Findings from the first colorectal cancer screening among 103 542 individuals in Vietnam with systematic review of colorectal cancer screening programs in Asia-Pacific region.

BACKGROUND Colorectal cancer is a leading cancer incidence and cause of death worldwide and in Vietnam. Although screening is considered an effective measure to prevent and control colorectal cancer, there is no such effort in Vietnam. METHODS Between 01 January 2018 and 31 October 2019, a population-based colorectal cancer screening program was conducted in Hanoi, Vietnam. A health advocacy campaign and follow-up phone calls were used to enroll residents aged ≥40 years old to complete an immunochemical-fecal occult blood testing. Positive immunochemical-fecal occult blood testing was followed by a colonoscopy. We also conducted a systematic review of the colorectal cancer screening programs in the Asia-Pacific region that used similar approach by searching Ovid Medline and PubMed databases. RESULTS During study period, 103 542 individuals among 672 742 eligible residents attended the screening of whom 81.5% participants finished immunochemical-fecal occult blood testing test and the positive rate was 6.1%. The coverage rate for immunochemical-fecal occult blood testing test was 11.9%. Among 2278 individuals who underwent colonoscopy, 3.5% were histologically diagnosed with cancer, 17.8% with advanced adenomas, and 23.1% with non-advanced adenomas. Males had significantly higher detection rate of advanced adenomas, cancer or ≥ two polyps/tumor than females (P < 0.0001). The systematic review showed that in two-step modality (i.e. immunochemical-fecal occult blood testing/fecal immunochemical test and colonoscopy), the test positive was from 4.1 to 10.6%. Once colonoscopy was performed subsequently, the rate of cancer among positive participants was from 1.7 to 16.4% and that of advanced adenomas was from 7.1 to 23.1%. CONCLUSION We showed that the two-step modality is a promising strategy for colorectal cancer screening in Vietnam that might apply to similar settings with limited resources.

[1]  Shivan J. Mehta,et al.  NCCN Guidelines Insights: Colorectal Cancer Screening, Version 2.2020. , 2020, Journal of the National Comprehensive Cancer Network : JNCCN.

[2]  P. Boffetta,et al.  Attributable Causes of Cancer in Vietnam , 2020, JCO global oncology.

[3]  T. H. Nguyen,et al.  The global, regional, and national burden of colorectal cancer and its attributable risk factors in 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017 , 2019, The lancet. Gastroenterology & hepatology.

[4]  Y. Nie,et al.  Mass screening for colorectal cancer in a population of two million older adults in Guangzhou, China , 2019, Scientific Reports.

[5]  Jae Wan Lim,et al.  Association of time to colonoscopy after a positive fecal test result and fecal hemoglobin concentration with risk of advanced colorectal neoplasia. , 2019, Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver.

[6]  D M Parkin,et al.  Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods , 2018, International journal of cancer.

[7]  American Cancer Society updates its colorectal cancer screening guideline , 2018, Cancer.

[8]  A. Jemal,et al.  Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries , 2018, CA: a cancer journal for clinicians.

[9]  C. Flowers,et al.  Colorectal cancer screening for average‐risk adults: 2018 guideline update from the American Cancer Society , 2018, CA: a cancer journal for clinicians.

[10]  P. Pinsky,et al.  Association of Colonoscopy Adenoma Findings With Long-term Colorectal Cancer Incidence , 2018, JAMA.

[11]  M. Kwak,et al.  Risk of Interval Cancer in Fecal Immunochemical Test Screening Significantly Higher During the Summer Months: Results from the National Cancer Screening Program in Korea , 2018, The American Journal of Gastroenterology.

[12]  R. Malekzadeh,et al.  Feasibility of Colon Cancer Screening by Fecal Immunochemical Test in Iran. , 2017, Archives of Iranian medicine.

[13]  A. Tsapas,et al.  Diagnostic Accuracy of Fecal Immunochemical Test in Patients at Increased Risk for Colorectal Cancer: A Meta-analysis , 2017, JAMA internal medicine.

[14]  C. Shun,et al.  Fecal Immunochemical Test Detects Sessile Serrated Adenomas and Polyps With a Low Level of Sensitivity , 2017, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[15]  Á. Lanas,et al.  Colorectal cancer population screening programs worldwide in 2016: An update , 2017, World journal of gastroenterology.

[16]  B. Levy,et al.  Which Fecal Immunochemical Test Should I Choose? , 2017, Journal of primary care & community health.

