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Background & Aims: The screening yield and related cost of a risk-adapted screening approach compared with established screening strategies in population-based colorectal cancer (CRC) screening are not clear., Methods: We randomly allocated 19,373 participants into 1 of the 3 screening arms in a 1:2:2 ratio: (1) one-time colonoscopy (n = 3883); (2) annual fecal immunochemical test (FIT) (n = 7793); (3) annual risk-adapted screening (n = 7697), in which, based on the risk-stratification score, high-risk participants were referred for colonoscopy and low-risk ones were referred for FIT. Three consecutive screening rounds were conducted for both the FIT and the risk-adapted screening arms. Follow-up to trace the health outcome for all the participants was conducted over the 3-year study period. The detection rate of advanced colorectal neoplasia (CRC and advanced precancerous lesions) was the main outcome. The trial was registered in the Chinese Clinical Trial Registry (number: ChiCTR1800015506)., Results: In the colonoscopy, FIT, and risk-adapted screening arms over 3 screening rounds, the participation rates were 42.4%, 99.3%, and 89.2%, respectively; the detection rates for advanced neoplasm (intention-to-treat analysis) were 2.76%, 2.17%, and 2.35%, respectively, with an odds ratio (OR) colonoscopy vs FIT of 1.27 (95% confidence interval [CI]: 0.99-1.63; P = .056), an OR colonoscopy vs risk-adapted screening of 1.17 (95% CI, 0.91-1.49; P = .218), and an OR risk-adapted screening vs FIT of 1.09 (95% CI, 0.88-1.35; P = .438); the numbers of colonoscopies needed to detect 1 advanced neoplasm were 15.4, 7.8, and 10.2, respectively; the costs for detecting 1 advanced neoplasm from a government perspective using package payment format were 6928 Chinese Yuan (CNY) ($1004), 5821 CNY ($844), and 6694 CNY ($970), respectively., Conclusions: The risk-adapted approach is a feasible and cost-favorable strategy for population-based CRC screening and therefore could complement the well-established one-time colonoscopy and annual repeated FIT screening strategies. (Chinese Clinical Trial Registry; ChiCTR1800015506)., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Introduction: Risk-adapted screening combining the Asia-Pacific Colorectal Screening score, fecal immunochemical test (FIT), and colonoscopy improved the yield of colorectal cancer screening than FIT. However, the optimal positivity thresholds of risk scoring and FIT of such a strategy warrant further investigation., Methods: We included 3,407 participants aged 50-74 years undergoing colonoscopy from a colorectal cancer screening trial. For the risk-adapted screening strategy, subjects were referred for subsequent colonoscopy or FIT according to their risk scores. Diagnostic performance was evaluated for FIT and the risk-adapted screening method with various positivity thresholds. Furthermore, a modeled screening cohort was established to compare the yield and cost using colonoscopy, FIT, and the risk-adapted screening method in a single round of screening., Results: Risk-adapted screening method had higher sensitivity for advanced neoplasm (AN) (27.6%-76.3% vs 13.8%-17.3%) but lower specificity (46.6%-90.8% vs 97.4%-98.8%) than FIT did. In a modeled screening cohort, FIT-based screening would be slightly affected because the threshold varied with a reduction of 76.0%-80.9% in AN detection and 82.0%-84.4% in cost when compared with colonoscopy. By contrast, adjusting the threshold of Asia-Pacific Colorectal Screening score from 3 to 5 points for risk-adapted screening varied from an increase of 12.6%-14.1% to a decrease of 55.6%-60.1% in AN detection, with the reduction of cost from 4.2%-5.3% rising to 66.4%-68.5%., Discussion: With an appropriate positivity threshold tailored to clinical practice, the risk-adapted screening could save colonoscopy resources and cost compared with the colonoscopy-only and FIT-only strategies., (Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.)

Background: We initiated the first multi-center cluster randomized trial of endoscopic screening for esophageal cancer and gastric cancer in China. The objective of the study was to report the baseline screening findings in this trial., Methods: We recruited a total of 345 eligible clusters from seven screening centers. In the intervention group, participants from high-risk areas were screened by endoscopy; in non-high-risk areas, high-risk individuals were identified using a questionnaire and advised for endoscopy. Lugol's iodine staining in esophagus and indigo carmine dye in stomach were performed to aid in the diagnosis of suspicious lesions. The primary outcomes of this study were the detection rate (proportion of positive cases among individuals who underwent endoscopic screening) and early detection rate (the proportion of positive cases with stage 0/I among all positive cases)., Results: A total of 149,956 eligible subjects were included. The detection rate was 0.7% in esophagus and 0.8% in stomach, respectively. Compared with non-high-risk areas, the detection rates in high-risk areas were higher, both in esophagus (0.9% vs. 0.1%) and in stomach (0.9% vs. 0.3%). The same difference was found for early-detection rate (esophagus: 92.9% vs. 53.3%; stomach: 81.5% vs. 33.3%)., Conclusions: The diagnostic yield of both esophagus and stomach were higher in high-risk areas than in non-high-risk areas, even though in non-high-risk areas, only high-risk individuals were screened. Our study may provide important clues for evaluating and improving the effectiveness of upper-endoscopic screening in China., Trial Registration: Protocol Registration System in Chinese Clinical Trial Registry, ChiCTR-EOR-16008577. Registered 01 June 2016-Retrospectively registered, http://www.chictr.org.cn/showprojen.aspx?proj=14372.

