Wu Weimiao, Tan Songsong, Huang Junjie, Chen Yingyao, Wong Martin C S, Xu Wanghong
Global Health Institute, Fudan University School of Public Health, Shanghai, China.
The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
Front Med (Lausanne). 2024 Jan 31;11:1232134. doi: 10.3389/fmed.2024.1232134. eCollection 2024.
The effectiveness of triage screening for colorectal cancer (CRC) is not fully achieved in Chinese populations, mainly due to low compliance to colonoscopy follow-up. This study aimed to collect viewpoints of experts in China on ongoing screening programs and emerging screening tests for CRC, which may help to improve effectiveness of CRC screening in the country.
We conducted 15 semi-structured interviews with experts involving CRC screening in China during October to November of 2020. Interview topics included personal characteristics, work context, opinions on ongoing screening programs, challenges and opportunities in optimization of screening strategies, and prospects for CRC screening in near future. To analyze the data, we used a generic qualitative research approach inspired by grounded theory, including open, axial, and selective coding.
This analysis revealed a total of 83 initial categories, 37 subcategories and 10 main categories, which included 4 core categories of current modality for CRC screening, factors influencing screening effectiveness, optimization of CRC screening modality, and prospects for development of CRC screening. The results provide insight into the factors underlying the challenges of the ongoing CRC screening programs in China: the most important concern is the low compliance to colonoscopy, followed by the low specificity of the currently-used initial tests. The experts proposed to use quantitative instead of qualitative fecal immunochemical test (FIT), and optimize risk assessment tools to improve specificity of initial tests. Regarding the emerging screening tests, 9 of 15 experts did not think that the novel techniques are good enough to replace the current tests, but can be used complementarily in opportunistic screening for CRC.
The viewpoints of Chinese experts suggested that use quantitative FIT or optimize risk assessment tools may help to identify high-risk individuals of CRC more accurately, improve adherence to colonoscopy, and thus fully achieve the effectiveness of screening.
在中国人群中，结直肠癌（CRC）分诊筛查的有效性尚未完全实现，主要原因是结肠镜检查随访的依从性较低。本研究旨在收集中国专家对当前CRC筛查项目和新兴筛查测试的观点，这可能有助于提高该国CRC筛查的有效性。
2020年10月至11月期间，我们对参与中国CRC筛查的专家进行了15次半结构化访谈。访谈主题包括个人特征、工作背景、对当前筛查项目的看法、优化筛查策略的挑战和机遇，以及近期CRC筛查的前景。为了分析数据，我们采用了一种受扎根理论启发的通用定性研究方法，包括开放式编码、轴心式编码和选择性编码。
该分析共揭示了83个初始类别、37个子类别和10个主要类别，其中包括CRC筛查当前模式、影响筛查有效性的因素、CRC筛查模式的优化以及CRC筛查发展前景这4个核心类别。结果深入了解了中国当前CRC筛查项目面临挑战的潜在因素：最主要的问题是结肠镜检查的依从性低，其次是目前使用的初始检测的特异性低。专家们建议使用定量而非定性的粪便免疫化学检测（FIT），并优化风险评估工具以提高初始检测的特异性。关于新兴筛查测试，15名专家中有9名认为新技术不足以取代当前测试，但可在CRC机会性筛查中互补使用。
中国专家的观点表明，使用定量FIT或优化风险评估工具可能有助于更准确地识别CRC高危个体，提高结肠镜检查的依从性，从而充分实现筛查的有效性。
