title: Screening for colorectal cancer in average-risk Chinese population using a mixed strategy with sigmoidoscopy and colonoscopy.
abstract: OBJECTIVE
  The Chinese population has been shown to have more distal colonic neoplasm and a higher sensitivity of sigmoidoscopic screening strategy for detecting advanced neoplasm compared with Western populations. This study was designed to evaluate the efficacy of the mixed screening strategy with sigmoidoscopy and colonoscopy in the average-risk Chinese population.
  
  
  METHODS
  Consecutive average-risk adults aged >/=50 years who underwent colonoscopy as part of a health checkup were enrolled. Data were analyzed in a hypothetical graded screening strategy using colonoscopy on patients older than a certain cutoff age or those with distal sentinel polyps. The sensitivity in detecting advanced colonic neoplasm and advanced proximal neoplasm as well as the number of colonoscopies reduced were assessed.
  
  
  RESULTS
  Of the 2,106 persons eligible for analysis, 1,193 (56.6 percent) were males and 913 (43.4 percent) were females. If the cutoff ages were 55, 60, and 65 years, and adenoma detected in the distal colon was the indication for subsequent colonoscopy, the detection rate for 1) advanced colonic neoplasm in the entire colon would be 94, 93.1, and 83.6 percent, respectively, and 2) advanced proximal neoplasm would be 84.8, 82.6, and 58.7 percent, respectively. The number of colonoscopic procedures could be reduced by 28, 48, and 65 percent if the cutoff ages were 55, 60, and 65 years, respectively.
  
  
  CONCLUSIONS
  The mixed screening strategy using a cutoff age at 60 years and distal adenoma as the sentinel lesion is an effective screening program in the average-risk Chinese population.
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, No. 7, Chung-Shan S. Road, Taipei, Taiwan.
authors.forename: Jyh-Ming
authors.initials: JM
authors.lastname: Liou
authors.forename: Jaw-Town
authors.initials: JT
authors.lastname: Lin
authors.forename: Shih-Pei
authors.initials: SP
authors.lastname: Huang
authors.forename: Han-Mo
authors.initials: HM
authors.lastname: Chiu
authors.forename: Hsiu-Po
authors.initials: HP
authors.lastname: Wang
authors.forename: Yi-Chia
authors.initials: YC
authors.lastname: Lee
authors.forename: Jou-Wei
authors.initials: JW
authors.lastname: Lin
authors.forename: Chia-Tung
authors.initials: CT
authors.lastname: Shun
authors.forename: Jin-Tung
authors.initials: JT
authors.lastname: Liang
authors.forename: Ming-Shiang
authors.initials: MS
authors.lastname: Wu
mesh_terms: D000368:Aged; D002681:China / Q000453:epidemiology; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000453:epidemiology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D012372:ROC Curve; D012680:Sensitivity and Specificity; D012812:Sigmoidoscopy