Objective To examine the effect of excess body weight on adherence and lesion detection in colorectal cancer(CRC)screening.Methods A cross-sectional analysis was conducted within an opportunistic CRC screening program...Objective To examine the effect of excess body weight on adherence and lesion detection in colorectal cancer(CRC)screening.Methods A cross-sectional analysis was conducted within an opportunistic CRC screening program in Chongqing,which enrolled 43,797 adults aged 35–74 years between 2021 and 2022.A total of 42,279 participants were included in the final analysis,of whom 19,462(46.0%)had excess body weight(BMI>24.0 kg/m2).Colonoscopy adherence and detection were compared between normal and excess body weight group,and associated factors were examined.Results Of the 7,002 participants recommended for colonoscopy,3,808(54.4%)had excess body weight.Adherence was significantly lower in the excess weight group(6.6%)than in the normal weight group(10.7%,P<0.001),and this trend was consistent across sex and age groups.The detection rates of advanced neoplasms(3.6%vs.1.8%)and non-advanced adenomas(10.7%vs.6.7%)were higher in the excess weight cohort,with a significant difference for any neoplasm(14.2%vs.8.9%,P<0.05).Differences in adherence-and detection-related factors were also observed between the groups.Conclusion Excess body weight was associated with lower colonoscopy adherence but higher neoplasm detection.These findings support the integration of weight management with targeted screening promotion to improve CRC prevention in this high-risk population.展开更多
Background:Clinical opportunistic screening is a cost-effective cancer screening modality.This study aimed to establish an easyto-use diagnostic model serving as a risk stratification tool for identification of indivi...Background:Clinical opportunistic screening is a cost-effective cancer screening modality.This study aimed to establish an easyto-use diagnostic model serving as a risk stratification tool for identification of individuals with malignant gastric lesions for opportunistic screening.Methods:We developed a questionnaire-based diagnostic model using a joint dataset including two clinical cohorts from northern and southern China.The cohorts consisted of 17,360 outpatients who had undergone upper gastrointestinal endoscopic examination in endoscopic clinics.The final model was derived based on unconditional logistic regression,and predictors were selected according to the Akaike information criterion.External validation was carried out with 32,614 participants from a community-based randomized controlled trial.Results:This questionnaire-based diagnostic model for malignant gastric lesions had eight predictors,including advanced age,male gender,family history of gastric cancer,low body mass index,unexplained weight loss,consumption of leftover food,consumption of preserved food,and epigastric pain.This model showed high discriminative power in the development set with an area under the receiver operating characteristic curve(AUC)of 0.791(95%confidence interval[CI]:0.750-0.831).External validation of the model in the general population generated an AUC of 0.696(95%CI:0.570-0.822).This model showed an ideal ability for enriching prevalent malignant gastric lesions when applied to various scenarios.Conclusion:This easy-to-use questionnaire-based model for diagnosis of prevalent malignant gastric lesions may serve as an effective prescreening tool in clinical opportunistic screening for gastric cancer.展开更多
Esophageal squamous cell carcinoma(ESCC)is the predominant subtype of esophageal cancer in China,and this neoplasm is associated with high morbidity and mortality as well as clear geographical heterogeneity.Since prim...Esophageal squamous cell carcinoma(ESCC)is the predominant subtype of esophageal cancer in China,and this neoplasm is associated with high morbidity and mortality as well as clear geographical heterogeneity.Since primary prevention for ESCC lacks a clear intervention target,secondary prevention,also known as screening and early diagnosis and early treatment,has become the mainstay of ESCC prevention and control in China.ESCC screening in China has been subject to decades of evaluation and practice.However,the ESCC screening strategy currently adopted in China has encountered a developmental bottleneck.In this review,we have summarized studies and significant findings for ESCC screening and proposed advancement of screening strategies as follows:1)evidence from randomized controlled trials is needed to support the effectiveness and health economic value of endoscopic screening for ESCC;2)the current traditional screening and surveillance strategies warrant reform,and a risk-prediction-based precision strategy should be established;and 3)a deeper understanding of the value of opportunistic screening in the prevention and control of ESCC in China is called for.Due to the low absolute prevalence of precancerous lesions,substantial investment of resources and nonnegligible risks of invasive screening techniques,precision and individualization should be the main direction of cancer screening programs for the future.We advocate cooperation on the part of Chinese scientists to solve this major China-specific health problem in the next decades.展开更多
