Objective To evaluate the effectiveness of the Asia-Pacific Colorectal Screening (APCS) questionnaire and the fecal immunochemical test (FIT), used alone and in combination,in population-based colorectal cancer screening, and to provide evidence for precision prevention and population stratification management of colorectal cancer.
Methods Data were collected from the 2024 Shandong Province colorectal cancer screening program.The study population consisted of 6 259 community residents aged 40–74 years who had lived locally for at least 3 years, recruited from 13 regions using community-based sampling. With pathological examination results as the gold standard, the detection rate of advanced neoplasia and the colonoscopy workload were analyzed for six screening methods: APCS, FIT (50 ng/mL), FIT (100 ng/mL), APCS + FIT (50 ng/mL), APCS + FIT (100 ng/mL), and direct colonoscopy.
Results APCS, FIT (50 ng/mL), FIT (100 ng/mL), APCS + FIT (50 ng/mL), APCS + FIT (100 ng/mL), and direct colonoscopy showed the detection rates for advanced neoplasia being 10.50%, 46.15%, 41.14%, 57.98%, 52.05%, and 7.35%, the detection rates for colorectal cancer being 1.06%, 10.38%, 15.19%, 15.97%, 21.90%, and 0.72%, and the detection rates for advanced adenoma being 9.44%, 35.77%, 25.95%, 42.02%, 30.14%, and 6.63%, respectively. The detection rates for advanced neoplasia, colorectal cancer, and advanced adenoma differed among the screening methods (all P < 0.001). APCS + FIT (50 ng/mL) yielded the highest detection rates for both advanced neoplasia and advanced adenoma, while APCS + FIT (100 ng/mL) had the highest detection rate for colorectal cancer. Stratified analysis revealed that FIT (50 ng/mL) had the highest detection rates for advanced neoplasia and advanced adenoma in community residents aged 40–54 years. FIT (100 ng/mL) showed the highest detection rate for colorectal cancer among residents aged 40–54 and 55–64 years. APCS + FIT (50 ng/mL) achieved the highest detection rates for advanced neoplasia and advanced adenoma in males, females, and residents aged 55–64 and 65–74 years. APCS + FIT (100 ng/mL) yielded the highest detection rates for colorectal cancer in males, females, and residents aged 65–74 years (all P < 0.001). Using the number of colonoscopies required to detect one lesion as an indicator of colonoscopy workload in population screening. That APCS + FIT (50 ng/mL) required the fewest colonoscopies to detect one case of advanced neoplasia and one case of advanced adenoma, at 1.72 (95%CI: 1.41–2.03) and 2.38 (95%CI: 1.95–2.81), respectively. APCS + FIT (100 ng/mL) required the fewest colonoscopies to detect one case of colorectal cancer, at 4.56 (95%CI: 3.52–5.61).
Conclusions In regions with limited medical resources, APCS + FIT is recommended to rapidly identify individuals at high risk of colorectal cancer. However, in regions with sufficient medical resources and funding, direct colonoscopy is recommended to achieve more comprehensive and precise lesion detection.
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