Assessing Individual Risk for High-Risk Early Colorectal Neoplasm for Pre-Selection of Screening in Shanghai, China: A Population-Based Nested Case–Control Study

Abstract

To identify people with high-risk early colorectal neoplasm is highly desirable for pre-selection in colorectal cancer (CRC) screening in low-resource countries. We aim to build and validate a risk-based model so as to improve compliance and increase the benefits of screening. Patients and Methods: Using data from the Shanghai CRC screening cohort, we conducted a population-based nested case-control study to build a risk-based model. Cases of early colorectal neoplasm were extracted as colorectal adenomas and stage 0-I CRC. Each case was matched with five individuals without neoplasm (controls) by the screening site and year of enrollment. Cases and controls were then randomly divided into two groups, with two thirds for building the risk prediction model and the other one third for model validation. Known risk factors were included for risk prediction models using logistic regressions. The area under the receiver operating characteristic curve (AUC) and Hosmer-Lemeshow chisquare statistics were used to evaluate model discrimination and calibration. The predicted individual risk probability was calculated under the risk regression equation. Results:The model incorporating age, sex, family history and lifestyle factors including body mass index (BMI), smoking status, alcohol, regular moderate-to-intensity physical activity showed good calibration and discrimination. When the risk cutoff threshold was defined as 17%, the sensitivity and specificity of the model were 63.99% and 53.82%, respectively. The validation data analysis also showed well discrimination. Conclusion:A risk prediction model combining personal and lifestyle factors was developed and validated for high-risk early colorectal neoplasm among the Chinese population. This risk-based model could improve the pre-selection for screening and contribute a lot to efficient population-based screening in low-resource countries.

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“… 4 In China, CRC is the second leading cause of cancer and the incidence has increased rapidly over the past two decades. 5 The primary risk factors for CRC include older age, family history, unhealthy diet, smoking and alcohol. 6 But the aetiology of CRC has not been completely illustrated and the immediate causes remain unknown.…”

Choice of injection time of conscious sedation and its impact on pain control in colonoscopy

“…FIT is convenient and economical, while colonoscopy has a greater CRC incidence reduction ( 4 ) and is currently regarded as the gold standard examination for colorectal lesion screening ( 5 , 6 ). The primary goals of these screenings are to identify and aptly remove colorectal adenomas and lesions that are believed to lead to the development of CRC ( 7 , 8 ).…”