Introduction: In colorectal cancer screening, implementing risk-adapted screening might be more effective than traditional screening strategies. We aimed to compare the effectiveness of a risk-adapted screening strategy with colonoscopy and fecal immunochemical test (FIT) in colorectal cancer screening., Methods: A randomized controlled trial was conducted in 6 centers in China since May 2018. Nineteen thousand five hundred forty-six eligible participants aged 50-74 years were recruited and randomly allocated into 1 of the 3 screening groups in a 1:2:2 ratio: (i) one-time colonoscopy (n = 3,916), (ii) annual FIT (n = 7,854), and (iii) annual risk-adapted screening (n = 7,776). Based on the risk-stratification score, high-risk subjects were referred for colonoscopy and low-risk ones were referred for FIT. All subjects with positive FIT were referred for diagnostic colonoscopy. The detection rate of advanced neoplasm was the primary outcome. The study is registered with the China Clinical Trial Registry (www.chictr.org.cn Identifier: ChiCTR1800015506)., Results: For baseline screening, the participation rates of the colonoscopy, FIT, and risk-adapted screening groups were 42.5% (1,665/3,916), 94.0% (7,386/7,854), and 85.2% (6,628/7,776), respectively. For the intention-to-screen analysis, the detection rates of advanced neoplasm were 2.40% (94/3,916), 1.13% (89/7,854), and 1.66% (129/7,776), with odds ratios (95% confidence intervals) of 2.16 (1.61-2.90; P < 0.001) for colonoscopy vs FIT, 1.45 (1.10-1.90; P < 0.001) for colonoscopy vs risk-adapted screening, and 1.49 (1.13-1.97; P < 0.001) for risk-adapted screening vs FIT, respectively. The numbers of subjects who required a colonoscopic examination to detect 1 advanced neoplasm were 18 in the colonoscopy group, 10 in the FIT group, and 11 in the risk-adapted screening group., Discussion: For baseline screening, the risk-adapted screening approach showed a high participation rate, and its diagnostic yield was superior to that of FIT at a similarly low load of colonoscopy.

China has not yet developed national guidelines for lung and colorectal cancer screening, and needs scientific evidence from the Chinese population for making policy. The aim of this study was to obtain compliance information to design a large-scale randomised lung and colorectal cancer screening trial in China. This multicentre, open label, pilot randomised trial was done at 33 community health-care centres and three hospitals in Haining (Zhejiang province), Changsha (Hunan province), and Lanzhou (Gansu province). Eligibility criteria included participants aged between 50 and 74 years, current smokers with a history of at least 30 pack-years, and passive smokers. Exclusion criteria included participation in another trial, history of lung or colorectal cancer, or evidence of previous cancer treatment. Participants were randomly allocated (1:1:1) using a predefined web-based system to: group 1, annual low-dose CT (LDCT) plus a baseline colonoscopy; group 2, biannual LDCT plus annual fecal immunochemical test (FIT); and group 3, annual fecal FIT plus septin-9 blood test. The primary outcomes of the study included the annual compliance and incidence of lung and colorectum cancer. This study was approved by the Ethical Committee of the Cancer Hospital, Chinese Academy of Medical Sciences, and registered in the Chinese Clinical Trial Registry, number ChiCTR-IOR-15007160. Between Aug 12, 2014, and June 30, 2017, 2696 participants were randomly assigned to three screening groups. Demographics and smoking history were similar across the three groups. Compliance for annual LDCT in group 1 was 86·8% (777 of 895 participants) at baseline, 69·0% (614 of 890) at the first round (T1), and 70·7% (626 of 885) at the second round (T2). Compliance for colonoscopy in group 1 was 56·4% (504 of 894). In group 2, compliance for biannual LDCT in group 2 was 91·9% (829 of 902) at baseline and 66·6% (595 of 894) at T2; compliance for annual FIT was 91·6% (826 of 902) at baseline, 79·9% (716 of 896) at T1, and 65·8% (588 of 894) at T2. The compliance rate of annual Septin-9 in group 3 was 91·0% (819 of 900) at the baseline, 68·7% (618 of 899) at T1, and 80·8% (725 of 897) at T2; and of annual FIT was 89·2% (803 of 900), 72·3% (650 of 899), and 78·8% (707 of 897), respectively. During the follow-up (until Dec 31, 2017), 13 lung cancer cases were confirmed in groups 1 and 2, and one colorectal cancer case in group 1. Three participants died of lung cancer and 14 died of other causes. In this pilot study, the feasibility study retention was established in a Chinese population and has now been adapted to a large-scale, randomised controlled trial that will determine whether to implement a nationwide screening programme for lung cancer, colorectal cancer, or both, in China. Cancer Hospital, Chinese Academy of Medical Sciences. [ABSTRACT FROM AUTHOR]