A Risk-Scoring System Combined with a Fecal Immunochemical Test Is Effective in Screening High-Risk Subjects for Early Colonoscopy to Detect Advanced Colorectal Neoplasms

Han Mo Chiu, Jessica Y.L. Ching, Kai Chun Wu, Rungsun Rerknimitr, Jingnan Li, Deng Chiang Wu, Khean Lee Goh, Takahisa Matsuda, Hyunsoo Kim, Rupert Leong, Khay Guan Yeoh, Vui Heng Chong, Jose D. Sollano, Furqaan Ahmed, Jayaram Menon, Joseph J.Y. Sung

Research output: Contribution to journalArticle

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Abstract

Background & Aims Age, sex, smoking, and family history are risk factors for colorectal cancer in Asia. The Asia-Pacific Colorectal Screening (APCS) scoring system was developed to identify subjects with a high risk for advanced neoplasm (AN). We tested an algorithm that combined APCS scores with fecal immunochemical test (FIT) in colorectal cancer screening. Methods We performed a multicenter prospective study, enrolling asymptomatic individuals older than 40 years old in 12 Asia-Pacific regions from December 2011 to December 2013. APCS scores were calculated for each individual (0-1 = low risk [LR], 2-3 = medium risk [MR], and 4-7 = high risk [HR] for AN). LR and MR subjects were offered FIT and referred for early colonoscopies if FIT results were positive. HR subjects were offered colonoscopies. The proportions of subjects with ANs were determined for each group based on colonoscopy findings; odd ratios for LR and MR subjects were calculated compared to LR individuals. We calculated the sensitivity of the APCS-FIT algorithm in identifying subjects with AN. Results A total of 5657 subjects were recruited: 646 subjects (11.4%) were considered LR, 3243 subjects (57.3%) were considered MR, and 1768 subjects (31.3%) were considered HR for AN. The proportions of individuals with an AN in these groups were 1.5%, 5.1%, and 10.9%, respectively. Compared with LR group, MR and HR subjects had a 3.4-fold increase and a 7.8-fold increase in risk for AN, respectively. A total of 70.6% subjects with AN (95% confidence interval: 65.6%-75.1%) and 95.1% subjects with invasive cancers (95% confidence interval: 82.2%-99.2%) were correctly instructed to undergo early colonoscopy examination. Conclusions The APCS scoring system, which is based on age, sex, family history, and smoking, is a useful tool for determining risk for colorectal cancer and advanced adenoma in asymptomatic subjects. Use of the APCS score-based algorithm in triaging subjects for FIT or colonoscopy can substantially reduce colonoscopy workload.

Original languageEnglish
Pages (from-to)617-625.e3
JournalGastroenterology
Volume150
Issue number3
DOIs
Publication statusPublished - 2016 Mar 1

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Colonoscopy
Colorectal Neoplasms
Neoplasms
Smoking
Confidence Intervals
Workload
Early Detection of Cancer

