Digestive Oncology Research Centre, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Östra, 416 85, Gothenburg, Sweden.
Arch Iran Med. 2023 Mar 1;26(3):138-146. doi: 10.34172/aim.2023.22.
Colorectal cancer (CRC) is the third most common cancer in Iran, where there is no organised CRC-screening programme. This study aimed to evaluate feasibility of CRC screening using a qualitative fecal immunochemical test (FIT) among Iranian average-risk adults.
In this feasibility study, 7039 individuals aged 50-75 years were invited by community health workers (CHWs) in southern Tehran and its suburban districts between April 2018 and November 2019. The CHWs performed a qualitative FIT with cut-off level 50 ng Hb/mL buffer and referred those with positive-FIT for colonoscopy to the endoscopy center of Shariati hospital in Tehran. Outcomes included acceptance rate, FIT positivity rate, colonoscopy compliance, detection rates and positive predictive values (PPVs) with 95% confidence interval for CRC and advanced adenomas (AAs).
Acceptance rate at initial invitation was 71.7%. From 4974 average-risk adults (1600 males and 3374 females) who were offered FIT, 96.8% (n=4813) provided valid samples, of whom 471 (9.8%) tested positive. Among FIT-positive participants, 150 (31.8%) underwent colonoscopy; CRC was detected in 2.0% (n=3) and adenomas in 27.3% (n=41). Detection rate of CRC and AAs per 1000-FIT-screened participants was 0.6 (0.1-1.8) [males: 0.7 (0.01-3.6), females: 0.6 (0.07-2.0)] and 4.2 (2.5-6.4) [males: 5.9 (2.6-11.0), females: 3.4 (1.7-6.0)], respectively. PPVs were 2.0% (0.4-5.7) for CRC and 13.3% (8.3-19.8) for AAs. There was no association between gender and the studied outcomes.
Our results partially support the feasibility of scaling up organized CRC-screening through the existing healthcare system in Iran; it remains to be discussed carefully to ensure the capacity of healthcare system for adequate colonoscopy services.
结直肠癌（CRC）是伊朗第三大常见癌症，但伊朗没有组织化的 CRC 筛查计划。本研究旨在评估使用定性粪便免疫化学测试（FIT）对伊朗普通风险成年人进行 CRC 筛查的可行性。
在这项可行性研究中，2018 年 4 月至 2019 年 11 月期间，社区卫生工作者（CHW）邀请了南部德黑兰及其郊区的 7039 名年龄在 50-75 岁之间的个体。CHW 使用 50ng Hb/mL 缓冲液的 cutoff 水平进行定性 FIT，并将阳性 FIT 的个体转诊至德黑兰 Shariati 医院的内镜中心进行结肠镜检查。结果包括初诊时的接受率、FIT 阳性率、结肠镜检查依从性、检出率和 CRC 和高级腺瘤（AA）的阳性预测值（PPV），置信区间为 95%。
初诊时的接受率为 71.7%。在 4974 名接受 FIT 的普通风险成年人（1600 名男性和 3374 名女性）中，96.8%（n=4813）提供了有效样本，其中 471 名（9.8%）测试结果阳性。在 FIT 阳性的参与者中，有 150 名（31.8%）进行了结肠镜检查；发现 2 例 CRC（2.0%）和 41 例腺瘤（27.3%）。每 1000 名 FIT 筛查参与者的 CRC 和 AA 检出率分别为 0.6（0.1-1.8）[男性：0.7（0.01-3.6），女性：0.6（0.07-2.0）]和 4.2（2.5-6.4）[男性：5.9（2.6-11.0），女性：3.4（1.7-6.0）]。PPV 分别为 2.0%（0.4-5.7）用于 CRC 和 13.3%（8.3-19.8）用于 AA。性别与研究结果之间无关联。
我们的结果部分支持通过伊朗现有的医疗保健系统扩大组织化 CRC 筛查的可行性；仍需仔细讨论，以确保医疗保健系统有能力提供足够的结肠镜检查服务。
