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. 2023 Dec 12;23(1):435.
doi: 10.1186/s12876-023-03060-3.

Age- and sex-stratified detection rates and associated factors of colorectal neoplasia in the Tianjin colorectal cancer screening program from 2012 to 2020

Zhen Yuan #  1 , Shuyuan Wang #  1 , Yuqi Wang #  1 , Hongzhou Li  2 , Weifeng Gao  3 , Xinyu Liu  4 , Youkui Han  5 , Zhaoce Liu  1   3 , Qinghuai Zhang  3   6   7 , Hong Ma  8 , Junying Wang  3 , Xiaomeng Wei  9 , Xipeng Zhang  10   11   12 , Wei Cui  13 , Chunze Zhang  14   15   16
Affiliations

Age- and sex-stratified detection rates and associated factors of colorectal neoplasia in the Tianjin colorectal cancer screening program from 2012 to 2020

Zhen Yuan et al. BMC Gastroenterol. .

Abstract

Purpose: Colorectal cancer (CRC) screening has been implemented in Tianjin, China since 2012. The objective was to estimate the neoplasia detection rate in a high-risk population by age and sex and to investigate the potential factors associated with colorectal neoplasia.

Patients and methods: This study is based on data of the Tianjin CRC screening program from 2012 to 2020. Residents with a positive high-risk factors questionnaire (HRFQ) or a positive faecal immunochemical test (FIT) were identified as high-risk participants and were subsequently recommended for a free colonoscopy.

Results: A total of 4,117,897 eligible participants aged 40-74 years completed both a HRFQ and FIT, and 217,164 (5.3%) of them were identified as high-risk participants. Positive rates of preliminary screening increased with age and were higher in females than in males. For 57,971 participants undertaking colonoscopy, the detection rates of nonadvanced adenoma, advanced adenoma and CRC were 37.8%, 5.7% and 1.6%, respectively. Detection rates of advanced neoplasia increased from the age of 50 and were higher in males. For nonadvanced neoplasia, a strong increase was observed in males from the age of 40 and in females from the age of 50. Male sex had a greater impact on individuals aged 40-49 than on older individuals. Several factors including current smoking, drinking, and higher body mass index (BMI) were significantly associated with the presence of neoplasia, whereas, these associations were mainly restricted to individuals aged above 50 but not those aged 40-49 years.

Conclusions: These findings support that age-specific risk stratification and sex-specific initiating ages for CRC screening should be recommended to improve the accuracy and effectiveness of current screening strategy.

Keywords: CRC screening; Cancer prevention; Early-onset CRC; Risk factors.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of participant recruitment in Tianjin Cancer Screening Program, 2012–2020. Abbreviations: CRC, colorectal cancer; HRFQ, high risk factor questionnaire; FIT, fecal immunological test
Fig. 2
Fig. 2
Positive rates of HRFQ, FIT and preliminary screening by age and sex. Abbreviations: HRFQ, high risk factor questionnaire; FIT, fecal immunological test
Fig. 3
Fig. 3
Detection rates of advanced neoplasia, nonadvanced neoplasia and any neoplasia stratified by age and sex
Fig. 4
Fig. 4
Multivariable analyses on the risk for advanced neoplasia and nonadvanced adenoma. Analyses were adjusted for sex, educational level, marital status, year of colonoscopy, smoking status, alcohol drinking, physical activity, body mass index, chronic diarrhoea, chronic constipation, mucus bloody stool, chronic appendicitis or appendectomy, chronic cholecystitis or cholecystectomy, psychiatric trauma in the past 20 years, personal history of any cancer, personal history of colorectal polyps and family history of colorectal cancer in first degree relatives. Abbreviations: OR, Odds ratio; CI, confidence interval; BMI, body mass index
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