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Original article
Participation and yield of a population-based colorectal cancer screening programme in China
  1. Hongda Chen1,
  2. Ni Li1,
  3. Jiansong Ren1,
  4. Xiaoshuang Feng1,
  5. Zhangyan Lyu1,
  6. Luopei Wei1,
  7. Xin Li1,
  8. Lanwei Guo1,
  9. Zhaoxu Zheng2,
  10. Shuangmei Zou3,
  11. Yueming Zhang4,
  12. Jiang Li1,
  13. Kai Zhang5,
  14. Wanqing Chen1,
  15. Min Dai1,
  16. Jie He6
  17. the group of Cancer Screening Program in Urban China (CanSPUC)
  1. 1 Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
  2. 2 Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
  3. 3 Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
  4. 4 Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
  5. 5 Department of Cancer Prevention, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
  6. 6 Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
  1. Correspondence to Professor Min Dai, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing 100021, China; daimin2002{at}hotmail.com and Professor Jie He, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; hejie{at}cicams.ac.cn

Abstract

Objective Colorectal cancer (CRC) screening has been widely implemented in many countries. However, evidence on participation and diagnostic yield of population-based CRC screening in China is sparse.

Design The analyses were conducted in the context of the Cancer Screening Program in Urban China, which recruited 1 381 561 eligible participants aged 40–69 years from 16 provinces in China from 2012 to 2015. 182 927 participants were evaluated to be high risk for CRC by an established risk score system and were subsequently recommended for colonoscopy. Participation rates and detection of colorectal neoplasms in this programme were reported and their associated factors were explored.

Results 25 593 participants undertook colonoscopy as recommended, with participation rate of 14.0%. High level of education, history of faecal occult blood test, family history of CRC and history of colonic polyp were found to be associated with the participation in colonoscopy screening. Overall, 65 CRC (0.25%), 785 advanced adenomas (3.07%), 2091 non-advanced adenomas (8.17%) and 1107 hyperplastic polyps (4.33%) were detected. Detection rates of colorectal neoplasms increased with age and were higher for men. More advanced neoplasms were diagnosed in the distal colon/rectum (65.2%). Several factors including age, sex, family history of CRC, dietary intake of processed meat and smoking were identified to be associated with the presence of colorectal neoplasms.

Conclusion The diagnostic yield was not optimal using colonoscopy screening in high-risk populations given the relatively low participation rate. Our findings will provide important references for designing effective population-based CRC screening strategies in the future.

  • colonoscopy
  • colorectal cancer
  • colorectal adenomas
  • cancer epidemiology
  • colorectal cancer screening

https://doi.org/10.1136/gutjnl-2018-317124

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    Footnotes

    • HC and NL contributed equally.

    • Contributors Conception and design: HC, MD and JH. Statistical analyses: HC and NL. Data acquisition and data interpretation: HC, NL, JR, XF, ZL, LW, XL and LG. Drafting of the article: HC and NL. All authors revised the manuscript and approved its final version.

    • Funding The study was supported by the National Natural Science Foundation (81703309), CAMS Innovation Fund for Medical Science (2017-I2M-1-006), Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences (2017PT32001), and National Key Research and Development Program of the Ministry of Science and Technology of China (2016YFC0905301).

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval The study was approved by the Ethics Committee of National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College.

    • Provenance and peer review Not commissioned; externally peer reviewed.