title: Performance of a colorectal cancer screening protocol in an economically and medically underserved population.
abstract: The performance of combining fecal immunochemical tests (FITs) and a high-risk factor questionnaire (HRFQ) in colorectal cancer (CRC) screening in economically and medically underserved populations is uncertain. This study investigated the performance of a CRC screening protocol of combining FITs and an HRFQ as primary screening methods in a rural Chinese population. A CRC mass screening was conducted using FITs and an HRFQ as the first and colonoscopy as the second stage of screening in Jiashan, 2007-2009. The target population was 31,963 residents in three communities. The compliance was 84.7% for HRFQ, 76.4% for FITs, and 78.7% for colonoscopy. The detected rates of cancer, adenoma, nonadenomatous polyps, and advanced neoplasm were 2.7%, 14.8%, 5.9%, and 8.9% by FITs, which were higher than those by HRFQ (0.5%, 9.2%, 4.8%, and 3.8%, respectively). There was no significant difference in detected rate for nonadenomatous polyps between FITs and HRFQ. A total of 41.2% adenomas, 53.2% nonadenomatous polyps, and 29.8% advanced neoplasms were detected by HRFQ but missed by FITs. Positive predictive value of the screening protocol of combining FITs and HRFQ for advanced neoplasm was 5.7%, which was higher than FITs alone. Men had a higher prevalence of advanced neoplasm than women. Results indicate that combining FITs and HRFQ as primary screening methods is an efficient CRC screening strategy in economically and medically underserved populations.
authors.affiliation: Cancer Institute, Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Zhejiang province, PR China.
authors.forename: Shan-Rong
authors.initials: SR
authors.lastname: Cai
authors.forename: Su-Zhan
authors.initials: SZ
authors.lastname: Zhang
authors.forename: Hong-Hong
authors.initials: HH
authors.lastname: Zhu
authors.forename: Yan-Qin
authors.initials: YQ
authors.lastname: Huang
authors.forename: Qi-Rong
authors.initials: QR
authors.lastname: Li
authors.forename: Xin-Yuan
authors.initials: XY
authors.lastname: Ma
authors.forename: Kai-Yan
authors.initials: KY
authors.lastname: Yao
authors.forename: Shu
authors.initials: S
authors.lastname: Zheng
mesh_terms: D000328:Adult; D000368:Aged; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology*; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D007159:Immunologic Tests; D008297:Male; D008403:Mass Screening; D008507:Medically Underserved Area; D008875:Middle Aged; D009780:Occult Blood; D010349:Patient Compliance; D011237:Predictive Value of Tests; D015995:Prevalence; D012307:Risk Factors; D012812:Sigmoidoscopy; D011795:Surveys and Questionnaires