Natural Population-based Colorectal Cancer (CRC) Screening in Hangzhou City
【Objective and Sense】CRC Screening practice was carried out for the first time among natural population in Hangzhou city based on CRC screening guide line established previously in rural area of small and medium-sized cities.Screening effect of the guideline on city population will be evaluated.The program has been designed to solve the problem met in screening practice,such as the low uptake and specificity,etc.Serum CRC screening methods were explored and their effects evaluated in order to perfect the China CRC screening guideline and provide theory and practice basis for it.【Content】①The study is to evaluate the screening effectiveness among natural population in city area,analyse the screening effects of combination of iFOBT and questionnaire and show the function of each high risk factors in the screening guideline.Each high risk factor was sorted for the first time according to its sensitivity and specificity.②The problem of low uptake rate was met in the process of screening practice among city natural population.It will provide the basis of decision-making for screening practice among city natural population in the future.③Resolution was designed to the problems met in the process of screening,such as low uptake rate and specificity.④The study is to evaluate barrier focused intervention to increase the colonoscopy adherence among high-risk population.⑤Using serum CEA as reference,the study is to evaluate the application value of serum M2-PK in CRC screening.⑥Diagnosis and predictive model was established by SELDI-TOF-MS in high-risk population.The study is to evaluate the application prospects of this model in CRC screening.⑦The study is to evaluate the application value of combination of serum M2-PK and serum protein profiles model.【Methods】Part One:Study on CRC screening among natural population in Xiacheng district, Hangzhou.①The screening effect among natural population in city.Main indicators: Early diagnosis rate;The detection rates of cancer and precancerous lesions;Uptake rates of iFOBT and questionnaire in primary and secondary screening;Positivity rates of iFOBT and questionnaire.Positive predictive value(PPVSensitivity and specificity of iFOBT and questionnaire;②The functions of iFOBT and questionnaire in screening. Main indicators:Detection number and ratio of cancer or precancerous lesions.③Analysis of high risk factors.Sensitivity and specificity of high risk factors to cancer and precancerous lesions.④Location distribution of cancer,adenomas,nonpolyposis. Main indicators:The number and ratio of lesions located in left colon(rectum,sigmoid, decending colon),transverse colon,right colon(ileocecal junction,ascending colon). City screening effect in urban area was compared with that in rural aera.Main indicators:The detection rate;Early detection rate;Uptake rate;rate of early colorectal cancer.Part Two Barrier-focused intervention to Nonadherent high risk population in city CRC screening Questionnaire investigation was designed to identify the main reasons of nonadherece by telephone interview with nonadherent subjects.Barrier focused interventions were designed and were carried out accoding to reasons. Intervention effects was evaluated.Main indicators:The ratio of main barriers to colonoscopy among nonadherence high-risk subjects;The change of colonoscopy adherence rate between pre and post intervention.Factors related to intervention effect was determined by logistic regression analysis.Part Three The exploration of serum CRC screening method.Using CEA as reference,the study evaluated the screening effect of serum M2-PK and serum protein profiles on cancer and precancerous lesions. Main indictors to serum M2-PK:ROC curve;ROC AUC;Sensitivity and Specificity. Main indicators to serum protein profiles:Model training;10-fold cross validation.The combined sensitivity and specificity.【Innovative Results】Based on study on colorectal cancer screening in Xiacheng district,the results have showed that①The CRC screening in urban area based on guideline established by our units had the same good results as in rural area.High risk factors questionnaire investigation had important role in CRC screening and it can make up the shortcomings of iFOBT and detect nonbleeding lesions,especially precancerous lesions such as adenomas and polyps;②Each high risk factor was sorted according to sensitivity and specificity for the first time among natural population in city.The unique Chinese high risk factors were proved to play important role in colorectal cancer screening.③Some issues,such as low uptake rate in primary and secondary screening,were raised in the process of urban CRC screening.Propaganda and mobilization should be reinforced on the basis of community in the primary screening.Hospital screening model should be adopted in the secondary screening.The study has established intervention program,in which high risk population was propagated and mobilized to udergo colonoscopy examination,then barrier-focused interventions were carried out to nonadherent high risk population.ⅢThe study has explored the value of serological CRC screening and show serum M2-PK and serum protein profiles may have application prospect to shrink high risk population and increase the sensitivity and specificity of colorectal cancer screening.