Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine Guangzhou, Guangzhou, P. R. China.
Shenzhen Hospital, Southern Medical University, Shenzhen, P. R. China.
Cancer Med. 2022 Nov;11(22):4321-4331. doi: 10.1002/cam4.4730. Epub 2022 Apr 20.
This study aimed to investigate the potential factors associated with adherence to colonoscopy among participants who were preliminarily screened positive in a community-based colorectal cancer screening program in China.
This study analyzed data from 1219 out of 6971 community residents who were identified as positive cases by the well-validated high-risk factor questionnaire (HRFQ) or fecal immunochemical test (FIT) in the preliminary screening stage for colorectal neoplasms. Patients showing adherence to colonoscopy were defined as those who received positive results in a preliminary screening for colorectal neoplasms and later received a colonoscopy examination as required. The associations of social-demographic factors, lifestyle behaviors, history of diabetes, body mass index (BMI), and risk factors in the HRFQ with adherence to colonoscopy were evaluated using logistic regression models.
Among 1219 participants who preliminarily screened positive, the top five risk factors reported by the participants were chronic constipation (25.9%), hematochezia (23.5%), family history of CRC in first-degree relatives (22.1%), chronic diarrhea (21.8%), and history of polyps (16.6%). Around 14.2% of participants who preliminarily screened positive reported three or more risk factors, and the proportion was 26.2% among participants who were positive according to both HRFQ and FIT. Among all participants who were preliminarily screened positive, the multivariable results showed that those who were married (OR = 1.58, 95% CI: 1.12, 2.25, p = 0.01), had chronic diarrhea (OR = 1.34, 95% CI: 1.00, 1.78, p = 0.047), and had a positive FIT (OR = 1.60, 95% CI: 1.21, 2.10, p < 0.001 for patients who were negative according to HRFQ but positive according to FIT; OR = 2.12, 95% CI: 1.33, 2.78, p = 0.002 for patients who were positive for both HRFQ and FIT) were more likely to adhere to colonoscopy, while participants with a history of cancer (OR: 0.50, 95% CI: 0.31, 0.79, p = 0.003) were less likely to adhere to colonoscopy. The results among participants who were tested positive according to only HRFQ were similar to those among all participants who were tested positive according to HRFQ or FIT. However, among participants who were tested positive according to only FIT, we only found that those who were married (OR = 2.52, 95% CI: 1.08, 5.90, p = 0.033) had a higher odds of adhering to colonoscopy, while those with a history of diabetes (OR = 0.35, 95% CI: 0.13, 0.96, p = 0.042) were less likely to adhere to colonoscopy.
Our findings provide evidence supporting the development of tailored interventional strategies that aim to improve adherence to colonoscopy for individuals with a high risk of colorectal neoplasms. Both barriers and facilitators associated with adherence to colonoscopy should be considered in supportive systems and health policies. However, further well-designed prospective studies are warranted to confirm our findings.
本研究旨在探讨中国社区为基础的结直肠癌筛查项目中初步筛查阳性者接受结肠镜检查的潜在相关因素。
本研究分析了来自 6971 名社区居民的 1219 名参与者的数据，这些参与者通过有效的高危因素问卷（HRFQ）或粪便免疫化学试验（FIT）初步筛查结直肠肿瘤呈阳性。将接受结肠镜检查的患者定义为初步筛查结直肠肿瘤呈阳性，随后按要求接受结肠镜检查的患者。使用逻辑回归模型评估社会人口统计学因素、生活方式行为、糖尿病史、体重指数（BMI）和 HRFQ 中的风险因素与接受结肠镜检查的关联性。
在 1219 名初步筛查阳性的参与者中，参与者报告的前五大风险因素依次为慢性便秘（25.9%）、血便（23.5%）、一级亲属结直肠癌家族史（22.1%）、慢性腹泻（21.8%）和息肉史（16.6%）。约 14.2%的初步筛查阳性者报告了三个或更多的风险因素，而 HRFQ 和 FIT 均阳性的参与者中这一比例为 26.2%。在所有初步筛查阳性的参与者中，多变量结果显示，已婚者（OR=1.58，95%CI：1.12，2.25，p=0.01）、有慢性腹泻者（OR=1.34，95%CI：1.00，1.78，p=0.047）和 FIT 阳性者（OR=1.60，95%CI：1.21，2.10，p<0.001，适用于 HRFQ 阴性但 FIT 阳性的患者；OR=2.12，95%CI：1.33，2.78，p=0.002，适用于 HRFQ 和 FIT 均阳性的患者）更有可能接受结肠镜检查，而有癌症史者（OR：0.50，95%CI：0.31，0.79，p=0.003）更不可能接受结肠镜检查。仅 HRFQ 阳性者的结果与 HRFQ 或 FIT 均阳性者的结果相似。然而，在仅 FIT 阳性的参与者中，我们只发现已婚者（OR=2.52，95%CI：1.08，5.90，p=0.033）接受结肠镜检查的可能性更高，而有糖尿病史者（OR=0.35，95%CI：0.13，0.96，p=0.042）接受结肠镜检查的可能性较低。
我们的研究结果为制定针对结直肠肿瘤高危人群的个体化干预策略提供了证据。在支持系统和卫生政策中，应考虑与结肠镜检查依从性相关的障碍和促进因素。然而，还需要进一步设计良好的前瞻性研究来证实我们的发现。
