A Risk-Scoring System Combined With a Fecal Immunochemical Test Is Effective in Screening High-Risk Subjects for Early Colonoscopy to Detect Advanced Colorectal Neoplasms

Abstract

The APCS scoring system, which is based on age, sex, family history, and smoking, is a useful tool for determining risk for colorectal cancer and advanced adenoma in asymptomatic subjects. Use of the APCS score-based algorithm in triaging subjects for FIT or colonoscopy can substantially reduce colonoscopy workload.

Colorectal Cancer Screening: Recommendations for Physicians and Patients from the U.S. Multi-Society Task Force on Colorectal Cancer

“…Risk stratifi cation has been poorly accepted because of limited accuracy in discriminating high-and low-prevalence subgroups ( 27 ). However, recent validated models appear to be simple to apply and had substantial accuracy in defi ning high-and low-risk groups for advanced adenomas ( 28,29 ). Th ere are no clinical trials comparing compliance or other outcomes using a risk-stratifi ed approach to the multiple options or sequential approaches.…”

Identifying the optimal strategy for screening of advanced colorectal neoplasia

“…When individuals are screened using FIT, we highly recommend using FIT and APCS together, because the APCS system improves the sensitivity of the screening strategy from 20% (FIT alone) to 37% (FIT or APCS ≥4). The combination strategy of FIT and APCS has already been suggested in two previous studies (Aniwan et al and Chiu et al ) . Aniwan et al reported that participants with both high‐risk APCS score and positive FIT results had a significantly higher detection rate of ACRN (6.15‐fold) than the other groups; thus, the authors suggested that, in countries with limited resources, participants with positive FIT results and high‐risk scores by APCS should be given priority for colonoscopy .…”

“…In addition, under this combination strategy, the number of individuals undergoing FIT can be minimized: Individuals with a high risk of APCS would directly receive colonoscopy without undergoing FIT, and only those with a low or moderate risk of APCS would undergo FIT . In the study of Chiu et al , only 71.4% of participants were required to undergo FIT …”

“…Conversely, a relatively high cut‐off value leads to poor sensitivity. Therefore, efforts have been made to combine risk stratification models with other screening methods, such as FIT or sigmoidoscopy, in order to improve diagnostic performance …”

Understanding colorectal cancer in Malaysia: A mini-review and pioneering colorectal cancer awareness, screening and treatment project

“…Generally, CRC screening is recommended for populations aged 50 to 75 years using fecal immunochemical test (FIT) 6 . A risk-stratified scoring system can also be considered to prioritize high-risk population for colonoscopy 19,20,18 . The diagnostic accuracy and effectiveness of FIT for CRC screening in Malaysian population has also been demonstrated 21 .…”