Background: Colorectal cancer (CRC) screening is effective in reducing CRC incidence and mortality. The aim of this study was to retrospectively determine and compare the detection rate of adenomas, advanced adenomas ...Background: Colorectal cancer (CRC) screening is effective in reducing CRC incidence and mortality. The aim of this study was to retrospectively determine and compare the detection rate of adenomas, advanced adenomas (AAs) and CRCs, and the number needed to screen (NNS) of individuals in an average-risk Chinese population of different ages and genders. Methods: This was a retrospective study performed at the Institute of Health Management, Chinese People’s Liberation Army General Hospital. Colonoscopy results were analyzed for 53,152 individuals finally enrolled from January 2013 to December 2019. The detection rate of adenomas, AAs, or CRCs was computed and the characteristics between men and women were compared using chi-squared test. Results: The average age was 48.8 years (standard deviation [SD], 8.5 years) for men and 50.0 years (SD, 9.0 years) for women, and the gender rate was 66.27% (35,226) vs . 33.73% (17,926). The detection rates of adenomas, AAs, serrated adenomas, and CRCs were 14.58% (7750), 3.09% (1641), 1.23% (653), and 0.59% (313), respectively. Men were statistically significantly associated with higher detection rates than women in adenomas (17.20% [6058/35,226], 95% confidence interval [CI] 16.74-17.53% vs . 9.44% [1692/17,926], 95% CI 8.94-9.79%, P < 0.001), AAs (3.72% [1309], 95% CI 3.47-3.87% vs . 1.85% [332], 95% CI 1.61-2.00%, P < 0.001), and serrated adenomas (1.56% [548], 95% CI 1.43-1.69% vs . 0.59% [105], 95% CI 0.47-0.70%, P < 0.001). The detection rate of AAs in individuals aged 45 to 49 years was 3.17% (270/8510, 95% CI 2.80-3.55%) in men and 1.69% (69/4091, 95% CI 1.12-1.86%) in women, and their NNS was 31.55 (95% CI 28.17-35.71) in men and 67.11 (95% CI 53.76-89.29) in women. The NNS for AAs in men aged 45 to 49 years was close to that in women aged 65 to 69 years (29.07 [95% CI 21.05-46.73]). Conclusions: The detection rates of adenomas, AAs, and serrated adenomas are high in the asymptomatic population undergoing a physical examination and are associated with gender and age. Our findings will provide important references for effective population-based CRC screening strategies in the future.展开更多
基金supported by the National Natural Science Foundation of China(grant number 82404340)the Fundamental Research Funds for the Central Universities,Peking Union Medical College(grant number 3332024216).
文摘Objective To examine the effect of excess body weight on adherence and lesion detection in colorectal cancer(CRC)screening.Methods A cross-sectional analysis was conducted within an opportunistic CRC screening program in Chongqing,which enrolled 43,797 adults aged 35–74 years between 2021 and 2022.A total of 42,279 participants were included in the final analysis,of whom 19,462(46.0%)had excess body weight(BMI>24.0 kg/m2).Colonoscopy adherence and detection were compared between normal and excess body weight group,and associated factors were examined.Results Of the 7,002 participants recommended for colonoscopy,3,808(54.4%)had excess body weight.Adherence was significantly lower in the excess weight group(6.6%)than in the normal weight group(10.7%,P<0.001),and this trend was consistent across sex and age groups.The detection rates of advanced neoplasms(3.6%vs.1.8%)and non-advanced adenomas(10.7%vs.6.7%)were higher in the excess weight cohort,with a significant difference for any neoplasm(14.2%vs.8.9%,P<0.05).Differences in adherence-and detection-related factors were also observed between the groups.Conclusion Excess body weight was associated with lower colonoscopy adherence but higher neoplasm detection.These findings support the integration of weight management with targeted screening promotion to improve CRC prevention in this high-risk population.
基金supported by grants from the National Science and Technology Fundamental Resources Investigation Program of China(No.2019FY101102)the National Natural Science Foundation of China(No.82073626)+1 种基金the National Key Research and Development Program of China(No.2021YFC2500405)the Sanming Project of Shenzhen(No.SZSM201612061).
文摘Background:Clinical opportunistic screening is a cost-effective cancer screening modality.This study aimed to establish an easyto-use diagnostic model serving as a risk stratification tool for identification of individuals with malignant gastric lesions for opportunistic screening.Methods:We developed a questionnaire-based diagnostic model using a joint dataset including two clinical cohorts from northern and southern China.The cohorts consisted of 17,360 outpatients who had undergone upper gastrointestinal endoscopic examination in endoscopic clinics.The final model was derived based on unconditional logistic regression,and predictors were selected according to the Akaike information criterion.External validation was carried out with 32,614 participants from a community-based randomized controlled trial.Results:This questionnaire-based diagnostic model for malignant gastric lesions had eight predictors,including advanced age,male gender,family history of gastric cancer,low body mass index,unexplained weight loss,consumption of leftover food,consumption of preserved food,and epigastric pain.This model showed high discriminative power in the development set with an area under the receiver operating characteristic curve(AUC)of 0.791(95%confidence interval[CI]:0.750-0.831).External validation of the model in the general population generated an AUC of 0.696(95%CI:0.570-0.822).This model showed an ideal ability for enriching prevalent malignant gastric lesions when applied to various scenarios.Conclusion:This easy-to-use questionnaire-based model for diagnosis of prevalent malignant gastric lesions may serve as an effective prescreening tool in clinical opportunistic screening for gastric cancer.
