A combination of clinical risk stratification and fecal immunochemical test is useful for identifying persons with high priority of early colonoscopy

Abstract

Background We aimed to develop a combination screening strategy for advanced colorectal neoplasia based on the Asia-Pacific Colorectal Screening score and fecal immunochemical test results.

Methods We reviewed the records of participants who had undergone a colonoscopy and fecal immunochemical test as part of a comprehensive health screening program. The prevalence of advanced colorectal neoplasia in participants 40–49 years old was analyzed according to Asia-Pacific Colorectal Screening scores and fecal immunochemical test results.

Results We analyzed the data of 9205 participants 40–49 years old and 3215 participants ≥50 years old. The prevalence of advanced colorectal neoplasia in participants 40–49 years old was 1.0%, 2.1%, 7.1%, and 13.4% in the “fecal immunochemical test (−) & Asia-Pacific Colorectal Screening < 2,” “fecal immunochemical test (−) & Asia-Pacific Colorectal Screening ≥ 2,” “fecal immunochemical test (+) & Asia-Pacific Colorectal Screening < 2,” and “fecal immunochemical test (+) & Asia-Pacific Colorectal Screening ≥ 2” subgroups, respectively. The prevalence of advanced colorectal neoplasia in “fecal immunochemical test (+) & Asia-Pacific Colorectal Screening ≥ 2” subgroup was higher than in participants ≥50 years old with Asia-Pacific Colorectal Screening ≥ 4 (13.4% vs. 5.8%, P < 0.001).

Conclusions Fecal immunochemical test-positive individuals 40–49 years old with an Asia-Pacific Colorectal Screening ≥ 2 have a higher risk of advanced colorectal neoplasia than individuals ≥50 years old with an Asia-Pacific Colorectal Screening ≥ 4.