title: A combination of clinical risk stratification and fecal immunochemical test results to prioritize colonoscopy screening in asymptomatic participants.
abstract: BACKGROUND
  Stool-based colonoscopy is the preferred strategy for colorectal cancer (CRC) screening. The Asia-Pacific Colorectal Screening System (APCS) score also is helpful in stratifying the risk for advanced neoplasia in the asymptomatic population. The combination of the fecal immunochemical test (FIT) result and clinical risk stratification may be more helpful in stratifying the risk.
  
  
  OBJECTIVE
  To evaluate the value of the combination of FIT and APCS scores in stratifying asymptomatic participants for colonoscopy.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  A total of 948 asymptomatic participants eligible for screening colonoscopy.
  
  
  METHODS
  FIT, APCS score evaluation, screening colonoscopy.
  
  
  METHODS
  The prevalence of colorectal neoplasia in 4 different groups of participants according to FIT and APCS score evaluations.
  
  
  RESULTS
  The prevalence of non-advanced and advanced neoplasia in the 4 groups (high risk with positive FIT result, high risk with negative FIT result, moderate risk with positive FIT result, and moderate risk with negative FIT result) was 44% versus 36.9%, 30.1% versus 11.6%, 27.1% versus 12%, and 22.6% versus 6.4%, respectively (P < .001). Participants with both high-risk scores and positive FIT results had a significantly higher detection rate of advanced neoplasia (6.15-fold, 95% confidence interval, 3.72-10.17) compared with the other 3 groups. Seven cancers were discovered; 4 were in the high-risk with positive FIT result group.
  
  
  CONCLUSIONS
  Hospital-based study.
  
  
  CONCLUSIONS
  In countries with limited resources, participants with positive FIT results and high-risk scores by APCS should be given priority for colonoscopy because this group is most likely to have advanced neoplasia. However, this strategy needs to be confirmed for its cost-effectiveness in a large, population-based study. (
  
  
  BACKGROUND
  TCTR20140228001.).
authors.affiliation: Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand.
authors.forename: Satimai
authors.initials: S
authors.lastname: Aniwan
authors.affiliation: Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand.
authors.forename: Rungsun
authors.initials: R
authors.lastname: Rerknimitr
authors.affiliation: Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand.
authors.forename: Pradermchai
authors.initials: P
authors.lastname: Kongkam
authors.affiliation: Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand.
authors.forename: Naruemon
authors.initials: N
authors.lastname: Wisedopas
authors.affiliation: Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand.
authors.forename: Yuwadee
authors.initials: Y
authors.lastname: Ponuthai
authors.affiliation: Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand.
authors.forename: Supakarn
authors.initials: S
authors.lastname: Chaithongrat
authors.affiliation: Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand.
authors.forename: Pinit
authors.initials: P
authors.lastname: Kullavanijaya
mesh_terms: D000236:Adenoma / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D000368:Aged; D058070:Asymptomatic Diseases; D000066491:Clinical Decision-Making; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D003430:Cross-Sectional Studies; D003661:Decision Support Techniques; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D013785:Thailand / Q000453:epidemiology