Background and Aims

Individuals without a family history of colorectal cancer (CRC) are screened uniformly despite interpersonal risk. To assess individual risk, we examined the age-specific prevalence of advanced colorectal neoplasia (ACRN) according to clinical risk factors and fecal immunochemical test (FIT) results.

Methods

Participants without a family history of CRC who underwent screening colonoscopies and FITs were included. Clinical risk factors for ACRN were identified by using a logistic regression model. Point scores were assigned to each associated factor based on a regression coefficient.

Results

A total of 34,658 participants were included. Age, male sex, smoking, and obesity were identified as risk factors. One-, 2-, and 1-point scores were assigned to male sex, smoking, and obesity, respectively. The prevalence of ACRN in individuals with 0, 1, and ≥2 risk score points was 1.4%, 1.6%, and 2.9% among those aged 50 to 51 years and 3.1%, 5.5%, and 7.5% among those aged ≥66 years, respectively. Among FIT-positive individuals, the prevalence of ACRN was 11.0% and 21.2% in those aged between 50 and 51 years and those aged ≥66 years, respectively. Among FIT-negative individuals with ≥2 risk score points, the prevalence of ACRN was 2.5% and 6.0% among those aged 50 to 51 years and those aged ≥66 years, respectively.

Conclusion

If the clinical risk score is ≥2 points (persons with smoking history or obese men), early colonoscopy may be recommended, even with no family history of CRC. Additionally, FIT may be an appropriate initial screening modality for average-risk individuals if the clinical risk score is 0 to 1.

中文翻译：

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基于临床危险因素的个体化结直肠癌筛查：超出结直肠癌家族史

背景和目标

尽管存在人际交往风险，但没有大肠癌家族史（CRC）的个体仍需接受统一筛查。为了评估个体风险，我们根据临床风险因素和粪便免疫化学测试（FIT）结果检查了晚期结直肠瘤形成（ACRN）的特定年龄患病率。

方法

没有CRC家族史的参加者接受结肠镜检查和FIT筛查。通过使用逻辑回归模型确定ACRN的临床危险因素。根据回归系数，将点分数分配给每个相关因子。

结果

总共包括34,658名参与者。年龄，男性，吸烟和肥胖被确定为危险因素。男性，吸烟和肥胖分别分为1分，2分和1分。风险得分分别为0、1，和≥2的人群中ACRN的患病率在50至51岁的人群中分别为1.4％，1.6％和2.9％，在66岁以上的人群中分别为3.1％，5.5％和7.5％。 ， 分别。在FIT阳性个体中，年龄在50至51岁之间和≥66岁的人群中ACRN的患病率分别为11.0％和21.2％。在风险得分≥2的FIT阴性个体中，年龄在50至51岁的人群和≥66岁的人群中，ACRN的患病率分别为2.5％和6.0％。

结论

如果临床风险评分≥2分（有吸烟史或肥胖男性），即使没有CRC家族史，也可能建议早期结肠镜检查。此外，如果临床风险评分为0到1，则FIT可能是适合平均风险个体的初始筛查方式。