Colorectal cancer in urban residents of Xuzhou from 2014 to 2021: a screening and follow-up study

Objective To analyze the screening and follow-up results for colorectal cancer (CRC) among urban residents in Xuzhou city, Jiangsu province from 2014 to 2021, thereby providing evidence for optimizing local CRC screening strategies.

Methods From July 2014 to December 2021, a randomized cluster sampling method was used to select 521 799 urban residents aged 40–74 years from 44 communities (8 in Gulou district, 5 in Yunlong district, 15 in Quanshan district, 5 in Jiawang district, and 11 in Tongshan district) in Xuzhou city. A risk assessment questionnaire was administered to identify high-risk populations for CRC, followed by clinical screening. The high-risk rate, colonoscopy compliance rate, and lesion detection rate were analyzed. All participants in the questionnaire survey underwent regular follow-up, with detailed documentation of outcomes.

Results From 2014 to 2021, a total of 118 012 urban residents in Xuzhou completed the questionnaire, with 15 444 high-risk individuals (high-risk rate: 13.09%) being identified. Among the high-risk group, 4 070 underwent colonoscopy (compliance rate: 26.35%). Colonoscopy detected non-neoplastic polyps (1 096 cases), non-advanced adenomas (812 cases), advanced adenomas (191 cases), and CRC (5 cases), which showed the detection rates of 26.93%, 19.95%, 4.69%, and 0.12%, respectively. The early diagnosis rate was 85.46% (194/227). By December 31, 2023, the median follow-up time was 6.1 years, with 458 reported CRC cases (cumulative incidence: 0.39%) and 107 CRC deaths (cumulative mortality: 0.09%). Among confirmed cases with TNM staging (280 cases, 61.14% of total new cases), the proportion of early-stage cancer was higher in the high-risk group (62.79%) than in the non-high-risk group (44.73%) (χ² = 4.76, P = 0.029).

Conclusions From 2014 to 2021 in Xuzhou, colonoscopy compliance and CRC detection rates remained low among high-risk urban populations. The high-risk group exhibited a higher proportion of early-stage cancer than the non-high-risk group, which suggested that CRC screening in high-risk populations can improve the early diagnosis rate.