All Science Journal Classification (ASJC) codes

  • Hepatology
  • Gastroenterology

Cite this

Chiu, Han Mo ; Ching, Jessica Y.L. ; Wu, Kai Chun ; Rerknimitr, Rungsun ; Li, Jingnan ; Wu, Deng Chiang ; Goh, Khean Lee ; Matsuda, Takahisa ; Kim, Hyunsoo ; Leong, Rupert ; Yeoh, Khay Guan ; Chong, Vui Heng ; Sollano, Jose D. ; Ahmed, Furqaan ; Menon, Jayaram ; Sung, Joseph J.Y. / A Risk-Scoring System Combined with a Fecal Immunochemical Test Is Effective in Screening High-Risk Subjects for Early Colonoscopy to Detect Advanced Colorectal Neoplasms. In: Gastroenterology. 2016 ; Vol. 150, No. 3. pp. 617-625.e3.
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title = "A Risk-Scoring System Combined with a Fecal Immunochemical Test Is Effective in Screening High-Risk Subjects for Early Colonoscopy to Detect Advanced Colorectal Neoplasms",
abstract = "Background & Aims Age, sex, smoking, and family history are risk factors for colorectal cancer in Asia. The Asia-Pacific Colorectal Screening (APCS) scoring system was developed to identify subjects with a high risk for advanced neoplasm (AN). We tested an algorithm that combined APCS scores with fecal immunochemical test (FIT) in colorectal cancer screening. Methods We performed a multicenter prospective study, enrolling asymptomatic individuals older than 40 years old in 12 Asia-Pacific regions from December 2011 to December 2013. APCS scores were calculated for each individual (0-1 = low risk [LR], 2-3 = medium risk [MR], and 4-7 = high risk [HR] for AN). LR and MR subjects were offered FIT and referred for early colonoscopies if FIT results were positive. HR subjects were offered colonoscopies. The proportions of subjects with ANs were determined for each group based on colonoscopy findings; odd ratios for LR and MR subjects were calculated compared to LR individuals. We calculated the sensitivity of the APCS-FIT algorithm in identifying subjects with AN. Results A total of 5657 subjects were recruited: 646 subjects (11.4{\%}) were considered LR, 3243 subjects (57.3{\%}) were considered MR, and 1768 subjects (31.3{\%}) were considered HR for AN. The proportions of individuals with an AN in these groups were 1.5{\%}, 5.1{\%}, and 10.9{\%}, respectively. Compared with LR group, MR and HR subjects had a 3.4-fold increase and a 7.8-fold increase in risk for AN, respectively. A total of 70.6{\%} subjects with AN (95{\%} confidence interval: 65.6{\%}-75.1{\%}) and 95.1{\%} subjects with invasive cancers (95{\%} confidence interval: 82.2{\%}-99.2{\%}) were correctly instructed to undergo early colonoscopy examination. Conclusions The APCS scoring system, which is based on age, sex, family history, and smoking, is a useful tool for determining risk for colorectal cancer and advanced adenoma in asymptomatic subjects. Use of the APCS score-based algorithm in triaging subjects for FIT or colonoscopy can substantially reduce colonoscopy workload.",
author = "Chiu, {Han Mo} and Ching, {Jessica Y.L.} and Wu, {Kai Chun} and Rungsun Rerknimitr and Jingnan Li and Wu, {Deng Chiang} and Goh, {Khean Lee} and Takahisa Matsuda and Hyunsoo Kim and Rupert Leong and Yeoh, {Khay Guan} and Chong, {Vui Heng} and Sollano, {Jose D.} and Furqaan Ahmed and Jayaram Menon and Sung, {Joseph J.Y.}",
year = "2016",
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doi = "10.1053/j.gastro.2015.11.042",
language = "English",
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pages = "617--625.e3",
journal = "Gastroenterology",
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Chiu, HM, Ching, JYL, Wu, KC, Rerknimitr, R, Li, J, Wu, DC, Goh, KL, Matsuda, T, Kim, H, Leong, R, Yeoh, KG, Chong, VH, Sollano, JD, Ahmed, F, Menon, J & Sung, JJY 2016, 'A Risk-Scoring System Combined with a Fecal Immunochemical Test Is Effective in Screening High-Risk Subjects for Early Colonoscopy to Detect Advanced Colorectal Neoplasms', Gastroenterology, vol. 150, no. 3, pp. 617-625.e3. https://doi.org/10.1053/j.gastro.2015.11.042

A Risk-Scoring System Combined with a Fecal Immunochemical Test Is Effective in Screening High-Risk Subjects for Early Colonoscopy to Detect Advanced Colorectal Neoplasms. / Chiu, Han Mo; Ching, Jessica Y.L.; Wu, Kai Chun; Rerknimitr, Rungsun; Li, Jingnan; Wu, Deng Chiang; Goh, Khean Lee; Matsuda, Takahisa; Kim, Hyunsoo; Leong, Rupert; Yeoh, Khay Guan; Chong, Vui Heng; Sollano, Jose D.; Ahmed, Furqaan; Menon, Jayaram; Sung, Joseph J.Y.

In: Gastroenterology, Vol. 150, No. 3, 01.03.2016, p. 617-625.e3.

Research output: Contribution to journalArticle

TY - JOUR

T1 - A Risk-Scoring System Combined with a Fecal Immunochemical Test Is Effective in Screening High-Risk Subjects for Early Colonoscopy to Detect Advanced Colorectal Neoplasms

AU - Chiu, Han Mo

AU - Ching, Jessica Y.L.