基金the charity project of the National Ministry of Health(No.201202014)the National Key R&D Program of China(No.2016YFC0901404)+2 种基金National Science&Technology Fundamental Resources Investigation Program of China(No.2019FY101102)the National Natural Science Foundation of China(No.82073626)the Digestive Medical Coordinated Development Center of the Beijing Municipal Administration of Hospitals(No.XXZ0204)。
文摘Esophageal squamous cell carcinoma(ESCC)is the predominant subtype of esophageal cancer in China,and this neoplasm is associated with high morbidity and mortality as well as clear geographical heterogeneity.Since primary prevention for ESCC lacks a clear intervention target,secondary prevention,also known as screening and early diagnosis and early treatment,has become the mainstay of ESCC prevention and control in China.ESCC screening in China has been subject to decades of evaluation and practice.However,the ESCC screening strategy currently adopted in China has encountered a developmental bottleneck.In this review,we have summarized studies and significant findings for ESCC screening and proposed advancement of screening strategies as follows:1)evidence from randomized controlled trials is needed to support the effectiveness and health economic value of endoscopic screening for ESCC;2)the current traditional screening and surveillance strategies warrant reform,and a risk-prediction-based precision strategy should be established;and 3)a deeper understanding of the value of opportunistic screening in the prevention and control of ESCC in China is called for.Due to the low absolute prevalence of precancerous lesions,substantial investment of resources and nonnegligible risks of invasive screening techniques,precision and individualization should be the main direction of cancer screening programs for the future.We advocate cooperation on the part of Chinese scientists to solve this major China-specific health problem in the next decades.
基金supported by the State Science and Technology Support Program(No.2012BAI37B04)the Joint Project of the National Natural Science Foundation of China and the Australian National Health and Medical Research Council(No.NSFC81561128020-NHMRCAPP1112767).
文摘Background: Colorectal cancer (CRC) screening is effective in reducing CRC incidence and mortality. The aim of this study was to retrospectively determine and compare the detection rate of adenomas, advanced adenomas (AAs) and CRCs, and the number needed to screen (NNS) of individuals in an average-risk Chinese population of different ages and genders. Methods: This was a retrospective study performed at the Institute of Health Management, Chinese People’s Liberation Army General Hospital. Colonoscopy results were analyzed for 53,152 individuals finally enrolled from January 2013 to December 2019. The detection rate of adenomas, AAs, or CRCs was computed and the characteristics between men and women were compared using chi-squared test. Results: The average age was 48.8 years (standard deviation [SD], 8.5 years) for men and 50.0 years (SD, 9.0 years) for women, and the gender rate was 66.27% (35,226) vs . 33.73% (17,926). The detection rates of adenomas, AAs, serrated adenomas, and CRCs were 14.58% (7750), 3.09% (1641), 1.23% (653), and 0.59% (313), respectively. Men were statistically significantly associated with higher detection rates than women in adenomas (17.20% [6058/35,226], 95% confidence interval [CI] 16.74-17.53% vs . 9.44% [1692/17,926], 95% CI 8.94-9.79%, P < 0.001), AAs (3.72% [1309], 95% CI 3.47-3.87% vs . 1.85% [332], 95% CI 1.61-2.00%, P < 0.001), and serrated adenomas (1.56% [548], 95% CI 1.43-1.69% vs . 0.59% [105], 95% CI 0.47-0.70%, P < 0.001). The detection rate of AAs in individuals aged 45 to 49 years was 3.17% (270/8510, 95% CI 2.80-3.55%) in men and 1.69% (69/4091, 95% CI 1.12-1.86%) in women, and their NNS was 31.55 (95% CI 28.17-35.71) in men and 67.11 (95% CI 53.76-89.29) in women. The NNS for AAs in men aged 45 to 49 years was close to that in women aged 65 to 69 years (29.07 [95% CI 21.05-46.73]). Conclusions: The detection rates of adenomas, AAs, and serrated adenomas are high in the asymptomatic population undergoing a physical examination and are associated with gender and age. Our findings will provide important references for effective population-based CRC screening strategies in the future.
