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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Application of fecal immunochemical test in colorectal cancer screening: A community-based, cross-sectional study in average-risk individuals in Hainan
Fan Zeng, Da-Ya Zhang, Shi-Ju Chen, Run-Xiang Chen, Chen Chen, Shi-Mei Huang, Da Li, Xiao-Dong Zhang, Jia-Jia Chen, Cui-Yi Mo, Lei Gao, Jun-Tao Zeng, Jian-Xin Xiong, Zhai Chen, Fei-Hu Bai
Fan Zeng, Da-Ya Zhang, Shi-Ju Chen, Run-Xiang Chen, Chen Chen, Shi-Mei Huang, Da Li, Xiao-Dong Zhang, Graduate School, Hainan Medical University, Haikou 571199, Hainan Province, China
Jia-Jia Chen, Cui-Yi Mo, Department of Gastroenterology, Qionghai People’s Hospital, Qionghai 571400, Hainan Province, China
Lei Gao, Jun-Tao Zeng, Department of Gastroenterology, Sanya Central Hospital, Sanya 572022, Hainan Province, China
Jian-Xin Xiong, Department of Gastroenterology, Hainan Second People’s Hospital, Wuzhishang 572299, Hainan Province, China
Zhai Chen, Department of Gastroenterology, Dongfang People’s Hospital, Dongfang 572699, Hainan Province, China
Fei-Hu Bai, Department of Gastroenterology, The Second Affiliated Hospital of Hainan Medical University, Haikou 570216, Hainan Province, China
Fei-Hu Bai, The Gastroenterology Clinical Medical Center of Hainan Province, Haikou 570216, Hainan Province, China
Co-first authors: Fan Zeng and Da-Ya Zhang.
Author contributions: Zeng F and Zhang DY contributed to this article equally, they are the co-first authors of this manuscript. Zeng F and Bai FH participated in the design of this study and performed the statistical analysis; Zeng F, Zhang DY, Chen SJ, and Bai FH drafted and revised the manuscript; Chen RX and Chen C recruited participants; Chen RX, Chen C, Huang SM, Li D, Zhang XD, Chen JJ, Mo CY, Gao L, Zeng JT, Xiong JX, and Chen Z participated in the data collection; and all authors read and approved the final manuscript.
Supported by the Innovation Platform for Academicians of Hainan Province, No. 2022136; the Specific Research Fund of the Innovation Platform for Academicians of Hainan Province, No. YSPTZX202313; Hainan Province Clinical Medical Center, No. 2021818; Hainan Provincial Health Industry Research Project, No. 22A200078; and National Clinical Key Specialty Capacity Building Project, China, No. 202330.
Institutional review board statement: The protocol was approved by the Clinical Ethics Committee of the Second Affiliated Hospital of Hainan Medical University and performed per Helsinki’s Declaration (approval number: LW20222142).
Informed consent statement: All participants provided written informed consent for data collection and storage.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Fei-Hu Bai, PhD, Doctor, Editor-in-Chief, Professor, Teacher, Department of Gastroenterology, The Second Affiliated Hospital of Hainan Medical University, No. 368 Yehai Avenue, Longhua District, Haikou 570216, Hainan Province, China. baifeihu_hy@163.com
Received: April 9, 2024
Revised: May 19, 2024
Accepted: June 18, 2024
Published online: August 15, 2024
Processing time: 119 Days and 12.2 Hours
BACKGROUND
The incidence of colorectal cancer (CRC) in China is steadily rising, with a high proportion of advanced-stage diagnoses. This highlights the significance of early detection and prevention measures to enhance survival rates. Fecal immunochemical testing (FIT) is a globally recommended CRC screening method; however, limited research has been conducted on its application in Hainan.
AIM
To assess the efficacy and adherence of FIT screening among average-risk individuals in Hainan, while also examining the risk factors associated with positive FIT results.
METHODS
This population-based cross-sectional study implemented FIT screening for CRC in 2000 asymptomatic participants aged 40-75 years from five cities and 21 community health centers in Hainan Province. The study was conducted from August 2022 to April 2023, employing a stratified sampling method to select participants. Individuals with positive FIT results subsequently underwent colonoscopy. Positive predictive values for confirmed CRC and advanced adenoma were calculated, and the relationship between relevant variables and positive FIT results was analyzed using χ2 tests and multivariate logistic regression.
RESULTS
A total of 1788 participants completed the FIT screening, with a median age of 57 years (interquartile range: 40-75). Among them, 503 (28.1%) were males, and 1285 (71.9%) were females, resulting in an 89.4% compliance rate for FIT screening. The overall positivity rate of FIT was 4.4% [79 out of 1788; 95% confidence interval (CI): 3%-5%]. The specific positivity rates for Haikou, Sanya, Orient City, Qionghai City, and Wuzhishan City were 9.6% (45 of 468; 95%CI: 8%-11%), 1.3% (6 of 445; 95%CI: 0.1%-3.1%), 2.7% (8 of 293; 95%CI: 1.2%-4.3%), 3.3% (9 of 276; 95%CI: 1.0%-6.3%), and 4.2% (11 of 406; 95%CI: 1.2%-7.3%), respectively. Significant associations were found between age, dietary habits, and positive FIT results. Out of the 79 participants with positive FIT results, 55 underwent colonoscopy, demonstrating an 82.2% compliance rate. Among them, 10 had a clean gastrointestinal tract, 43 had polyps or adenomas, and 2 were confirmed to have CRC, yielding a positive predictive value of 3.6% (95%CI: 0.9%-4.2%). Among the 43 participants with polyps or adenomas, 8 were diagnosed with advanced adenomas, resulting in an advanced adenoma rate of 14.5% (95%CI: 10.1%-17.7%).
CONCLUSION
In the Hainan region, FIT screening for CRC among asymptomatic individuals at average risk is feasible and well-received.
Core Tip: The incidence of colorectal cancer (CRC) in China is steadily rising, fecal immunochemical testing (FIT) is a globally recommended CRC screening method. To assess the efficacy and adherence of FIT screening among average-risk individuals in Hainan, while also examining the risk factors associated with positive FIT results. This population-based cross-sectional study implemented FIT screening for CRC in 2000 asymptomatic participants aged 40-75 years from five cities and 21 community health centers in Hainan Province. This study found that in the Hainan region, FIT screening for CRC among asymptomatic individuals at average risk is feasible and well-received.
