比较结肠镜检查、粪便免疫化学检测（FIT）或一种新型风险适应性筛查方法在结直肠癌（CRC）筛查项目中的接受率。还研究了相关风险因素。该研究基于自2018年5月起在六个研究中心进行的一项正在进行的关于结直肠癌筛查项目的随机对照试验。参与的参与者是那些处于基线筛查阶段的人。所有参与者以1∶2∶2的比例随机分配到以下三个干预组之一：结肠镜检查组、FIT组和新型风险适应性筛查组。所有参与者通过既定的风险评分系统进行结直肠癌风险评估。高危受试者被建议进行结肠镜检查，而低危受试者接受FIT检查。通过问卷调查和临床检查收集详细的流行病学数据。计算三组的参与率和依从率。使用多变量逻辑回归模型探讨与筛查接受度相关的潜在因素。该研究共有19546名符合条件的参与者，其中结肠镜检查组有3916人，FIT组有7854人，新型风险适应性筛查组有7776人。在这19546名参与者中，平均年龄为60.5岁（标准差=6.5），男性有8154人（41.7%）。结肠镜检查组、FIT组和新型风险适应性筛查组的参与率分别为42.5%（42.5）、94.0%（94.0）和85.2%（85.2）。在新型风险适应性筛查组中，需要进行结肠镜检查的高危参与者的参与率为49.2%（49.2），需要进行FIT检查的低危参与者的参与率为94.0%（94.0）。多变量逻辑回归模型的结果表明，有几个因素与结直肠癌筛查的参与率相关联，包括年龄、教育背景、吸烟史、既往肠道检查史、慢性炎症性肠病以及一级亲属中的结直肠癌家族史。FIT和新型风险适应性筛查方法的参与率高于结肠镜检查组。需要进一步努力，包括针对特定目标人群开展健康促进活动，以提高参与度，从而确保结直肠癌筛查项目的有效性。
