Improved risk scoring systems for colorectal cancer screening in Shanghai, China

Abstract

Background: An optimal risk-scoring system enables more targeted offers for colonoscopy in colorectal cancer (CRC) screening. This analysis aims to develop and validate scoring systems using parametric and non-parametric methods for average-risk populations.Methods: Screening data of 807,695 subjects and 2806 detected cases in the firstround CRC screening program in Shanghai were used to develop risk-predictive models and scoring systems using logistic-regression (LR) and artificial-neuralnetwork (ANN) methods. Performance of established scoring systems was evaluated using area under the receiver operating characteristic curve (AUC), calibration, sensitivity, specificity, number of high-risk individuals and potential detection rates of CRC.Results: Age, sex, CRC in first-degree relatives, chronic diarrhoea, mucus or bloody stool, history of any cancer and faecal-immunochemical-test (FIT) results were identified as predictors for the presence of CRC. The AUC of LR-based system was 0.642 when using risk factors only in derivation set, and increased to 0.774 by further incorporating one-sample FIT results, and to 0.808 by including two-sample FIT results, while those for ANN-based systems were 0.639, 0.763 and 0.805, respectively. Better calibrations were observed for the LR-based systems than the ANN-based ones. Compared with the currently used initial tests, parallel use of FIT with LR-based systems resulted in improved specificities, less demands for colonoscopy and higher detection rates of CRC, while parallel use of FIT with ANN-based systems had higher sensitivities; incorporating FIT in the scoring systems further increased specificities, decreased colonoscopy demands and improved detection rates of CRC. Conclusions: Our results indicate the potentials of LR-based scoring systems incorporating one-or two-sample FIT results for CRC mass screening. External validation is warranted for scaling-up implementation in the Chinese population.

Modifiable lifestyle factors have a larger contribution to colorectal neoplasms than family history

“…With regard to the percent with positive family history in FDR (7.8%), it was lower than that from most western countries, but was comparable with or even higher than other reports from China (2.7%-5.9%) [ 26 , 27 ], with some studies only reporting an overall positive rate of high-risk assessment questionnaire, ranging from 3.3% to 15.0% [ 4 , 28 – 30 ]. This could be partly caused by the wide geographical, economic and racial variation in in the pattern of cancer [ 2 , 31 , 32 ], which might be associates with multiple factors, such as genetic, lifestyle, and environmental factors.…”

Risk Scoring Systems for Predicting the Presence of Colorectal Neoplasia by Fecal Immunochemical Test Results in Chinese Population

“…A community-based CRC screening program was performed using the recommended screening strategy in the 16 districts of Shanghai, China, in 2013. As described in our previous reports, all permanent residents aged 50–74 years with no history of CRC were eligible and recruited to participate in the program voluntarily ( 11 , 23 ).…”

“…All lesions detected were further evaluated by biopsy to confirm the pathological diagnosis. When using CRC as the outcome among the 807,109 subjects with complete data of primary tests, we defined the prevalent CRC at the screening as those diagnosed within 2 years of screening to allow the clinical identification, as previously described ( 23 ). Therefore, the outcome in the analysis included the screen-detected CRC obtained from the program reporting system (within 90 days of screening), and the missed or interval CRC supplemented through a record linkage with the Shanghai Cancer Registry using a unique ID number (within 2 years of screening).…”

“…In this study, we aimed to develop and validate FIT-specific scoring systems for CRC in all screened subjects and for colorectal neoplasia in high-risk subjects attending colonoscopy. We also compared the performance of the FIT-specific scoring systems for CRC with (i) the parallel use of risk stratification and FIT, the recommended primary screening test for CRC in Mainland of China ( 22 ), and (ii) the unified scoring system incorporating FIT results in our previous report ( 23 ), both of which followed a traditional primary screening of risk assessment and FIT, ignoring the heterogeneity in biological characteristics, risk factors, and progression between the bleeding and nonbleeding cancers. Our analyses may help to develop a novel FIT-risk assessment primary screening, which may facilitate more accurate risk stratification for colonoscopy and improve the effectiveness and cost-effectiveness of CRC screening.…”

Reducing workloads of public health workers in organised colorectal cancer screening in China

“…Several measures could be taken to reduce the workloads of PHWs in organised CRC screening, which is of great importance for the sustainable implementation of CRC screening (Sun et al, 2018). First of all, the initial tests currently used in organised screening in China can be greatly improved by utilising updated population‐specific RA tool (National Cancer Center, 2021); conducting one‐sample qualitative FIT instead of currently used two‐sample tests (Goede et al, 2013; Kapidzic et al, 2017; Lee et al, 2014; Schreuders et al, 2019); incorporating FIT results in risk scoring system rather than using the two methods in parallel (Wu et al, 2022); or using quantitative FIT in the population as in others (Kaminski et al, 2020; Lee et al, 2014). All these improvements may achieve higher screening accuracy, greater colonoscopy yield and higher detection rates of CRC—hence a much lower burden on PHWs.…”