Combining fecal immunochemical testing and questionnaire-based risk assessment in selecting participants for colonoscopy screening in the Chinese National Colorectal Cancer Screening Programs - A population-based cohort study

Sep 21, 2026

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Colorectal cancer screening can reduce CRC burden through earlier detection, but benefits depend on selecting genuinely high-risk individuals and achieving high colonoscopy uptake. This multicenter population-based prospective cohort study compared a combined approach using questionnaire-based risk-factor interviews plus fecal immunochemical test (FIT) results versus a questionnaire-only strategy. Participants aged 40–74 were followed through December 31, 2022. Primary outcomes included participation rate and screening yield, with secondary outcomes including cost per detected case.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages16

Reading Time40 min

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Abstract

Background

Methods and findings

Results and outcomes

PLOS MEDICINE OPEN ACCESS Citation: Dong X, Du L, Luo Z, Xu Y, Wang C, Wang F, et al. (2024) Combining fecal immunochemical testing and questionnaire-based risk assessment in selecting participants for colonoscopy screening in the Chinese National Colorectal Cancer Screening Programs: A population-based cohort study. PLoS Med 21(2): e1004340 . [https://doi.org/10.1371/journal](https://doi.org/10.1371/journal). pmed.1004340 Academic Editor: Aadel A. Chaudhuri, Washington University in St Louis, UNITED STATES Received: June 8, 2023 Accepted: December 28, 2023 Published: February 22, 2024 Copyright: © 2024 Dong et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: Data sharing is only possible after getting a research permission with the Ministry of Industry and Information Technology of China and National Cancer Center of China. The data application (study aims, hypothesis, and protocol) should be sent to National Cancer Prevention and Control Network group (email: [ncpcn@cicams.ac.cn](ncpcn@cicams.ac.cn)) . RESEARCH ARTICLE Combining fecal immunochemical testing and questionnaire-based risk assessment in selecting participants for colonoscopy screening in the Chinese National Colorectal Cancer Screening Programs: A populationbased cohort study Xuesi Dong1,2☯, Lingbin Du3☯, Zilin Luo1,2☯, Yongjie Xu1,2☯, Chenran Wang1,2☯, Fei Wang1,2, Wei Cao1,2, Liang Zhao1,2, Yadi Zheng1,2, Hongting Zhu4, Changfa Xia1, Jiang Li1, Mulong Du5, Dong Hang5, Jiansong Ren1,2, Jufang Shi1,2, Hongbing Shen5, Wanqing Chen1,2, Ni Li1,2 *, Jie He1 *, Cancer Screening Program in Urban China (CanSPUC) Group 1 Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, 2 Chinese Academy of Medical Sciences Key Laboratory for National Cancer Big Data Analysis and Implement, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, 3 Department of Cancer Prevention, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, China, 4 Yongkang Center for Disease Control and Prevention, Yongkang, China, 5 Department of Epidemiology and Biostatistics, Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, China ☯ These authors contributed equally to this work. * [nli@cicams.ac.cn](nli@cicams.ac.cn) (NL); [hejie@cicams.ac.cn](hejie@cicams.ac.cn) (JH) Abstract Background Screening reduces colorectal cancer (CRC) burden by allowing early resection of precancerous and cancerous lesions. An adequate selection of high-risk individuals and a high uptake rate for colonoscopy screening are critical to identifying people more likely to benefit from screening and allocating healthcare resources properly. We evaluated whether combining a questionnaire-based interview for risk factors with fecal immunochemical test (FIT) outcomes for high-risk assessment is more efficient and economical than a questionnairebased interview-only strategy. Methods and findings In this multicenter, population-based, prospective cohort study, we enrolled community residents aged 40 to 74 years in 29 provinces across China. From 2016 to 2020, a total of 1,526,824 eligible participants were consecutively enrolled in the Cancer Screening Program in Urban China (CanSPUC) cohort, and 940,605 were enrolled in the Whole Life Cycle of Cancer Screening Program (WHOLE) cohort, with follow-up to December 31, 2022. The PLOS Medicine | [https://doi.org/10.1371/journal.pmed.1004340](https://doi.org/10

FAQs

What strategies were compared for selecting participants in this study?

The study compared an RF–FIT strategy that combined questionnaire-based interviews for risk factors with fecal immunochemical test (FIT) outcomes versus an RF strategy using interview-based risk factors only.

Who were the participants and how long were they followed?

Community residents aged 40 to 74 years across 29 provinces in China were enrolled between 2016 and 2020, with follow-up through December 31, 2022.

What were the main outcomes used to evaluate screening performance?

Primary outcomes were participation rate and yield, including detection rate of advanced neoplasms and early-stage CRC, and screening yield per 10,000 invitees; secondary outcome was cost per detected case.

Sep 21, 2026

Uploaded by Patrick