Risk-Adaptive Screening Model for CRC Superior to FIT in Detecting Advanced Neoplasms

Colonoscopy technology concept
A risk-adaptive screening modality synthesizing 5 risk factors for colorectal cancer is associated with a high participation rate and higher diagnostic yield.

Use of a novel risk-adaptive screening modality synthesizing 5 risk factors for colorectal cancer (CRC) is associated with higher diagnostic yield than fecal immunochemical tests (FIT) in detecting advanced neoplasm, according to a study in the American Journal of Gastroenterology.

Findings were part of an interim analysis of baseline screening in the ongoing TARGET-C trial. Researchers from China randomized 19,546 participants (age range, 50-74 years) to received colonoscopy screening (n=3916), annual FIT (n=7854), or annual risk-adapted screening (n=7776).

Researchers used a modified version of the Asia-Pacific Colorectal Screening score for risk stratification in the risk-adaptive screening cohort. The score synthesizes risk factors for CRC, including age, sex, family history of CRC among first-degree relatives, smoking, and body mass index. A score ≥4 categorized a patient as high risk, whereas a score <4 defined low-risk patients. High- and low-risk patients were referred to either colonoscopy or FIT screening, respectively. Patients with positive FIT were referred for a diagnostic colonoscopy. The primary outcome of the study was detection rate of advanced neoplasm.

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Higher participation rates were observed for patients undergoing FIT (94.0%) and risk-adapted screening (85.2%) compared with those undergoing colonoscopy (42.5%). The detection rate of advanced neoplasms during the intention-to-screen analysis was highest for those in the colonoscopy group (2.40%) and lowest for those in the FIT group 1.13%. The detection rate for the risk-adaptive approach was 1.66%. Corresponding odds ratios (ORs) were 2.16 (95% CI, 1.61-2.90; P <.001) for colonoscopy vs FIT, 1.49 (95% CI, 1.13-1.97; P <.001) for risk-adapted screening vs FIT, and 1.45 (1.10-1.90; P <.001) for colonoscopy vs risk-adapted screening.

The detection rate of advanced neoplasm among high-risk patients in the risk-adapted screening group was approximately 5.4%, which was significantly higher than the 2.4% detection rate observed in the colonoscopy group (OR, 1.72; 95% CI, 1.20-2.48; P =.004). A total of 18, 11, and 10 in the colonoscopy, risk-adapted screening, and FIT groups, respectively, required colonoscopy to detect at least 1 advanced neoplasm.

Limitations of the study included suboptimal compliance to diagnostic colonoscopy in FIT-positive participants, as well as the lack of long-term participation and diagnostic yield data.

The researchers concluded that “development of effective risk prediction models and design of suitable risk-adapted screening strategies” for CRC “are highly promising and deserve further attention in the era of precision medicine.”

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Chen H, Lu M, Liu C, et al. Comparative evaluation of participation and diagnostic yield of colonoscopy vs fecal immunochemical test vs risk-adapted screening in colorectal cancer screening: Interim analysis of a multicenter randomized controlled trial (TARGET-C) [published online April 13, 2020]. Am J Gastroenterol. doi: 10.14309/ajg.0000000000000624