Improvement of Asia-Pacific colorectal screening score and evaluation of its use combined with fecal immunochemical test

He, Xuxia; Yuan, Siyi; Li, Wenbin; Yang, Hong; Ji, Wen; Wang, Zhiqiang; Hao, Jianyu; Chen, Chuan; Chen, Weiqing; Ying-xin, Gao; Li, Lingbo; Cheng, Kailiang; Qian, Jiaming; Wang, Li; Li, Jingnan

doi:10.1186/s12876-019-1146-2

Cited by 17 publications

(22 citation statements)

References 36 publications

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“…Only studies that were conducted in Asia employed RA tools as part of the screening process. For example, the Asia-Pacific Colorectal Screening (APCS) score [26] identified people who had a 3.4-fold (95% CI 1.8-6.4) increased risk of advanced colorectal neoplasia in a prospective multi-centre study in China [63]. RA tools appear to be an efficient and cost-effective way to identify individuals at high risk of CRC [64] and the evidence indicates that, overall, they merit consideration by other LMICs.…”

Section: Discussionmentioning

confidence: 99%

“…Opportunistic interventions (5/6) that were conducted from clinics or hospitals achieved an uptake of > 65% [19,21,[25][26][27]. Most population-based sampling studies achieved better stool test uptake proportions when participants were approached face-to-face (40,53,63,76, 83 and 98%) compared to recruitment through letter, phone, or media call (14, 35 and 63%). Two population-based studies with the lowest participation rates and two population-based studies with the highest participation rates required participants to return two FITs rather than one FIT (14 and 40% vs 76 and 98%, respectively) [24,[28][29][30].…”

Section: Recruitmentmentioning

confidence: 99%

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The implementation of colorectal cancer screening interventions in low-and middle-income countries: a scoping review

et al. 2021

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Background Low- and middle-income countries (LMICs) experienced increasing rates of colorectal cancer (CRC) incidence in the last decade and lower 5-year survival rates compared to high-income countries (HICs) where the implementation of screening and treatment services have advanced. This review scoped and mapped the literature regarding the content, implementation and uptake of CRC screening interventions as well as opportunities and challenges for the implementation of CRC screening interventions in LMICs. Methods We systematically followed a five-step scoping review framework to identify and review relevant literature about CRC screening in LMICs, written in the English language before February 2020. We searched Medline, Embase, Web of Science and Google Scholar for studies targeting the general, asymptomatic, at-risk adult population. The TIDieR tool and an implementation checklist were used to extract data from empirical studies; and we extracted data-informed insights from policy reviews and commentaries. Results CRC screening interventions (n = 24 studies) were implemented in nine middle-income countries. Population-based screening programmes (n = 11) as well as small-scale screening interventions (n = 13) utilised various recruitment strategies. Interventions that recruited participants face-to-face (alone or in combination with other recruitment strategies) (10/15), opportunistic clinic-based screening interventions (5/6) and educational interventions combined with screening (3/4), seemed to be the strategies that consistently achieved an uptake of > 65% in LMICs. FOBT/FIT and colonoscopy uptake ranged between 14 and 100%. The most commonly reported implementation indicator was ‘uptake/reach’. There was an absence of detail regarding implementation indicators and there is a need to improve reporting practice in order to disseminate learning about how to implement programmes. Conclusion Opportunities and challenges for the implementation of CRC screening programmes were related to the reporting of CRC cases and screening, cost-effective screening methods, knowledge about CRC and screening, staff resources and training, infrastructure of the health care system, financial resources, public health campaigns, policy commitment from governments, patient navigation, planning of screening programmes and quality assurance.

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Section: Discussionmentioning

confidence: 99%

Section: Recruitmentmentioning

confidence: 99%

The implementation of colorectal cancer screening interventions in low-and middle-income countries: a scoping review

et al. 2021

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“…NEUROG1 + FIT model detected all CRC cases, besides 35.85–47.17% of AA, when specificity was fixed around 98% and 95%. The diagnostic competence of this model resulted more evident when compared to the FIT model (including FIT, age and gender), proposed in other works for CRC detection in symptomatic [ 29 ] and asymptomatic [ 30 ] patients. For the FIT model, sensitivity for AN and AA considerably decreased, more abruptly for 98.21% specificity.…”

