Journal Article

DKFZ-2022-01818

http://join2-wiki.gsi.de/foswiki/pub/Main/Artwork/join2_logo100x88.png Comparison of Colonoscopy, Fecal Immunochemical Test, and Risk-adapted Approach in a Colorectal Cancer Screening Trial (TARGET-C).

Chen, H. ; Shi, J. ; Lu, M. ; Li, Y. ; Du, L. ; Liao, X. ; Wei, D. ; Dong, D. ; Gao, Y. ; Zhu, C. ; Ying, R. ; Zheng, W. ; Yan, S. ; Xiao, H. ; Zhang, J. ; Kong, Y. ; Li, F. ; Zou, S. ; Liu, C. ; Wang, H. ; Zhang, Y. ; Lu, B. ; Luo, C. ; Cai, J. ; Tian, J. ; Miao, X. ; Ding, K. ; Brenner, H.DKFZ* ; Dai, M.

2023
Elsevier Science New York, NY

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Please use a persistent id in citations: doi:10.1016/j.cgh.2022.08.003

Abstract: The screening yield and related cost of a risk-adapted screening approach compared with established screening strategies in population-based CRC screening are not clear.We randomly allocated 19,373 participants into one of the three screening arms in a 1:2:2 ratio: (1) one-time colonoscopy (n=3,883); (2) annual fecal immunochemical test (FIT) (n=7,793); (3) annual risk-adapted screening (n=7,697), 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).In the colonoscopy, FIT, and risk-adapted screening arms over three 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 odds ratio (OR)colonoscopyvs.FIT of 1.27 (95% confidence interval [CI]: 0.99-1.63; P=0.056), ORcolonoscopyvs.risk-adapted screening of 1.17 (95% CI: 0.91-1.49; P=0.218), and ORrisk-adapted screeningvs.FIT of 1.09 (95% CI: 0.88-1.35; P=0.438); the numbers of colonoscopies needed to detect one advanced neoplasm were 15.4, 7.8, and 10.2, respectively; the costs for detecting one advanced neoplasm from a government perspective using package payment format were CNY6,928 ($1,004), CNY5,821 ($844), and CNY6,694 ($970), respectively.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.

Keyword(s): colonoscopy ; colorectal cancer screening ; fecal immunochemical test ; personalized screening ; risk stratification

Note: Volume 21, Issue 3, March 2023, Pages 808-818

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Contributing Institute(s):

1. C070 Klinische Epidemiologie und Alternf. (C070)
2. Präventive Onkologie (C120)
3. DKTK HD zentral (HD01)

Research Program(s):

1. 313 - Krebsrisikofaktoren und Prävention (POF4-313) (POF4-313)

Appears in the scientific report 2022

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Database coverage:
; Clarivate Analytics Master Journal List ; Current Contents - Clinical Medicine ; Essential Science Indicators ; IF >= 10 ; JCR ; SCOPUS ; Science Citation Index Expanded ; Web of Science Core Collection

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