# Population-based screening for colorectal cancer in Wuhan, China

## TL;DR

A large study in Wuhan, China, shows that a non-invasive fecal DNA test can effectively detect colorectal cancer and precancerous lesions in a population-based screening program.

## Contribution

This study provides real-world evidence of fecal DNA test effectiveness for population-based CRC screening in China.

## Key findings

- 4.5% of 98,683 subjects tested positive for colorectal cancer or precancerous lesions using a fecal DNA test.
- The test detected CRC at a rate of 1.3% and advanced precancerous lesions at 2.3%.
- 28.0% of colonoscopies showed colorectal neoplasms without pathological confirmation.

## Abstract

Fecal DNA test has emerged as a non-invasive alternative for colorectal cancer (CRC) screening in average-risk population. However, there is currently insufficient evidence in China to demonstrate the effectiveness of population-based CRC screening using fecal DNA based test. Here, a large-scale real-world study for CRC screening was implemented in Wuhan, Hubei province, China. A total of 98,683 subjects aged between 45 and 60 years were screened by a fecal DNA test (ColoTect®) which detected methylation status of SDC2, ADHFE1, and PPP2R5C. Participants who tested positive were advised to receive diagnostic colonoscopy. 4449 (4.5%) subjects tested positive for fecal DNA test, and 3200 (71.9%) underwent colonoscopy. Among these, 2347 (73.3%) had abnormal colonoscopy findings, of which 1330 (56.7%) subjects received pathological diagnosis. Detection rates for CRC and advanced precancerous lesions were 1.3% and 2.3%, respectively. Detection rates for nonadvanced adenomas and polyps were 14.0% and 21.6%, respectively. 28.0% of all colonoscopies showed colorectal neoplasm but lack pathological diagnosis. 6.1% showed other abnormalities such as enteritis. In conclusion, preliminary real-world evidence suggested that fecal DNA tests had promising diagnostic yield in population-based CRC screening.

https://www.chictr.org.cn/showproj.html?proj=192838, identifier ChiCTR2300070520.