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

Abstract

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.

Association of Escherichia coli containing polyketide synthase in the gut microbiota with colorectal neoplasia in Japan

“…The study aimed to evaluate the diagnostic ability and effectiveness of colorectal cancer screening techniques and biomarkers. 16 We recruited all island residents aged 40-79 years without uncontrollable complications, including unstable angina, acute myocardial infarction, heart failure, chronic respiratory disease, and bleeding tendency, which would hinder the safe performance of colonoscopy.…”

A scoping review of risk-stratified bowel screening: current evidence, future directions

“…Therefore, it is proposed that a 2-day FIT could help to prioritise patients for colonoscopy. Another Japanese study [ 26 ] evaluated the performance of an 8-point risk score based on age, sex, CRC family history, BMI and smoking and in combination with FIT at different thresholds for 1 and 2 days. PPV was higher in the combined risk score and FIT group with increased sensitivity but lower specificity.…”

Precision Colorectal Cancer Fecal Immunological Test Screening With Fecal-Hemoglobin-Concentration–Guided Interscreening Intervals

“…The analysis did not include the additional information on other risk factors associated with CRC. Although using f-Hb concentrations could offer a straightforward method to personalize screening, several studies have suggested incorporating additional individual characteristics—such as family history, body mass index, and smoking—as risk scores in conjunction with FIT to enhance the precision of cancer detection . There are already systems in place where information such as sex, age, and the quantitative FIT result is registered in existing databases for all screening participants.…”