Section: Discussionmentioning

confidence: 85%

Value of Serum NEUROG1 Methylation for the Detection of Advanced Adenomas and Colorectal Cancer

et al. 2020

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Aberrant DNA methylation detected in liquid biopsies is a promising approach for colorectal cancer (CRC) detection, including premalignant advanced adenomas (AA). We evaluated the diagnostic capability of serum NEUROG1 methylation for the detection of AA and CRC. A CpG island in NEUROG1 promoter was assessed by bisulfite pyrosequencing in a case-control cohort to select optimal CpGs. Selected sites were evaluated through a nested methylation-specific qPCR custom assay in a screening cohort of 504 asymptomatic family-risk individuals. Individuals with no colorectal findings and benign pathologies showed low serum NEUROG1 methylation, similar to non-advanced adenomas. Contrarily, individuals bearing AA or CRC (advanced neoplasia—AN), exhibited increased NEUROG1 methylation. Using >1.3518% as NEUROG1 cut-off (90.60% specificity), 33.33% of AN and 32.08% of AA were identified, detecting 50% CRC cases. Nonetheless, the combination of NEUROG1 with fecal immunochemical test (FIT), together with age and gender through a multivariate logistic regression resulted in an AUC = 0.810 for AN, and 0.796 for AA, detecting all cancer cases and 35–47% AA (specificity 98–95%). The combination of NEUROG1 methylation with FIT, age and gender demonstrated a convenient performance for the detection of CRC and AA, providing a valuable tool for CRC screening programs in asymptomatic individuals.

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“…Thus, combining the risk score with the FIT is strongly considered a more favorable option. Some previous studies have demonstrated the improved detectability of ACN with the additional use of a risk score to the FIT ( 14 , 25 – 27 ). Our study confirmed the improved sensitivity with the use of a risk score; notably, our study newly clarified that the improvement of the screening sensitivity with the use of the risk score is more remarkable for right-sided ACN.…”

Section: Discussionmentioning

confidence: 99%

Risk Stratification Score Improves Sensitivity for Advanced Colorectal Neoplasia in Colorectal Cancer Screening: The Oshima Study Workgroup

Sekiguchi

Kakugawa²,

Ikematsu³

et al. 2021

Clin Transl Gastroenterol

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INTRODUCTION: Noninvasive colorectal cancer (CRC) screening methods with higher sensitivity for advanced colorectal neoplasia (ACN) than the fecal immunochemical test (FIT) alone are warranted. This study aimed to elucidate the diagnostic performance of a risk stratification score calculated using baseline individual characteristics and its combination with FIT for detecting ACN. METHODS: This cross-sectional analysis of data from a prospective cohort in Izu Oshima, Japan, included asymptomatic individuals age 40–79 years who underwent both 2-day quantitative FIT and screening colonoscopy. The 8-point risk score, calculated based on age, sex, CRC family history, body mass index, and smoking history, was assessed. Colonoscopy results were used as reference. RESULTS: Overall, 1,191 individuals were included, and 112 had ACN. The sensitivity and specificity of the 1-/2-day FIT (cutoff: 50–200 ng Hb/mL) for ACN were 17.9%–33.9% (4.9%–22.0% for right-sided ACN) and 91.8%–97.6%, respectively. The risk score's c-statistic for ACN was 0.66, and combining the score (cutoff: 5 points) with 1-/2-day FIT (cutoff: 50–200 ng Hb/mL) yielded a sensitivity and specificity for ACN of 46.4%–56.3% (43.9%–48.8% for right-sided ACN) and 76.6%–80.8%, respectively. The specificity of the risk score and FIT combination for all adenomatous lesions was 82.4%–86.4%. DISCUSSION: The 8-point risk score remarkably increased the sensitivity for ACN, particularly for right-sided ACN. Although the specificity decreased, it was still maintained at a relatively high level. The risk score and FIT combination has the potential to become a viable noninvasive CRC screening option.

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Improvement of Asia-Pacific colorectal screening score and evaluation of its use combined with fecal immunochemical test

Cited by 17 publications

References 36 publications

The implementation of colorectal cancer screening interventions in low-and middle-income countries: a scoping review

The implementation of colorectal cancer screening interventions in low-and middle-income countries: a scoping review

Value of Serum NEUROG1 Methylation for the Detection of Advanced Adenomas and Colorectal Cancer

Risk Stratification Score Improves Sensitivity for Advanced Colorectal Neoplasia in Colorectal Cancer Screening: The Oshima Study Workgroup

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