[17]  D. Park,et al.  Risk and Characteristics of Postcolonoscopy Interval Colorectal Cancer after a Positive Fecal Test: A Nationwide Population-Based Study in Korea , 2017, Cancer research and treatment : official journal of Korean Cancer Association.

[18]  T. Sriprayoon,et al.  High prevalence of advanced colorectal neoplasia in the Thai population: a prospective screening colonoscopy of 1,404 cases , 2016, BMC Gastroenterology.

[19]  C. Sohn,et al.  Does Low Threshold Value Use Improve Proximal Neoplasia Detection by Fecal Immunochemical Test? , 2016, Digestive Diseases and Sciences.

[20]  T. Matsuda,et al.  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. , 2016, Gastroenterology.

[21]  S. Wong,et al.  Diagnostic Accuracy of a Qualitative Fecal Immunochemical Test Varies With Location of Neoplasia But Not Number of Specimens. , 2015, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[22]  S. Winawer,et al.  The History of Colorectal Cancer Screening: A Personal Perspective , 2015, Digestive Diseases and Sciences.

[23]  G. Young,et al.  Population Screening for Colorectal Cancer Means Getting FIT: The Past, Present, and Future of Colorectal Cancer Screening Using the Fecal Immunochemical Test for Hemoglobin (FIT) , 2014, Gut and liver.

[24]  J. Oh,et al.  Validity of Fecal Occult Blood Test in the National Cancer Screening Program, Korea , 2013, PloS one.

[25]  Atle Fretheim,et al.  Flexible sigmoidoscopy versus faecal occult blood testing for colorectal cancer screening in asymptomatic individuals. , 2013, The Cochrane database of systematic reviews.

[26]  David Lieberman,et al.  Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) Guideline , 2013, Endoscopy.

[27]  T. Smyrk,et al.  Recommended intervals between screening and surveillance colonoscopies. , 2013, Mayo Clinic proceedings.

[28]  C. Shun,et al.  Association between early stage colon neoplasms and false-negative results from the fecal immunochemical test. , 2013, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[29]  W. Tan,et al.  Opportunistic screening for colorectal neoplasia in Singapore using faecal immunochemical occult blood test. , 2013, Singapore medical journal.

[30]  E. Kuipers,et al.  Reasons for Participation and Nonparticipation in Colorectal Cancer Screening: A Randomized Trial of Colonoscopy and CT Colonography , 2012, The American Journal of Gastroenterology.

[31]  H. Brenner,et al.  Efficacy of a nationwide screening colonoscopy program for colorectal cancer. , 2012, Gastroenterology.

[32]  E. Uchida,et al.  Total colonoscopy detects early colorectal cancer more frequently than advanced colorectal cancer in patients with fecal occult blood. , 2010, Journal of Nippon Medical School = Nippon Ika Daigaku zasshi.

[33]  K. Eu,et al.  Screening for colorectal cancer using a quantitative immunochemical faecal occult blood test: a feasibility study in an Asian population , 2009, Techniques in Coloproctology.

[34]  D. Moher,et al.  Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement , 2009, BMJ.

[35]  M. Chew,et al.  Colorectal cancer mass screening event utilising quantitative faecal occult blood test. , 2009, Singapore medical journal.

[36]  Douglas G Altman,et al.  The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. , 2014, International journal of surgery.

[37]  T. Morikawa,et al.  A Comparison of the Immunochemical Fecal Occult Blood Test and Total Colonoscopy in the Asymptomatic Population , 2005 .

[38]  P. Rozen,et al.  An occupational GI cancer screening program. , 2001, Gastrointestinal endoscopy.

[39]  J. Jankowski,et al.  Molecular basis for risk factors , 2000, BMJ : British Medical Journal.

[40]  T. Okubo,et al.  Estimation of the Optimal Cut Off Point in a New Immunological Faecal Occult Blood Test in a Corporate Colorectal Cancer Screening Programme , 1996, Journal of medical screening.

[41]  L M Schuman,et al.  Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study. , 1993, The New England journal of medicine.

[42]  B. Vogelstein,et al.  A genetic model for colorectal tumorigenesis , 1990, Cell.

[43]  Loren Laine,et al.  What Level of Bowel Prep Quality Requires Early Repeat Colonoscopy: Systematic Review and Meta-Analysis of the Impact of Preparation Quality on Adenoma Detection Rate , 2014, The American Journal of Gastroenterology.

[44]  C. Klabunde,et al.  Colorectal cancer screening barriers and facilitators in older persons. , 2010, Preventive medicine.