AU - Wu, Kai Chun

AU - Rerknimitr, Rungsun

AU - Li, Jingnan

AU - Wu, Deng Chiang

AU - Goh, Khean Lee

AU - Matsuda, Takahisa

AU - Kim, Hyunsoo

AU - Leong, Rupert

AU - Yeoh, Khay Guan

AU - Chong, Vui Heng

AU - Sollano, Jose D.

AU - Ahmed, Furqaan

AU - Menon, Jayaram

AU - Sung, Joseph J.Y.

PY - 2016/3/1

Y1 - 2016/3/1

N2 - Background & Aims Age, sex, smoking, and family history are risk factors for colorectal cancer in Asia. The Asia-Pacific Colorectal Screening (APCS) scoring system was developed to identify subjects with a high risk for advanced neoplasm (AN). We tested an algorithm that combined APCS scores with fecal immunochemical test (FIT) in colorectal cancer screening. Methods We performed a multicenter prospective study, enrolling asymptomatic individuals older than 40 years old in 12 Asia-Pacific regions from December 2011 to December 2013. APCS scores were calculated for each individual (0-1 = low risk [LR], 2-3 = medium risk [MR], and 4-7 = high risk [HR] for AN). LR and MR subjects were offered FIT and referred for early colonoscopies if FIT results were positive. HR subjects were offered colonoscopies. The proportions of subjects with ANs were determined for each group based on colonoscopy findings; odd ratios for LR and MR subjects were calculated compared to LR individuals. We calculated the sensitivity of the APCS-FIT algorithm in identifying subjects with AN. Results A total of 5657 subjects were recruited: 646 subjects (11.4%) were considered LR, 3243 subjects (57.3%) were considered MR, and 1768 subjects (31.3%) were considered HR for AN. The proportions of individuals with an AN in these groups were 1.5%, 5.1%, and 10.9%, respectively. Compared with LR group, MR and HR subjects had a 3.4-fold increase and a 7.8-fold increase in risk for AN, respectively. A total of 70.6% subjects with AN (95% confidence interval: 65.6%-75.1%) and 95.1% subjects with invasive cancers (95% confidence interval: 82.2%-99.2%) were correctly instructed to undergo early colonoscopy examination. Conclusions The APCS scoring system, which is based on age, sex, family history, and smoking, is a useful tool for determining risk for colorectal cancer and advanced adenoma in asymptomatic subjects. Use of the APCS score-based algorithm in triaging subjects for FIT or colonoscopy can substantially reduce colonoscopy workload.

AB - Background & Aims Age, sex, smoking, and family history are risk factors for colorectal cancer in Asia. The Asia-Pacific Colorectal Screening (APCS) scoring system was developed to identify subjects with a high risk for advanced neoplasm (AN). We tested an algorithm that combined APCS scores with fecal immunochemical test (FIT) in colorectal cancer screening. Methods We performed a multicenter prospective study, enrolling asymptomatic individuals older than 40 years old in 12 Asia-Pacific regions from December 2011 to December 2013. APCS scores were calculated for each individual (0-1 = low risk [LR], 2-3 = medium risk [MR], and 4-7 = high risk [HR] for AN). LR and MR subjects were offered FIT and referred for early colonoscopies if FIT results were positive. HR subjects were offered colonoscopies. The proportions of subjects with ANs were determined for each group based on colonoscopy findings; odd ratios for LR and MR subjects were calculated compared to LR individuals. We calculated the sensitivity of the APCS-FIT algorithm in identifying subjects with AN. Results A total of 5657 subjects were recruited: 646 subjects (11.4%) were considered LR, 3243 subjects (57.3%) were considered MR, and 1768 subjects (31.3%) were considered HR for AN. The proportions of individuals with an AN in these groups were 1.5%, 5.1%, and 10.9%, respectively. Compared with LR group, MR and HR subjects had a 3.4-fold increase and a 7.8-fold increase in risk for AN, respectively. A total of 70.6% subjects with AN (95% confidence interval: 65.6%-75.1%) and 95.1% subjects with invasive cancers (95% confidence interval: 82.2%-99.2%) were correctly instructed to undergo early colonoscopy examination. Conclusions The APCS scoring system, which is based on age, sex, family history, and smoking, is a useful tool for determining risk for colorectal cancer and advanced adenoma in asymptomatic subjects. Use of the APCS score-based algorithm in triaging subjects for FIT or colonoscopy can substantially reduce colonoscopy workload.

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