Brief Article
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Dec 28, 2009; 15(48): 6111-6116
Published online Dec 28, 2009. doi: 10.3748/wjg.15.6111
Performance value of high risk factors in colorectal cancer screening in China
Wen Meng, Shan-Rong Cai, Lun Zhou, Qi Dong, Shu Zheng, Su-Zhan Zhang
Wen Meng, Shan-Rong Cai, Lun Zhou, Qi Dong, Shu Zheng, Su-Zhan Zhang, Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, Zhejiang Province, China), The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
Wen Meng, Department of Cardiothoracic Surgery, Hangzhou First People’s Hospital, Hangzhou 310006, Zhejiang Province, China
Author contributions: Meng W, Zheng S and Zhang SZ designed the research; Meng W, Cai SR, Zhou L and Dong Q performed the research; Meng W and Cai SR analyzed the data; Meng W and Zheng S wrote the paper.
Supported by 11th 5-Year Key Programs for Science and Technology Development of China, No. 2006BAI02A08
Correspondence to: Su-Zhan Zhang, Professor, Cancer Institute, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, Zhejiang Province, China. zhangsuzhan@yahoo.com
Telephone: +86-571-87214404 Fax: +86-571-87214404
Received: September 5, 2009
Revised: November 10, 2009
Accepted: November 17, 2009
Published online: December 28, 2009
Abstract

AIM: To analyze the performance value of high risk factors in population-based colorectal cancer (CRC) screening in China.

METHODS: We compared the performance value of the immunochemical fecal occult blood test (iFOBT) and other high risk factors questionnaire in a population sample of 13 214 community residents who completed both the iFOBT and questionnaire investigation. Patients with either a positive iFOBT and/or questionnaire were regarded as a high risk population and those eligible were asked to undergo colonoscopy.

RESULTS: The iFOBT had the highest positive predictive value and negative predictive value in screening for advanced neoplasia. The iFOBT had the highest sensitivity, lowest number of extra false positive results associated with the detection of one extra abnormality for screening advanced neoplasias and adenomas. A history of chronic cholecystitis or cholecystectomy, chronic appendicitis or appendectomy, and chronic diarrhea also had a higher sensitivity than a history of adenomatous polyps in screening for advanced neoplasias and adenomas. The sensitivity of a history of chronic cholecystitis or cholecystectomy was highest among the 10 high risk factors in screening for non-adenomatous polyps. A history of chronic appendicitis or appendectomy, chronic constipation, chronic diarrhea, mucous and bloody stool, CRC in first degree relatives, malignant tumor and a positive iFOBT also had higher sensitivities than a history of adenomas polyps in screening for non-adenomatous polyps. Except for a history of malignant tumor in screening for non-adenomatous polyps, the gain in sensitivity was associated with an increase in extra false positive results associated with the detection of one extra abnormality.

CONCLUSION: The iFOBT may be the best marker for screening for advanced neoplasias and adenomas. Some unique high risk factors may play an important role in CRC screening in China.

Keywords: Colorectal cancer; Cancer screening; Feces; Occult blood; Risk factors; Predictive value of tests